Falls linked to increased risk of dementia in older adults

In a retrospective study of Medicare claims data, researchers found that dementia was more commonly diagnosed within a year of a fall compared to other types of injuries.

Key Takeaways

• In a retrospective cohort study of more than 2 million older adults who sustained an injury, 10.6% of patients who fell were subsequently diagnosed with dementia.
• Compared with other types of injuries, a fall was associated with a 21% increased risk of future diagnosis of dementia.
• Findings support implementation of cognitive screenings for older adults who have experienced a fall that resulted in an emergency room visit or hospitalization.

Researchers at Brigham and Women’s Hospital, a founding member of the Mass General Brigham health care system, have published new results showing that among older adults who suffered a traumatic injury, those who fell were more likely to subsequently be diagnosed with the disease of Alzheimer’s and related forms of dementia. . To improve early identification of dementia, the researchers recommend conducting cognitive screenings in older adults who experience an injurious fall that results in an emergency department visit or hospitalization. Results are published in JAMA network opened.

“I often see patients admitted after a fall, which is one of the most common reasons for admission to a trauma center and can lead to serious injuries. This raises an important question: why do these falls happen in the first place?” said first author Alexander Ordoobadi, MD, a physician in the Brigham’s Department of Surgery. Ordoobadi completed work on the study as part of his research fellowship at the Gillian Reny Stepping Strong Center for Trauma Innovation at Brigham. “We treat the injuries, provide rehabilitation, but often overlook the underlying risk factors that contribute to falls, despite a growing body of evidence suggesting a link between falls and cognitive decline.”

According to the Centers for Disease Control and Prevention, more than 14 million older adults, or one in four, report falls each year, and falls are also the leading cause of injury in older adults. These injuries can have long-term or permanent consequences, including a decrease in functional status, an overall loss of independence, or the risk of death. Falls also result in more than $50 billion per year in healthcare expenditures.

Fall injuries are also thought to be associated with cognitive outcomes in older adults, as loss of motor function is a frequent precursor to cognitive decline and may also increase the risk of falls. However, cognitive health is not closely considered in current fall prevention guidelines.

The researchers analyzed Medicare Fee-For-Service data from 2014-2015, including 2,453,655 older adult patients who suffered a traumatic injury, as well as follow-up data for one year after the first fall. The researchers found that half of the patients in the study sustained their injuries during a fall, and that these patients were significantly more likely to be diagnosed within a year of their injuries.

The relationship between falls and dementia appears to be a two-way street. Cognitive decline can increase the risk of falls, but trauma from those falls can also accelerate the progression of dementia and make a later diagnosis more likely. Thus, falls may be a precursor to events that could help us identify people who need further cognitive screening.”

Molly Jarman, PhD, MPH, senior author, assistant professor in the Department of Surgery and associate director of the Center for Surgery and Public Health at the Brigham

The study suggests that completing cognitive screenings in older patients after a fall could detect dementia earlier. However, this is easier said than done, especially in light of the disparity in access to primary care among older adults.

“One of the biggest challenges we face is the lack of ownership in the process of follow-up screening for cognitive impairment, as there may not be enough time for these screenings in an emergency department or trauma center,” Ordoobadi said. “Ideally, older adults should receive follow-up care after an injury from a primary care provider or geriatrician who can monitor their cognitive health and long-term functional recovery after the injury, but many older adults do not have a regular primary care provider and do not have access to a geriatrician.”

The study results additionally highlight the need for more physicians to provide care to older adults, including cognitive assessments after fall injuries.

“Our study highlights the opportunity for early intervention and the need for more physicians who can provide comprehensive care to older adults,” Jarman said. “If we can establish that falls serve as early indicators of dementia, we can identify other precursors and early events that we can intervene on, which would significantly improve our approach to managing cognitive health in older adults.”