October 9, 2024
Falls are common and potentially serious in older adults, since they can lead to broken hips and other serious medical complications. A new study suggests another reason to be wary of falls: They may be an early warning sign of impending Alzheimer’s disease or other forms of dementia.
By analyzing Medicare health records involving more than two million older men and women, researchers found that dementia was more often diagnosed in the year after a fall compared to other types of injuries, such as car accidents, burns, cuts, poisonings or machinery accidents. Among those who had a fall requiring medical attention, 10.6 percent were subsequently diagnosed with Alzheimer’s disease or other forms of dementia in the following year. Compared to other types of injuries, falls were associated with a 21 percent increased risk for a future dementia diagnosis.
Based on their findings, the researchers recommend that tests of memory and thinking skills be performed in older adults who have a fall that is serious enough to require a visit to the emergency room or admission to a hospital. Such cognitive screenings are often a first step leading to a diagnosis of Alzheimer’s disease. The findings were published in JAMA Network Open.
“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?” said Dr. Alexander Ordoobadi, the study’s first author and a resident physician in the Department of Surgery at Brigham and Women’s Hospital. “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.”
Falls are a leading cause of serious injury in older adults, affecting more than one in four Americans over 65. These injuries can have long-lasting or permanent consequences, limiting older people’s ability to carry out day-to-day activities. Physical limitations can also be a precursor to cognitive decline and further increase the risk of subsequent falls.
“The relationship between falls and dementia appears to be a two-way street,” said senior author Molly Jarman, 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.”
Cognitive screening can help to ensure early detection and diagnosis of dementia, a priority of the Center for Disease Control and Prevention’s Healthy Brain Initiative. Early detection can help to connect those with dementia to treatment and support services in their community, helping to extend their independence and quality of life. It can also help families to prepare and may defray long-term costs. Early detection of cognitive problems may in some cases help doctors identify treatable causes of memory loss, such as vitamin deficiencies or medication side effects.
“Ideally, after an injury, older adults should receive follow up care with a primary care provider or geriatrician who can monitor their cognitive health and long-term functional recovery after the injury, added Dr. Ordoobadi, though he acknowledged that many older adults don’t have ready access to such health care.
Falls are especially common in those who already have Alzheimer’s disease: 70 percent of those with dementia experience at least one fall each year. Those with early signs of dementia who live alone are at higher risk after a fall of not getting immediate help, increasing the likelihood of their dying. Those with memory and thinking problems are also five times more likely to be admitted to long-term care facilities after a fall.
So what can be done to help prevent falls, or to minimize their impact? Various measures may help.
*Fall-proof your home. Most falls occur in the home. Take care to remove any stacks of papers, loose carpets, extension cords or dropped clothing items that may be on the floor. Promptly wipe up spills of water or other liquids in the kitchen or bathroom since they can be slippery and increase the risk of falls. Put the lights on at night and do not assume that you know your way in the dark, be focused when getting into challenging activities (for example, getting into the bathtub, or going up or down the stairs), and wear shoes that are easy and comfortable without being loose.
*Keep a list of all of the medications you take — both non-prescription and prescription. This includes any supplements that you take, such as vitamins. Many drugs can lead to drowsiness and other side effects that can diminish attention and increase the risk of falls. Keep the list of medications with you, so that your doctor can check for interactions or side effects if any new medications are added to your regimen.
*Consider strength and balance exercises. Regular exercise and physical activity, even if it is light, can help to maintain muscle strength and balance and may help to minimize the risk of falls. Studies have shown that treadmill training can reduce the risk of subsequent falls. Tai chi, too, can be a good way to build balance.
By ALZinfo.org, The Alzheimer’s Information Site. Reviewed by Eric Schmidt, PhD, of The Fisher Center lab at The Rockefeller University.
Source: Alexander J. Ordoobadi, MD; Hiba Dhanani, MD, ScM; Samir R. Tulebaey, MD; et al: “Risk of Dementia Diagnosis After Injurious Falls in Older Adults.” JAMA Network Open, September 30, 2024.
