People with dementia who have vision impairment or live with a spouse are at an increased risk for future falls, according to a study published in Alzheimer’s & Dementia.
In the United States, medical costs for falls approach $50 billion annually. The population of individuals living with dementia are twice as likely to fall and three times more likely to incur serious injury from a fall compared with individuals without dementia. Despite the high cost and associated health care burden, few studies have investigated potential fall risk factors.
For the study, researchers evaluated data from the National Health and Aging Trends Study (NHATS) collected in 2015 and 2016 for fall risk factors. The study population comprised 5581 adults aged ≥65 years living in the US in the community setting. Falls were defined as any fall, slip, or trip in which an individual lost their balance and landed on the floor, ground, or at a lower level.
The researchers determined probable dementia by asking participants if they ever had dementia or Alzheimer disease. They also relied on a dementia screening questionnaire and neuropsychological tests of memory, orientation, and executive function.
NHATS interviewers assessed physical environmental factors, such as conditions inside and outside the home, including tripping hazards, and neighborhood social and economic deprivation, such as income, education, and employment status.
Among the study participants, 58.0% were aged 65-74 years, 55.8% were women, 84.2% were White, 57.1% had above a high school education, 7.2% had financial hardship, 30.4% had a history of falling in 2015, and 27.8% lived alone. A total of 488 participants had dementia. Compared with individuals without dementia, those with dementia were older, fewer were White, they had a lower level of education, more had financial hardship, and they had poorer health function (all P <.001).
Overall, 31.7% of the participants had a fall in 2016. The proportion of individuals with dementia who had a fall was greater than control individuals (45.5% vs 30.9%; P <.001), respectively.
Before adjusting for cofounders, people with dementia with the 15% highest social deprivation scores (odds ratio [OR], 0.43; 95% CI, 0.27-0.69) had an education below high school compared with an education above high school (OR, 0.47; 0.26-0.87), and were Black compared with White (OR, 0.58; 95% CI, 0.37-0.93) were less likely to fall.
After adjusting for cofounders, increased risk for fall was associated with:
- a history of falls in 2015 (adjusted OR [aOR], 6.20; 95% CI, 3.81-10.09),
- living with a spouse compared with living alone (aOR, 2.43; 95% CI, 1.09-5.43), and
- vision impairment (aOR, 2.22; 95% CI, 1.12-4.40).
For the individuals without dementia, fall risk was associated with:
- a history of falls in 2015 (aOR, 2.92; 95% CI, 2.50-3.40),
- a fear of falling (aOR, 1.65; 95% CI, 1.34-2.02),
- poor lower extremity performance (aOR, 1.63; 95% CI, 1.32-2.01),
- financial hardship (aOR, 1.50; 95% CI, 1.04-2.17),
- symptoms of depression (aOR, 1.37; 95% CI, 1.15-1.64), and
- living in a home in disrepair (aOR, 1.34; 95% CI, 1.12-1.61).
The major limitation of this study was that report of fall relied on participant recall.
The researchers noted that patients with dementia who had vision impairment, lived with a spouse, and had a history of falls may be more at risk for future falls. They concluded that “Incorporating appropriate fall-risk factors could inform effective falls screening and prevention strategies for PLWD [persons living with, versus without, dementia].”
Okoye SM, Fabius CD, Reider L, Wolff JL. Predictors of falls in older adults with and without dementia. Alzheimers Dement. Published online January 12, 2023. doi:10.1002/alz.12916