Patient Safety Tip of the Week Archive

What’s New in the Patient Safety World

February 2023

Dementia and Risk for Falling

Okoye et al. (Okoye 2023) analyzed a sample of 5581 community-dwelling adults aged 65 years and older who participated in the National Health and Aging Trends Study. (NHATS). The NHATS is a population-based survey of health and disability trends and trajectories among Americans aged 65 years and older.

Patients with dementia had a significantly higher risk of falls than those without dementia (45.5% vs 30.9%; P < .001).

They also identified other factors associated with falls in this population. As you’d expect, a history of prior falls was significantly associated with subsequent falls among those with dementia (odds ratio 6.20). Similarly, impairment of vision also significantly increased the risk for falls (OR 2.22). Interestingly, living with a spouse vs alone was a risk factor (OR 2.43). The authors offer two possible explanations for this. One is that those living alone tend to be women with milder cognitive impairment and better functional status. The other is that those living with a spouse who has dementia may have problems of their own that limit their ability to prevent their spouse from falling.

One finding that was counterintuitive was that some indicators of lower socioeconomic status (lower educational attainment and high neighborhood social deprivation) were associated with lower likelihood of falls. There was no obvious good explanation for this.

Perhaps we shouldn’t be surprised by the findings of this study. We’ll definitely add dementia to our list of risk factors for falls in the elderly.

Some of our prior columns related to falls:

April 16, 2007 “Falls With Injury”
July 17, 2007 “Falls in Patients on Coumadin or Heparin or Other Anticoagulants”
January 1, 2008 “Fall Prevention”
October 7, 2008 “Lessons from Falls....from Rehab Medicine”
November 18, 2008 “Ticket to Ride: Checklist, Form, or Decision Scorecard?”
August 4, 2009 “Faulty Fall Risk Assessments?”
September 22, 2009 “Psychotropic Drugs and Falls in the SNF”
December 22, 2009 “Falls on Toileting Activities”
January 2010 “Falls in the Radiology Suite”
June 2010 “Seeing Clearly a Common Sense Intervention”
May 29, 2012 “Falls, Fractures, and Fatalities”
June 5, 2012 “Minor Head Trauma in the Anticoagulated Patient”.
January 15, 2013 “Falls on Inpatient Psychiatry”
March 2013 “Sedative/Hypnotics and Falls”
December 3, 2013 “Reducing Harm from Falls on Inpatient Psychiatry”
June 2014 “New Glasses and Fall Risk”
July 8, 2014 “Update: Minor Head Trauma in the Anticoagulated Patient”
August 2014 “Cataract Surgery and Falls”
November 4, 2014 “Progress on Fall Prevention”
March 2015 “Another Paradox: Falls Due to Walking Aids”
June 9, 2015 “Add This to Your Fall Risk Assessment”
July 28, 2015 “Not All Falls Are the Same”
October 2015 “Patient Perception of Fall Risk”
October 27, 2015 “Sentinel Event Alert on Falls and View from Across the Pond”
February 16, 2016 “Fall Prevention Failing?”
March 14, 2017 “More on Falls on Inpatient Psychiatry”
July 2017 “Mobility vs. Falls”
February 2018 “Global Sensory Impairment and Patient Safety”
February 20, 2018 “Delirium and Falls”
March 2019 “Newborn Falls”
July 2019 “Increasing Mortality After Falls in Elderly”
January 14, 2020 “More on Newborn Falls”
June 16, 2020 “Tracking Technologies”
October 2020 “Pre-op Testing Before Cataract Surgery Leads to What?”
August 23, 2022 “Yes, There is a Proper Way to Assess Orthostatic Hypotension”
September 13, 2022 “Smart Socks and Robots for Fall Prevention?”
November 22, 2022 “The Apple Watch and Patient Safety”
November 29, 2022 “Preventing Newborn Falls”

References:

Okoye SM, Fabius CD, Reider L, Wolff JL. Predictors of falls in older adults with and without dementia. Alzheimer's Dement 2023; 1-10

https://alz-journals.onlinelibrary.wiley.com/doi/epdf/10.1002/alz.12916

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