Fall in elderly associated with increased risk of future dementia: JAMA

A new study published in the Journal of American Medical Association showed that dementia in older persons is more commonly diagnosed within a year following a fall-related injury. Individuals who have dementia and moderate cognitive impairment, which is a prelude to dementia, are more likely to fall. Newer research suggest that older persons who have moderate cognitive impairment which is a risk factor for Alzheimer disease and associated dementias (ADRD), are more likely to fall. It is uncertain how likely it is that an older adult may get dementia following a fall. Thus, this study was to look into the likelihood of a new ADRD diagnosis following a fall in older individuals.

This retrospective cohort analysis utilized Medicare Fee-for-Service information from 2014 to 2015 with follow-up data available for at least a year following the index visit. The participants comprised persons 66 years of age and older without a prior dementia diagnosis who had suffered a catastrophic accident that led to an ED or inpatient visit. The period of data analysis was August 2023 to July 2024 which compared to other injury mechanisms as determined by the Ninth Revision of the International Classification of Diseases and the ICD-10 external cause of injury codes. A Cox multivariable competing risk model that took into account the competing risk of mortality and accounted for possible confounders was used to evaluate the likelihood of receiving a new ADRD diagnosis within a year following a fall.

• 2,453,655 older adults who had suffered a catastrophic injury were included in the study, the mean age was 78.1 years where 1,522,656 were female, 124,396 were Black and 2,232,102 were White.
• In 1,228,847 cases, the mechanism of injury was a fall. ADRD was identified more often within a year after a fall when compared to other injury mechanisms. Following a fall, the unadjusted hazard ratio (HR) for incident dementia diagnosis was 1.63.
• After adjusting for medical comorbidities, patient demographics, and injury features, as well as the competing risk of mortality, falling was found to be independently linked to an elevated risk of dementia diagnosis among older persons on multivariable Cox competing risk analysis.

The HR was 1.27 for the subgroup of older individuals who had not recently been admitted to a skilled care facility. Overall, the outcome of this research found that 10.6% of older persons received a dementia diagnosis during the first year following a fall which indicated that new dementia diagnoses were frequent following falls.

Source:

Ordoobadi, A. J., Dhanani, H., Tulebaev, S. R., Salim, A., Cooper, Z., & Jarman, M. P. (2024). Risk of Dementia Diagnosis After Injurious Falls in Older Adults. In JAMA Network Open (Vol. 7, Issue 9, p. e2436606). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2024.36606