Objective: Older people with dementia have an increased risk of falling and of suffering injuries. However, little is known about their fall risk factors and no successful intervention study has been performed among people with cognitive impairment. Therefore the aim of this study was to study factors associated with falls among cognitively impaired older people in geriatric care settings.
Design: A population–based cross-sectional study.
Materials and Methods: All geriatric settings in the county; 68 residential care facilities, 31 nursing homes, 66 group dwellings for people with dementia, 7 rehabilitation/short-stay units, 2 somatic geriatric, and 2 psychogeriatric clinics were included. A total of 4,297 residents lived in these settings and in 3,323 residents being >= 65 years data were collected. Of these residents 2,008, (60.4%) were cognitively impaired and they became the study population. Of the participants 69% were women and the mean age was 83.5 ± 6.8 (65-101) years. The residents were assessed by means of the Multi-Dimensional Dementia Assessment Scale (MDDAS) and questions about use of physical restraint, pain, previous falls during stay and falls and injuries during the preceeding week.
Results: 189 out of 2,008 (9.4%) cognitively impaired residents had fallen at least once during the last week, which corresponds to a fall incidence of 4.9 falls / person year (PY). In univariate analyses, impaired balance and gait, treatment with selective serotonin reuptake inhibitors (SSRI’s), neuroleptics, and behaviors grouped as escape behavior, wandering behavior, restless behavior and verbally disruptive/attention-seeking behavior were significantly associated with falls, as was depressive, paranoid, and manic/hyperactive symptoms. In a logistic regression model being able to get up from a chair, previous falls, needing a helper when walking, and manic/hyperactive symptoms were the most important factors associated with falls. Cholinesterase inhibitors were not associated with falls.
Conclusion: Preventing falls in cognitively impaired older people seem to be especially difficult and must probably include treatment of psychiatric and behavioral symptoms, improvement of gait and balance, and better supervision.
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