Abstract
Abstract Objective: to investigate the frequency of falls and clinical and physical-functional factors associated with falls, and the accuracy of such factors to identify the risk of falling in cognitively impaired older adults. Method: a cross-sectional study with cognitively impaired older adults was carried out using the Mini-Mental State Examination. The dependent variable was a history of falls in the previous six months. The independent variables were self-reported mental confusion, hearing and visual impairment, physical fatigue, muscle weakness, dizziness, body imbalance, insecurity when walking, diagnosed depression, hospitalizations, continuous use medications (form from study used), muscle mass (calf circumference) and handgrip strength (dynamometry), functional capacity (Pfeffer) and mobility (SAM-Br). Descriptive statistics were applied. The groups were compared using the Mann Whitney U test, the risk factors were identified by univariate and multivariate logistic regression, and the area under the ROC curve (AUC) was calculated for the associated factors. Results: 216 cognitively impaired older adults were included in the analysis, 41.7% of whom were fallers. Multivariate regression analyzes indicated that complaints of visual impairment (OR=2.8; p=0.015) and body imbalance (OR=2.7; p=0.004), and greater medication use (OR=1.1; p=0.038) were associated with a history of falls. The AUC found poor accuracy for quantity of medications as a screening tool for fallers (AUC=0.6 [0.5; 0.7]; p=0.028). Conclusion: cognitively impaired older adults had a high frequency of falls. Complaints of visual impairment, body imbalance and polypharmacy were predictors of falls. The early assessment of these factors can contribute to the identification of cognitively-impaired older adults at risk of falling in clinical practice and research.
Highlights
Cognitive impairment and dementia are important clinical syndromes and a common health concern in older adults[1]
There was no significant difference between groups in terms of age, sex, education, cognitive status and previous diagnosis of dementia, nutritional status and level of physical activity, representing homogeneity between the groups for possible confounding variables
The comparison of possible factors associated with falls among older adults with cognitive deficits revealed that those who fell used a greater number of continuous use medications, had a higher frequency of the diagnosis of depression and complaints of visual impairment, body imbalance and insecurity when walking
Summary
Cognitive impairment and dementia are important clinical syndromes and a common health concern in older adults[1]. Mild Cognitive Impairment (MCI) is considered an intermediate state between the normal cognitive changes of aging and the early clinical characteristics of dementia, Alzheimer’s disease[2]. The consequent deficits in memory, temporal orientation, language, problem solving, attention, motor initiation and executive functions related to planning and working memory can result in impairments in the functional capacity of these older adults and increase the risk of falls[1,3]. A long-lived cognitively impaired older adult who is a victim of falls is at greater risk of serious injury, resulting in excessive health costs[3,7]
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