Nearly half of older people with dementia experience falls, suggesting new research that also identifies multiple risk factors for these falls.
In a study of more than 5,500 participants, 45.5% of those with dementia experienced one or more falls, compared to 30.9% of those without dementia.
Visual impairment and living with a spouse were among the strongest predictors of future fall risk in participants with dementia. was associated with a lower likelihood of falling.
Dr. Safiya Okoye
Overall, the results highlight the need for an interdisciplinary approach to prevent falls in older adults with dementia, said lead author and nursing and health professional at Drexel University in Philadelphia, Pennsylvania. said Dr. Safiyyah M. Okoye, an assistant professor at the university. Medscape medical news.
“We need to consider different aspects and find ways to interact beyond the clinic,” she said.
In addition to reviewing medications that may cause falls and screening for visual impairment, clinicians should also consider resources to improve home environments and ensure families receive appropriate care, Okoye said. pointed out that it is necessary to
Here are the findings: publish online January 12th Alzheimer’s disease and dementia: Journal of the Alzheimer’s Association.
No “silver bullet”
Every year, millions of seniors are injured due to falls. People with dementia are especially vulnerable. This group is twice as likely to fall as he is and up to three times as likely to suffer serious fall-related injuries such as broken bones, the researchers note.
Falls are the leading cause of hospitalization for people with dementia. Evidence to date indicates that people with dementia are more likely to experience adverse health effects such as: delirium, in hospital compared with those without dementia. Even minor fall-related injuries have been associated with patients being discharged to nursing homes rather than going home.
Okoye emphasized that many factors contribute to falls, including health status. functions such as walking and balance. medications; home environment; and activity level.
“There are many facets and there is no one silver bullet to deal with falls. It has to be addressed holistically,” she said.
Existing research “overwhelmingly” focuses on health- and function-related factors that can be addressed in a clinic or referral, rather than on environmental and social factors.
She added that although community-dwelling older adults with dementia are at higher risk of falling, few studies have addressed the risk of falling among these adults.
A new analysis included a nationally representative sample of 5581 community-dwelling adults who participated in both the 2015 and 2016 National Health and Aging Trends Study (NHATS). NHATS is a population-based survey of health and disability trends and trajectories for Americans age 65 and older.
During interviews, participants were asked, either personally or by proxy, about falls over the past 12 months. Falling at baseline was assessed as a predictor of falling in his subsequent 12 months.
To determine the likelihood of dementia, researchers asked whether doctors had told participants they had dementia or had dementia. Alzheimer’s diseaseThey also used a dementia screening questionnaire and neuropsychological tests of memory, orientation and executive function.
Of all samples, most (n = 5093) did not have dementia.
Physical environmental factors assessed included household conditions such as clutter, tripping hazards and structural problems, and neighborhood social and economic deprivations such as income, education level and employment status. I was.
Drop rates and counterintuitive findings
Results showed that people with dementia experienced significantly more falls than those without (45.5% vs 30.9%; P. < .001).
Furthermore, a history of falls was significantly associated with subsequent falls in people with dementia (odds ratio [OR]6.20; 95% CI 3.81 – 10.09), visual impairment (OR 2.22; 95% CI 1.12 – 4.40), living with spouse vs living alone (OR 2.43; 95% CI 1.09 – 5.43).
A possible explanation for the higher risk of falls in people who live with a partner is that people who live alone usually have better functioning. Also, cohabiting partners tend to be the same age as the person with dementia and may have their own challenges.
Interestingly, higher neighborhood social deprivation was associated with lower likelihood of falls (highest deprivation score, OR, 0.55, 95% CI, 0.31 – 0.98), Okoye noted, It’s counter-intuitive,” he said.
This result, she noted, may be related to the social environment. “Maybe there are more people around the house and more people looking to them, or more people in the community who know them. Regardless, there may be social resources out there,” she said.
New findings underscore the idea that falls are a multifaceted phenomenon, not only in older people with dementia, but also in older people without dementia.
Physicians can play a role in reducing falls in people with dementia by asking about falls, eliminating medications associated with fall risk, and screening and correcting visual and hearing impairments. she suggested.
It could also help patients identify hazards in the home, such as clutter and poor lighting, and ensure that they are addressed, Okoye added.
no surprise
Comments on Medscape Medical NewsDavid S. Knopman, MD, a clinical neurologist at the Mayo Clinic in Rochester, Minnesota, said the finding that visual impairment and a previous history of falls predict subsequent falls was “not surprising.”
Knopman, whose research has focused on late-life cognitive impairment, was not involved in the current study.
Risk mitigation is “of course” a key business objective, he said. “Awareness and optimization of the patient’s living space are key strategies to reduce the risk of falls,” he added.
Knopman reiterated that those who qualify for dementia have a high mortality rate and often lose the ability to live outside of institutions.
This research is supported by the National Institute on Aging. Investigators and Knopman have not reported any related financial relationships.
Alzheimer’s dementia. Published online on January 12, 2023. overview
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