Abstract
BackgroundMost previous studies on dementia and injuries have focused on a particular type of injury, and few studies have investigated overall injury in people with dementia. In this study, we investigated the risk factors and risk of overall injury, including the diagnosis, cause, and intentionality of injury, in people with and without dementia in Taiwan.MethodsWe collected relevant data between 2000 and 2013 from the National Health Insurance Research Database (NHIRD). Overall, 455,630 cases, consisting of 91,126 people with dementia and 364,504 people without dementia, were included in this study and we performed subgroup analysis. A multivariate Cox proportional hazards regression analysis was used to determine the risk of injuries.ResultsThe 14-year follow-up data showed that people with dementia had a higher risk of injury-related hospitalization than did people without dementia (19.92% vs 18.86%, hazard ratio (HR) = 1.070, p < 0.001). Regarding the cause of injury, people with dementia were more likely to be hospitalized due to suffocation (HR = 2.301, p < 0.001), accidental drug poisoning (HR = 1.485, p < 0.001), or falls (HR = 1.076, p < 0.001), and were less likely to be hospitalized due to suicide or self-inflicted injury (HR = 0.670, p < 0.001) or a traffic accident (HR = 0.510, p < 0.001) than were people without dementia. Subgroup analysis showed that people with dementia with any of the three subtypes of dementia were at a higher risk of homicide or abuse than were people without dementia (vascular dementia, HR = 2.079, p < 0.001; Alzheimer’s disease, HR = 1.156, p < 0.001; other dementia, HR = 1.421, p < 0.001). The risk factors for overall injury included dementia diagnosis, female gender, age 65–74 years, and seeking medical attention for an injury within the past year.ConclusionPeople with dementia are at a higher risk of injury-related hospitalization than people without dementia. The results of this study provide a reference for preventing suffocation, drug poisoning, and falls in people with dementia. In addition, government agencies should pay attention to and intervene in cases of abuse suffered by people with dementia.
Highlights
Most previous studies on dementia and injuries have focused on a particular type of injury, and few studies have investigated overall injury in people with dementia
People with dementia were at a higher risk of hospitalization due to a foreign body entering through an orifice, sprains and strains, and burns than were people without dementia
For the cause of injury, people with dementia were at a higher risk of hospitalization due to suffocation and accidental poisoning by drugs
Summary
Most previous studies on dementia and injuries have focused on a particular type of injury, and few studies have investigated overall injury in people with dementia. We investigated the risk factors and risk of overall injury, including the diagnosis, cause, and intentionality of injury, in people with and without dementia in Taiwan. People with dementia may exhibit disturbing behavior, including sleep problems, paranoia/delusion, diurnal disturbance, aggressiveness, and personality changes; the condition can be so severe that it will interfere with their personal relationships and their ability to engage in daily activities [6,7,8]. Injury is a public health problem worldwide and has become a leading cause of death as lifestyles continue to evolve. Injury may cause long-term disability and severe trauma [9]. In Taiwan, according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), injury is classified into three categories based on the following: 1) the nature of the injury: N-code (800–999), including fractures, dislocations, injuries, open wounds, contusions, crush injuries, burns, and poisoning, which facilitate clinical diagnosis and treatment; 2) the external cause of the injury: E-code (E800–E999), including traffic and transport accidents, food or drug poisoning, poisoning by other substances (solid, liquid, gas, vapor), fall, fire and flame, drowning and suffocation, suicide and self-injury, homicide, natural environment, accidents during medical procedures, and injury due to law enforcement or war; these causes of injury can help develop injury prevention programs; and 3) supplemental description: in case of N-code 800–999, an E-code (for external cause of injury) should be specified to indicate unintentional injury (E800–E949) or intentional injury (E950–E969) [10]
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