[Longitudinal Transitions of Fall States Based on a Multi-State Markov Model and Their Associated Risk Factors].

Objective: To investigate the transition intensity and transition probabilities of fall states among middle-aged and older adults in China, and to assess the impact of potential risk factors on falls. Methods: We utilized in the study data from the China Health and Retirement Longitudinal Study (CHARLS) and employed a multi-state Markov model (MSM) to analyze the transition intensity and probabilities between states of no falls or falls without treatment, falls requiring treatment, and death. Results: A total of 14722 participants were enrolled, with a mean age of (59.4 years ± 9.7 years), and 47.9% were male. The median follow-up period was 9 years (interquartile range [IQR], 7-9 years). At baseline, 12381 participants (84.1%) reported no falls or falls without treatment, while 2341 (15.9%) reported falls requiring treatment. Participants who experienced falls requiring treatment within one follow-up cycle had a 55.2% probability of not falling again or only falling without treatment in the subsequent two years, a 37.6% probability of continuing to experience falls requiring treatment, and a 7.2% probability of death. The risk of transitioning from a state of no falls or falls without treatment to falls requiring treatment increased by 8.6% for every 5-year increase in age. The risk was 35.1% higher for females compared to males. Rural residents had a 10.1% higher risk. Those who were divorced, separated, widowed, or never married had a 20.7% higher risk. Higher degrees of physical function impairment were associated with an increased risk. Depressive symptoms increased the risk by 31.6%. Having one chronic disease raised the risk by 9.6%, while multimorbidity led to a 28.8% increase in risk. Conclusion: According to the findings of the study, falls are a dynamic process and emphasis should be given to fall prevention for older adults, individuals with a history of fall-related medical visits, those living alone, those with impaired physical function, and those with depressive symptoms.