Falls in cognitive impairment and dementia
Section snippets
Epidemiology of falls in patients with cognitive impairment and dementia
As shown in Table 1, a wide variation exists in the estimation of the incidence of falls in people with cognitive impairment and dementia [12], [43], [56], [87], [89]. The method of data collection seems to be the most important variable, with studies that recorded data retrospectively producing much lower estimates of fall rates [12], [56] than those using prospective methods [43], [87], [89]. Excluding studies that used retrospective data, there is remarkable consistency across studies,
Causes of falls in patients with cognitive impairment and dementia
Many studies have identified cognitive impairment [14], [17], [23], [50], [65], [70], [72], [74], [87], [88], [95] or dementia [39], [40], [56], [72] as an independent risk factor for falls. These findings are consistent across populations living in the community [14], [17], [56], [65], [87], [88], [95], in hospitals [74], and in residential or nursing homes [23], [39], [40], [50], [70], [72]. Determining the mechanisms by which cognitive impairment and dementia increase the risk of falls in
Prevention of falls in patients with cognitive impairment and dementia
Several studies have shown that preventing falls in older people who do not have cognitive impairment or dementia is possible [11], [18], [19], [20], [25], [28], [37], [85], [96]. A multifactorial approach that targets gait and balance, medications, environmental risk factors and orthostatic hypotension has reduced falls successfully in community-dwelling older adults [85] and casualty attendees [25]. Other studies found that exercise [11], [18], [20], [96], withdrawal of medication [19], and
Further research
Compared with cognitively normal people who experience falls, there has been little research in cognitively impaired people who fall. Issues that still need to be addressed include the following:
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Determining specific risk factors for falls and their relative importance in different circumstances, such as place of residence, degree of cognitive impairment, and type of dementia
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Investigating the role of neurocardiovascular instability in patients with dementia who fall (theoretically, this has an
Summary
Older people with cognitive impairment and dementia are at increased risk for falls and subsequent adverse events. The most common risk factors for falls that are found specifically in patients with cognitive impairment and dementia are postural instability, medication, neurocardiovascular instability (particularly orthostatic hypotension), and environmental hazards. Based on data from studies in cognitively normal people who fall, modification of these risk factors may prevent falls in older
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