Longitudinal association between falls and Alzheimer’s disease and related dementia (ADRD) in the community dwelling elderly population

Abstract

AbstractBackgroundFalls are higher amongst elderly with ADRD and are a major cause of functional impairment and increased mortality. The primary purpose of this study was to examine if fall status of community dwelling elderly residents with and without ADRD differ over a four year period and additionally, does receipt of rehabilitation in any year modify this association.MethodData for this analysis was drawn from the 2015‐2018 National Health and Aging Trends Study (NHATS). Participants included sample persons (N=3,235) age 65 and older who resided in the community or residential care facilities that were not nursing homes. Baseline characteristics of individuals in ADRD (n= 264) and non‐ADRD group (n=2,971) was compared using chi square statistic. A generalized estimating equation model (multivariate logistic regression) was used to estimate odds ratio of falls in the two groups, adjusted for sociodemographic and clinical conditions that are predictors of fall risk.ResultAt baseline, ADRD group comprised of older, increased number of racial/ethnic minorities other than non‐Hispanic Whites, more frail individuals who reported increased use of assistive device (AD) and had a presence of depression. Those in the non‐ADRD group at baseline had significantly decreased odds for falls, however no statistically significant change was observed for fall status over four years in the two groups (non‐ADRD vs ADRD) and this association was not modified by receipt of rehabilitation. Males had decreased odds ratio (OR 0.87, 95% CI ‐0.22, ‐0. 012) for falls compared to females in both groups and compared to non‐Hispanic Whites, those who were non‐Hispanic Blacks (OR 0.59, 95% CI ‐0.66, ‐0.36) and Blacks (0.58, 95%CI ‐0.82, ‐0.25) had decreased odds ratio for falls. Those who used AD, had depression and received rehabilitation services showed increased odds for falls. No differences were found in terms of fall status for those who lived alone and were frail.ConclusionFuture studies should examine the bi‐directional interplay between falls and rehabilitation with inclusion of other predictors of fall risk in elderly with ADRD. This can provide further evidence on whether rehabilitation can be used as an effective non‐pharmacological intervention in the management of elderly with ADRD.