Falls Linked to Increased Dementia Risk in Older Adults

TOPLINE:

Older adults who experience falls are at a higher risk of developing dementia within a year. The study found that 10.6% of patients who fell were diagnosed with dementia compared with 6.1% with other injuries.

METHODOLOGY:

• Researchers conducted a retrospective cohort study using US Medicare Fee-for-Service data from 2014 to 2015, including follow-up data for at least 1 year after the index encounter.
• A total of 2,453,655 older adults aged 66 years or older who experienced a traumatic injury were included, with 50.1% of injuries resulting from falls.
• The primary outcome was the diagnosis of dementia within 1 year after experiencing a fall, identified using International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 codes and analyzed using a Cox multivariable competing risk model.
• Covariates included patient demographics, Charlson Comorbidity Index, prior skilled nursing facility admission, injury severity, presence of head or neck trauma, surgery for hip fracture, and diagnosis of delirium during the index encounter.

TAKEAWAY:

• Falls were associated with a 21% increased hazard of new dementia diagnosis compared with other injury mechanisms (hazard ratio [HR], 1.21; 95% CI, 1.20-1.21; P
• In older adults without a recent skilled nursing facility admission, falls were associated with a 27% increased hazard of new dementia diagnosis (HR, 1.27; 95% CI, 1.26-1.28; P
• The overall rate of incident dementia diagnosis was higher in patients with an inpatient admission than in those with an emergency department visit (12.2% vs 7.5%; P
• Delirium during the index encounter was associated with an increased risk for future dementia diagnosis (HR, 1.66; 95% CI, 1.64-1.69; P

IN PRACTICE:

“Implementing cognitive screening after injurious falls in older adults may aid in the timely diagnosis of dementia, which would allow patients and their families to plan for the future, implement supports to promote ongoing safety in the community, and gain access to treatments,” the authors wrote.

SOURCE:

This study was led by Alexander J. Ordoobadi, MD, Brigham and Women’s Hospital in Boston. It was published online on September 30 in JAMA Network Open.

LIMITATIONS:

This retrospective, observational study limited the ability to draw causal conclusions. The transition from ICD-9 to ICD-10 codes may have affected the accuracy of coding injury mechanisms. The sensitivity of identifying dementia diagnoses using Medicare claims is low, which may have potentially missed preexisting diagnoses. The low rate of delirium during the index encounter may have been due to inaccurate coding or failure of recognition. The data from 2014 to 2015 may not have reflected current trends, but the underlying association is unlikely to have changed.

DISCLOSURES:

Ali Salim, MD, disclosed receiving grants from the National Institutes of Health and other organizations. Molly P. Jarman, PhD, reported receiving grants from the National Institute on Minority Health and Health Disparities and the Department of Defense. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.