A senior sitting in a wheelchair

A large-scale study by Swedish researchers has found that older adults who use wheelchairs are at lower risk for fractures from falls compared to ambulatory patients who are able to walk on their own.

The goal of the study, which was published in the Feb. 13 issue of JAMA Network Open, was to investigate whether patients with immobility who use wheelchairs have a different risk of fracture and injurious falls when compared with ambulatory adults. Many clinical guidelines internationally consider immobility a risk factor for secondary osteoporosis and fracture, and physicians are encouraged to evaluate fracture risk and the presence of osteoporosis in these patients.

Researchers from the Sahlgrenska Osteoporosis Centre, Institute of Medicine at the University of Gothenburg, Gothenburg, Sweden, studied 55,442 older adults who used wheelchairs and compared them to the same number of adults in an ambulatory control group. The patients were identified through a national database of adults 65 and older at Swedish healthcare facilities.

The study found the risk of injurious falls without fracture was 2.1-fold lower among patients who used wheelchairs than in the ambulatory control group.

“In this retrospective cohort study of older adults, wheelchair use was associated with a lower risk of fracture than observed in ambulatory controls,” the authors wrote. “These findings suggest that immobility associated with wheelchair use should not be considered a risk factor for fracture.”

Overall, patients who used wheelchairs had a significantly increased risk of death than those in the ambulatory control group. The authors noted that although regular physical exercise is important to maintaining physical fitness and reducing the risk of thromboembolic events, pressure ulcers, and bone loss, clinicians may need to consider prescribing wheelchairs as an option for older adults who are becoming increasingly frail and are at high risk of falls or fractures. 

“The results from this study indicate that the risk of fall and fracture is decreased in patients who use wheelchairs, supporting the prescription of this aid if the risk of falls and fractures is deemed high,” the authors wrote. “It should, however, be acknowledged that this study does not factor in potentially other negative outcomes associated with wheelchair use.”