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BOSTON — Falls among older adults are a relatively common issue that only gets worse with age. Now, a new study has unveiled a concerning link between fall injuries and the onset of dementia.
The research, published in JAMA Network Open, suggests that experiencing a fall could be an early warning sign of cognitive decline, potentially leading to dementia less than a year later.
The study, conducted by researchers from Brigham and Women’s Hospital and other institutions, examined Medicare data for over 2.4 million adults 66 and older who suffered traumatic injuries between 2014 and 2015. The findings revealed that older adults who experienced falls were significantly more likely to be diagnosed with dementia within the following year compared to those who sustained injuries during other types of accidents.
Of the 1.2 million patients who fell down and injured themselves, a startling 10.6% received a dementia diagnosis within 12 months. In contrast, only 6.1% of those injured in other accidents were diagnosed with dementia during the same period. Even after accounting for factors such as age, pre-existing health conditions, and injury severity, falls were associated with a 21% higher risk of dementia diagnosis.
These results highlight the importance of cognitive screening for older adults who experience falls severe enough to warrant a trip to the emergency room or hospitalization. Early detection of cognitive impairment could lead to timely interventions and support for patients and their families.
“I often see patients admitted after falls, which are among the most common reasons for trauma center admissions and can lead to severe injuries. This raises an important question: Why are these falls happening in the first place?” says first author Alexander Ordoobadi, MD, a resident physician in the Department of Surgery at the Brigham, in a media release. “We treat the injuries, provide rehabilitation, but often overlook the underlying risk factors that contribute to falls despite a growing body of evidence suggesting a link between falls and cognitive decline.”
Interestingly, the increased risk of dementia diagnosis following a fall was even more pronounced among older adults without recent admissions to skilled nursing facilities. This suggests that community-dwelling seniors who fall may be particularly vulnerable and in need of cognitive screening.
The research team hypothesizes that the link between falls and dementia could be explained in two ways. First, some patients may have undiagnosed dementia at the time of their fall, which is only discovered during medical evaluation after the incident. On the other hand, patients who fall may be experiencing mild cognitive impairment – a precursor to dementia – which increases their fall risk and eventually progresses to full-blown dementia.
“The relationship between falls and dementia appears to be a two-way street,” adds senior author Molly Jarman, PhD, MPH, assistant professor in the Department of Surgery and deputy director of the Center for Surgery and Public Health at the Brigham. “Cognitive decline can increase the likelihood of falls, but trauma from those falls may also accelerate dementia’s progression and make a diagnosis more likely down the line. Thus, falls may be able to act as precursor events that can help us identify people who need further cognitive screening.”
The study’s results call for a multidisciplinary approach to fall prevention and post-fall care for seniors. Healthcare providers, from emergency room doctors to primary care physicians, should be aware of the potential cognitive implications of falls in their older patients.
As the population ages and lives longer than ever before, understanding the complex relationship between physical incidents like falls and cognitive health becomes increasingly crucial.
“Our study highlights the opportunity to intervene early and the need for more clinicians who can provide comprehensive care for older adults,” says Jarman. “If we can establish that falls serve as early indicators of dementia, we could identify other precursors and early events that we could intervene on, which would significantly improve our approach to managing cognitive health in older adults.”
Paper Summary
Methodology
The researchers analyzed Medicare claims data for adults 66 and older who experienced traumatic injuries in 2014-2015. They compared those who fell to those injured by other means, tracking new dementia diagnoses over the following year. The team used statistical methods to account for various factors that might influence dementia risk, such as age, sex, race, and pre-existing health conditions.
Key Results
The study found that 10.6% of patients who fell were diagnosed with dementia within a year, compared to 6.1% of those with other injuries. After adjusting for various factors, falls were associated with a 21% higher risk of dementia diagnosis. The increased risk was even higher (27%) for those without recent nursing home admissions.
Study Limitations
As an observational study, it can’t prove that falls cause dementia. The reliance on Medicare claims data may have missed some dementia cases or falls. The study period (2014-2015) is somewhat dated, though the researchers believe the fundamental relationship between falls and dementia risk likely remains unchanged.
Discussion & Takeaways
The findings suggest that falls could be an early sign of cognitive decline or undiagnosed dementia. The study highlights the need for cognitive screening after falls in older adults, especially for those living independently in the community. This could lead to earlier dementia diagnosis and intervention.
Funding & Disclosures
The study was supported by a grant from the National Institute on Aging. Some authors reported receiving grants or honoraria from various sources, but these were not directly related to this study.
Fell down a lot when I was a kid. Brain still working fine at 72yrs
I appreciate the statement, “Why are these falls happening in the first place?” Asking the cause of a problem is a novel approach in medicine, which usually just treats symptoms and ignores causes. however, there are no good treatments for dementia, and telling people who fall that they may be higher risk for dementia is frightening. Of course, it makes sense that brain dysfunction will lead to increased falls, and dementia is one type of brain dysfunction. However, telling an elderly patient that their fall could indicate dementia will produce anxiety and depression, and will not stop any dementia.
On the other hand, according to the study, “Participants included adults aged 66 years and older who experienced a traumatic injury that resulted in an emergency department (ED) or inpatient encounter and did not have a preexisting diagnosis of dementia.” This begs the question, what was the treatment given to these people who fell and experienced trauma? Could the medication prescribed for the trauma itself cause brain problems, which could lead to or exacerbate dementia? Yes! Some of these people may have received pain medication or opioids, which could impact cognitive function.
This means the increased incidence in dementia in the following year in old people who experienced trauma from falling could be from the medical care they received, and not from the fall. This study does not mention any of the treatments received, so this possibility should have been discussed in this article and study, and is a major study design flaw.