Risk Factors for Falls in Older Adults With Cognitive Loss

BACKGROUND: Falls and their associated injuries can be a serious safety issue for older adults with neurocognitive disorders. Falling is the second leading cause of unintentional injury leading to death; adults over the age of 65 have the greatest number of fatal falls (World Health Organization, 2018). Falls occur as a result of complex interactions of biological, behavioral, environmental, and socioeconomic risk factors. Age, gender, and cognitive decline are established risk factors for falls in older adults (Anstey, Von Sanden, & Luszcz, 2006; Chang, & Do, 2015; Muir, Gopaul, & Montero Odasso, 2012). Other factors to be considered include complex medications, type of housing, functional performance, mobility impairments, use of gait devices, and type of leisure activities. Identifying factors associated with increased risk for falls can lead to strategies to ensure safety in client’s homes and communities.

RESEARCH QUESTION: What factors, if any, are associated with falls in older adults with neurocognitive disorders?

METHOD: This study is a secondary data analysis of 159 older adults evaluated for memory loss in a Midwest Memory Clinic. Participants have a diagnosis of Neurocognitive disorder, specifically, Alzheimer’s Disease, cognitive disorder NOS, mild cognitive impairment, dementia NOS, or other memory impairment. Data points included cognitive scores (Mini Mental State Exam and Cognitive Performance Test), demographic factors (age, gender, marital status, education, living situation), and functional measures (leisure activity, mobility, and medication management).

ANALYSIS: The data was analyzed with SPSS software. A comparison of means were used to examine relationships among several factors of participants who have fallen (N = 65) and not fallen (N = 94). A binary logistic regression determined the significance of association among these variables in three models.

RESULTS: Preliminary, two-tailed independent sample t tests showed significant differences (p<0.05) between fallers and non fallers in the type of living situation, those with complex medications, mobility impairments, use of gait devices, and type of leisure. Age, years of education, and cognition measured by MMSE and CPT scores were not significant. A binary logistic regression was applied to analyze each factor regressed off the dependent variable of falls. Based on the results, three models were created. Model 1, living situation and type of leisure, explained 12.85% of the variance between fallers and non fallers; Model 2, adding mobility impairment and use of a gait device increased the R square value to 0.19; Model 3, adding complex medications, increased the R square value to 0.204.

CONCLUSION: Results of this study indicate the odds of falling in older adults with neurocognitive disorders are associated with the living situation, mobility impairments, the use of gait devices, type of leisure activities, and complex medication routine. A change of residence from a house to a more accessible living environment may be a consideration in screening for falls risk. Those reporting more active leisure activities such as walking, gardening, and exercising, have greater odds of falling potentially due to increased opportunities for falling. Severity of cognitive loss and age were not found to be significant factors with this study population.

When assessing falls risk, therapists should consider the environmental context of the client’s living situation, physical factors, specifically, mobility impairments and the use of gait devices, and complexity of the medication regimen. Knowing the factors associated with a higher risk of falls, clinicians can guide clients and family members to take precautions to prevent falls.

References

World Health Organization. (2018). WHO global report on falls. Geneva: World Health Organization. https://www.who.int/news-room/fact-sheets/detail/falls

Muir, S. W., Gopaul, K., & Montero Odasso, M. M. (2012). The role of cognitive impairment in fall risk among older adults: A systematic review and meta-analysis. Age and Ageing, 41(3), 299–308. http://doi.org/10.1093/ageing/afs012

Chang, V., & Do, M. (2015). Risk factors for falls among seniors: Implications of gender. American Journal of Epidemiology, 181, 7, pp. 521-531. https://doi.org.ezp3.lib.umn.edu/10.1093/aje/kwu268

Anstey, K. J., Von Sanden, C., & Luszcz, M. A. (2006). An 8-year prospective study of the relationship between cognitive performance and falling in very old adults. Journal of the American Geriatrics Society, 54(8), 1169–1176. http://doi.org/10.1111/j.1532-5415.2006.00813.x