Abstract
The aim of this study was to identify in-hospital fall risk factors specific for multimorbid hospitalized geriatric patients with dementia (PwD) during hospitalization. Geriatric inpatients during ward-based rehabilitation (n = 102; 79.4% females; 82.82 (6.19) years of age; 20.26 (5.53) days of stay) were included in a comprehensive fall risk assessment combining established clinical measures, comprehensive cognitive testing including detailed cognitive sub-performances, and various instrumented motor capacity measures as well as prospective fall registration. A combination of unpaired t-tests, Mann–Whitney-U tests, and Chi-square tests between patients with (“in-hospital fallers”) and without an in-hospital fall (“in-hospital non-fallers”), univariate and multivariate regression analysis were used to explore the best set of independent correlates and to evaluate their predictive power. In-hospital fallers (n = 19; 18.63%) showed significantly lower verbal fluency and higher postural sway (p < 0.01 to 0.05). While established clinical measures failed in discriminative as well as predictive validity, specific cognitive sub-performances (verbal fluency, constructional praxis, p = 0.01 to 0.05) as well as specific instrumented balance parameters (sway area, sway path, and medio-lateral displacement, p < 0.01 to 0.03) significantly discriminated between fallers and non-fallers. Medio-lateral displacement and visuospatial ability were identified in multivariate regression as predictors of in-hospital falls and an index combining both variables yielded an accuracy of 85.1% for fall prediction. Results suggest that specific cognitive sub-performances and instrumented balance parameters show good discriminative validity and were specifically sensitive to predict falls during hospitalization in a multimorbid patient group with dementia and an overall high risk of falling. A sensitive clinical fall risk assessment strategy developed for this specific target group should include an index of selected balance parameters and specific variables of cognitive sub-performances.
Highlights
Among older persons at risk of falling, persons with dementia (PwD) or cognitive impairment (CI)represent the highest risk populations with a twice as high fall risk compared to cognitively unimpaired, and a fall incidence of 70–85% per year [1,2]
The inclusion criterion for Geriatric Rehabilitation for Patients with Dementia Study” (GREDE) was the diagnosis of mild to moderate dementia as a secondary diagnosis confirmed by a geriatrician according to core criteria for all-cause dementia based on a standardized approach, including clinical history, physical and neurological examination, neuroimaging, laboratory tests, and neuropsychological testing [36]
We found that the combination of selected balance parameters and specific variables of cognitive sub-performances has the potential to provide a clinically meaningful surveillance of
Summary
Among older persons at risk of falling, persons with dementia (PwD) or cognitive impairment (CI). Represent the highest risk populations with a twice as high fall risk compared to cognitively unimpaired, and a fall incidence of 70–85% per year [1,2]. Fall rates are dramatic, especially so in PwD/CI, with a threefold fall risk compared to cognitively unimpaired patients [3]. Sensors 2020, 20, 5385 incidence rate, 17% of geriatric rehabilitation hospital patients in mixed populations with respect to cognitive status sustain a fall [4], while about 40% of patients with dementia in psychogeriatric wards fall at least once during a hospital stay [5]. Falls occur as an interaction of multiple individuum-related and environment-related risk factors [2,6], with fall risk drastically increasing as the number of risk factors, such as motor impairment, polypharmacy, history of falls, advancing age, female gender, and visual impairment, increases [6,7].
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