Falling in elderly is associated with increased risk for future dementia: JAMA

A new study published in the Journal of American Medical Association suggests cognitive screening for senior citizens who have sustained fall and needed hospitalization or the emergency room. According to this study, older persons who have moderate cognitive impairment, which is a prelude to Alzheimer's disease and associated dementias (ADRD) are more likely to fall. However, it is unknown how likely it is for an older adult to have dementia following a fall. Thus, this study by Alexander Ordoobadi was to ascertain the likelihood of a new ADRD diagnosis in older individuals following a fall.

The Medicare program Fee-for-Service data from 2014 to 2015 were analyzed in this retrospective cohort analysis, with follow-up data available for at least a year following the index visit. Adults who were of 66 years of age and older with severe injury that required medical attention in the emergency department (ED) or an inpatient stay were included in the study as participants. The period of data analysis was August 2023 to July 2024. The primary exposure, as determined by the International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 external cause of injury codes, was falling. A Cox multivariable competing risk model that accounted for the competing risk of mortality and adjusted for possible confounders was employed to evaluate the probability of receiving a new ADRD diagnosis within a year following a fall.

A total of 2,453,655 older adult patients with traumatic injuries were included in the study where the mean (SD) age was 78.1 (8.1) years. Of this, 1,522,656 (62.1%) were female, 124,396 (5.1%) were Black and 2,232,102 (91.0%) were White.

A fall constituted the mechanism of injury in 1,228 847 instances (50.1%). Among injury mechanisms, ADRD was detected more often within a year after a fall. Following a fall, the incident dementia diagnosis had an uncorrected hazard ratio (HR) of 1.63.

Upon doing a multivariate Cox competing risk analysis it was shown that falling was independently linked to an elevated chance of dementia diagnosis in older persons.

In this cohort research, new ADRD diagnoses were more prevalent after falls than after other types of injury, with 10.6% of older persons identified with ADRD within the first year after a fall. Overall, the findings of this study support the introduction of cognitive screening in older persons who have an injurious fall that leads to an ED visit or hospital admission in order to improve the early detection of ADRD.

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