Fall-Associated Difficulty with Activities of Daily Living in Functionally Independent Individuals Aged 65 to 69 in the United States: A Cohort Study Nishant K. Sekaran, MD, MSc,* †§ Hwajung Choi, PhD,* † Rodney A. Hayward, MD,* †§ and Kenneth M. Langa, MD, PhD* †‡§ OBJECTIVES: To determine whether falling would be a marker for future difficulty with activities of daily (ADLs) that would vary according to fall frequency and associated injury. DESIGN: Longitudinal analysis. SETTING: Community. PARTICIPANTS: Nationally representative cohort of 2,020 community-living, functionally independent older adults aged 65 to 69 at baseline followed from 1998 to 2008. MEASUREMENTS: ADL difficulty. RESULTS: Experiencing one fall with injury (odds ratio (OR) = 1.78, 95% confidence interval (CI) = 1.29–2.48), at least two falls without injury (OR = 2.36, 95% CI = 1.80– 3.09), or at least two falls with at least one injury (OR = 3.75, 95% CI = 2.55–5.53) in the prior 2 years was independently associated with higher rates of ADL difficulty after adjustment for sociodemographic, behavioral, and clinical covariates. CONCLUSION: Falling is an important marker for future ADL difficulty in younger, functionally independent older adults. Individuals who fall frequently or report injury are at highest risk. J Am Geriatr Soc 61:96–100, 2013. Key words: activities of daily living; falls; disability; older adults D isability in older adults is an important public health concern. Recent studies document increasing disability in older Americans after 3 decades of decline. 1,2 A recent analysis of the National Health and Nutrition Examination Surveys (NHANES) concluded that the rate of new disabil- ity increased in individuals aged 60 to 69 between 1998 and 2004. Minorities and overweight or obese individuals experienced higher rates of disability; the overall trend was independent of other measured sociodemographic factors, chronic conditions, and health behaviors. 3 This finding suggests that younger groups of older adults may spend an increasing proportion of their lives with disability. Falling is a common event in older adults and a known risk factor for future disability in individuals aged 75 and older. 4–6 Falls can result in injury, higher rates of skilled nursing home placement, high medical costs, and loss of patient confidence leading to voluntary restriction of activity. 7–9 The relationship between falls and disability has not been systematically explored in younger groups of healthier older adults. Many of these individuals are newly retired and eligible for Medicare and may have the most to gain from earlier identification for future disability. The relationship between falls and difficulty with activi- ties of daily living (ADLs) was assessed in a nationally repre- sentative cohort of functionally independent, community- living older adults aged 65 to 69 at baseline followed for 10 years. It was hypothesized that falling would be an important marker of future ADL difficulty that would vary according to fall frequency and associated injury. METHODS Study Population Data from the Health and Retirement Study (HRS), a nationally representative, biennial longitudinal survey of adults aged 51 and older in the United States designed to evaluate the socioeconomic and health dynamics of older adults, were analyzed. The National Institute on Aging From the *Robert Wood Johnson Foundation Clinical Scholars Program; † Department of Internal Medicine, School of Medicine; ‡ Institute for Social Research, University of Michigan; and § Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan. Address correspondence to Nishant K. Sekaran, Department of Internal Medicine, University of Michigan Medical School and VA Ann Arbor Healthcare System, 3119 Taubman Center, 1500 East Medical Center Drive, SPC 5376, Ann Arbor, MI 48109. E-mail: nishants@umich.edu DOI: 10.1111/jgs.12071 JAGS 61:96–100, 2013 © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society 0002-8614/13/$15.00