Dementia more frequently diagnosed in older adults within a year of fall-related injury

Key takeaways:

• Falls were tied to increased risk for a dementia diagnosis vs. other mechanisms of injury.
• The findings show a need for cognitive screening among older adults who experience a fall.

Falling was associated with an increased risk for a diagnosis of Alzheimer’s disease or other dementias in older adults, according to a recent analysis in JAMA Network Open.

Falls are the leading cause of injury among adults aged 65 years and older, with one in four older adults — over 14 million — reporting falling annually, according to the CDC.

“We want to understand why falls happen, and also what care older adults need to maximize their quality of life after a fall,” Molly Jarman, PhD, MPH, an assistant professor of surgery at Harvard University, told Healio.

Researchers conducted a retrospective cohort study to determine the risk for a diagnosis of Alzheimer’s disease or other types of dementia within 1 year of a fall or another mechanism of injury using Medicare Fee-for-Service data from 2014 to 2015. The analysis included 2,453,655 older adult patients who experienced a traumatic injury.

Results showed falls as the cause of injury in 50.1% of incidents within the study cohort.

A diagnosis of Alzheimer’s disease or other dementias occurred more frequently within 1 year of a fall compared with other injury mechanisms (10.6% vs. 6.1%).

Researchers reported higher rates for a dementia diagnosis after falls compared with other injury mechanisms among both patients who required inpatient admission after the injury (13.1% vs. 10.4%) and patients who required just an ED visit (9.8% vs. 5.6%).

The researchers found that falling corresponded to a 21% increase in risk for a dementia diagnosis among older adults (HR = 1.21; 95% CI, 1.2-1.21) after they controlled for factors like patient demographics and injury characteristics.

Jarman and colleagues reported a 27% increase in risk for a dementia diagnosis after a fall among a subset of older adults without a recent skilled nursing facility admission (HR = 1.27; 95% CI, 1.26-1.28).

In comparison, falls corresponded to a 10% increase in risk for a dementia diagnosis among older adults with a recent skilled nursing facility admission (HR = 1.1; 95% CI, 1.09-1.12).

Patients who needed only an ED visit after a fall had a 29% higher risk for a dementia diagnosis (HR = 1.29; 95% CI, 1.28-1.3), whereas this increased risk was 6% among those who needed inpatient admission (HR = 1.06; 95% CI, 1.05-1.08).

“We don’t know why patients who fall are at increased risk for developing dementia, but our best guess is that they have mild cognitive impairment at the time of the fall and subsequently develop dementia in the year after the fall,” Jarman explained. “Walking requires substantial cognitive capacity to coordinate motor movements, maintain balance, and safely navigate the environment.”

Impairments in motor domains often precede diagnoses of dementia “and would place patients at risk both for falling and for developing dementia,” she added.

The researchers could not determine cause and effect because of the study’s observational design. Additionally, some falls may have been incorrectly coded as an unspecified injury.

Jarman told Healio that the results ultimately suggest that older adults who are injured following a fall should undergo cognitive screening.

“Initial screening could be performed during the initial hospitalization after a fall, and subsequent screening could be performed by the patient’s primary care physician or a geriatrician,” she said. “Currently, it is not routine practice to perform cognitive screening for older adults who experience a fall, and we hope that the results of our study will encourage clinicians to monitor the cognitive health of older adults who fall.”

References:

• Older adult falls data. https://www.cdc.gov/falls/data-research/index.html. Accessed Oct. 2, 2024.
• Ordoobadi A, et al. JAMA Netw Open. 2024;doi:10.1001/jamanetworkopen.2024.36606.