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Factors Associated With Falls Among Older, Cognitively Impaired People in Geriatric Care Settings: A Population-Based Study

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Objective

The authors studied factors associated with falls among cognitively impaired older people in geriatric care settings.

Method

This was a study using all geriatric care settings in a county in northern Sweden. Residents were assessed by means of the Multi-Dimensional Dementia Assessment Scale, supplemented with questions concerning the use of physical restraints, pain, previous falls during the stay, and falls and injuries during the preceding week. Data about both falls and cognition were collected in 3,323 residents age 65 and older. Of these residents 2,008 (60.4%) were cognitively impaired, and they became the study population. Of the participants, 69% were women; mean age: 83.5 years.

Results

Of 2,008 cognitively impaired residents, 189 (9.4%) had fallen at least once during the preceding week. Being able to get up from a chair, previous falls, needing a helper when walking, and hyperactive symptoms were the factors most strongly associated with falls.

Conclusion

Preventing falls in cognitively impaired older people is particularly difficult. An intervention strategy would probably have to include treatment of psychiatric and behavioral symptoms, improvement of gait and balance, and adjustment of drug treatment, as well as careful staff supervision.

Section snippets

Sample

The design of the current investigation was a prevalence study performed over a period of one week in May 2000 in the county of Västerbotten in northern Sweden. At that time, the county had a population of approximately 256,000 people, 44,211 (17.3%) of whom were age 65 and older. An assessment scale was distributed to all geriatric settings in the county, including 68 residential care facilities, 31 nursing homes, 66 group dwellings for people with dementia, 7 rehabilitation/short-stay units,

RESULTS

Of 2,008 cognitively impaired residents, 189 (9.4%) had fallen at least once during the preceding week. Twenty-seven of the fallers (14.3%) had sustained serious injuries, such as fractures, cuts needing stitches, head injuries, and injuries to internal organs, and 93 fallers (49.2%) had sustained minor injuries, such as bruises or minor cuts or abrasions. Only 69 (36.5%) sustained no registered injury from their fall. Seventy-two percent of the residents sustaining a fall in this study had

DISCUSSION

This study confirms a high incidence of falls and fall-related injuries among cognitively impaired older people living in geriatric care settings. The high proportion of fallers in this study compared with previous studies suggests a reliable reporting of falls.4, 12, 13 The high proportion of injurious falls could indicate that cognitively impaired older people are more susceptible to injuries when falling, but could also indicate an underreporting of non-injurious falls.

An interesting finding

CONCLUSION

Older people with cognitive impairment run a high risk of sustaining falls, especially injurious falls. Preventing falls in older people with cognitive impairment seems to be particularly difficult, since many of the factors associated with falls in this group are connected with the consequences of the cognitive impairment itself—loss of memory, changes in gait, compromised ADL functioning, and prevalence of psychiatric symptoms. Prevention of falls probably needs to include treatment of

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  • Cited by (0)

    This study was supported financially by grants from the Umeå University Foundation for Medical Research, the Swedish Foundation for Healthcare Sciences and Allergy Research, the County Council of Västerbotten, the Federation of County Councils in Sweden, the Field Research Center for the Elderly in Västerbotten, Gun and Bertil Stohne's Foundation, and Erik and Anne-Marie Detlof's Foundation, Umeå University.

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