The Relationship between Dementia and Falling in Long-stay Hospital Patients

Abstract

Introduction: Adults with dementia have an increased risk for falling. Several studies indicate an annual falls incidence as high as 60% among people with dementia with as many as 4 falls per person annually (1). The key risk factors for falls include the many conditions associated with dementia such as cognitive impairment, gait and balance deficits, visual impairment, muscle weakness, impaired functioning and unsafe wandering (2). This study examines a sub-population of patients with a diagnosis of dementia taken from a larger sample of long-stay patients who were identified in acute care hospital beds. Their history of falls prior to admission to hospital as well as their medical history, functional, and social history were gathered and a comparison was done between those with dementia who had a history of falls and those that did not. Methods: Retrospective chart reviews were conducted on long-stay hospital patients in a a Regional Health Authority in New Brunswick, Canada. The initial sample was a stratified random sample of 223 of the 302 identified patients. The sub-population for this study consists of 119 of these patients with a known diagnosis of dementia, either made prior to admission or during their hospitalization. The history of falls prior to admission and during their hospital stay was collected. Comparisons between those who had a history of falls prior to admission and those who did not fall were done. The information gathered allows for comparisons in their medical history, medication usage, mobility status, functional status and living arrangements prior to admission. Results: In the sample of 119 patients with dementia, 68 (57.1%) had history of falls prior to admission. The mean age in the group that fell was 82.7 years (sd 8.5) and in those that did not fall the mean age was 78.5 years (sd 10.2). In those who fell, they most often lived with their spouse at home (39.7%) and in those who did not fall they most frequently lived alone (39.2%). The most common reason for admission to hospital was related to their dementia, 27.9% in the fallers, and 39.2% in the non-fallers. Fractures were the reason for admission in 11.8% of the fallers. In the group with a history of falls the majority (60.3%) had a history of falls within one month prior to admission. Benzodiazepine use and neuroleptic use was over 25% in both groups at the time of hospital admission. Prior to admission, the group that did not have a history of falls were more independent in their bathing and toileting. Incontinence of urine (42.6%) and stool (33.8%) was more common in those who fell, almost 2 fold. In those with a history of falls, 41.2% required the use of a walking aid compared to only 19.6% in those who did not fall. The majority (54.9%) of those who did not fall were independent ambulators before admission, compared to 35.6% in the group that fell. In both groups the majority needed assistance or was dependent in some of their instrumental activities of daily living. However those who did not fall were less dependent. For those with a history of falls prior to admission, 38.2% fell again during their hospital stay and 25.5% of those who had not fallen before admission fell while in hospital. Conclusions: In a group of long-stay hospital patients with dementia, the majority had a history of falls prior to admission (most within the last month). The group that fell used a walking device (cane or walker) more frequently and most were living at home with a spouse or other family member. Fractures were the reason for admission in some of these patients with a history of falls. Benzodiazepine and neuroleptic use was common in both fallers and non-fallers. The group with a history of falls needed more assistance with their activities of daily living and instrumental activities of daily living. The fall rate in hospital was greater in those with a history of falls prior to admission but a quarter of those with no fall history experienced falls during their hospital stay.