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Precipitating factors for falls among patients with dementia on a psychogeriatric ward

Published online by Cambridge University Press:  02 February 2010

Sofie Tängman ,
Staffan Eriksson ,
Yngve Gustafson  and
Lillemor Lundin-Olsson
Sofie Tängman*
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University. Umeå, Sweden
Staffan Eriksson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University. Umeå, Sweden
Yngve Gustafson
Affiliation:
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden
Lillemor Lundin-Olsson
Affiliation:
Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University. Umeå, Sweden
*
Correspondence should be addressed to: Sofie Tängman, Geriatric Medicine, Umeå University, SE-901 87 Umeå, Sweden. Phone: +46 90 785 88 46; Fax: +46 90 13 06 23. Email: [email protected].
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Abstract

Background: Predisposing factors alone explain only a limited proportion of the variation in fall events, especially in people with dementia. The aim of this study was to identify precipitating factors for falls among people with dementia.

Methods: We examined prospective fall registrations over a two-year period on a psychogeriatric hospital ward in the north of Sweden. Circumstances associated with each fall event were analyzed by independent reviewers, possible precipitating factors were documented, evaluated and the most likely precipitating factors were identified. In total, 223 patients with any type of diagnosed dementia were admitted to the ward and 91 fell at least once. Of these, 46 were women and 45 were men (mean age 80.3 years, range 60–94).

Results: A total of 298 falls were registered, 62% of which were sustained by men. The most likely factor or combination of factors could be ascertained in 247 falls (83%). Falls took place at all hours but almost half of the falls (44%) occurred during the nightshift (between 9pm and 7am). Acute disease or symptoms of disease and/or acute drug side-effects were, alone or in combination with other factors, judged to precipitate more than three out of four falls.

Conclusion: It is possible to identify many precipitating factors that may contribute to a fall. Falls in people with dementia should be regarded as a symptom of acute disease or as a drug side-effect until proven otherwise. Prompt detection of these relevant factors is, therefore, essential.

Keywords

accidental fallsrisk factorsdementiahospitalsprospective studies
Type
Research Article
Information
International Psychogeriatrics , Volume 22 , Issue 4 , June 2010 , pp. 641 - 649
Copyright
Copyright © International Psychogeriatric Association 2010

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References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders: DSM-IV. Washington, DC: American Psychiatric Association.Google Scholar
Baker, B. R., Duckworth, T. and Wilkes, E. (1978). Mental state and other prognostic factors in femoral fractures of the elderly. Journal of the Royal College of General Practitioners, 28, 557–559.Google ScholarPubMed
Bouwen, A., de Lepeleire, J. and Buntinx, F. (2008). Rate of accidental falls in institutionalised older people with and without cognitive impairment halved as a result of a staff-oriented intervention. Age and Ageing, 37, 306–310.CrossRefGoogle ScholarPubMed
Buchner, D. M. and Larson, E. B. (1987). Falls and fractures in patients with Alzheimer-type dementia. JAMA, 257, 1492–1495.CrossRefGoogle ScholarPubMed
Coussement, J., de Paepe, L., Schwendimann, R., Denhaerynck, K., Dejaeger, E. and Milisen, K. (2008). Interventions for preventing falls in acute- and chronic-care hospitals: a systematic review and meta-analysis. Journal of the American Geriatrics Society, 56, 29–36.CrossRefGoogle ScholarPubMed
Eriksson, S., Gustafson, Y. and Lundin-Olsson, L. (2007). Characteristics associated with falls in patients with dementia in a psychogeriatric ward. Aging: Clinical and Experimental Research, 19, 97–103.Google Scholar
Eriksson, S., Strandberg, S., Gustafson, Y. and Lundin-Olsson, L. (2008). Circumstances surrounding falls in patients with dementia in a psychogeriatric ward. Archives of Gerontology and Geriatrics.Google Scholar
Folstein, M., Folstein, S. and McHugh, P. R. (1975) “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle Scholar
Gillespie, L. D. et al. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, Issue 2. Art.No.: CD007146. doi: 10.1002/1451858. CD007146.pub2.CrossRefGoogle Scholar
Hartikainen, S., Lonnroos, E. and Louhivuori, K. (2007). Medication as a risk factor for falls: critical systematic review. Journals of Gerontology. Series A: Biological Sciences and Medical Sciences, 62, 1172–1181.CrossRefGoogle ScholarPubMed
Jensen, J., Lundin-Olsson, L., Nyberg, L. and Gustafson, Y. (2002). Falls among frail older people in residential care. Scandinavian Journal of Public Health, 30, 54–61.CrossRefGoogle ScholarPubMed
Jensen, J., Nyberg, L., Gustafson, Y. and Lundin-Olsson, L. (2003). Fall and injury prevention in residential care -effects in residents with higher and lower level of cognition. Journal of the American Geriatrics Society, 51, 627–635.CrossRefGoogle ScholarPubMed
Kallin, K., Lundin-Olsson, L., Jensen, J., Nyberg, L. and Gustafson, Y. (2002). Predisposing and precipitating factors for falls among older people in residential care. Public Health, 116, 263–271.CrossRefGoogle ScholarPubMed
Kallin, K., Gustafson, Y., Sandman, P. O. and Karlsson, S. (2004a). Drugs and falls in older people in geriatric care settings. Aging Clinical Experimental Research, 16, 270–276.CrossRefGoogle ScholarPubMed
Kallin, K., Jensen, J., Olsson, L. L., Nyberg, L. and Gustafson, Y. (2004b). Why the elderly fall in residential care facilities, and suggested remedies. Journal of Family Practice, 53, 41–52.Google ScholarPubMed
Laurila, J. V., Laakkonen, M. L., Tilvis, R. S. and Pitkala, K. H. (2008). Predisposing and precipitating factors for delirium in a frail geriatric population. Journal of Psychosomatic Research, 65, 249–254.CrossRefGoogle Scholar
Littbrand, H., Rosendahl, E., Lindelof, N., Lundin-Olsson, L., Gustafson, Y. and Nyberg, L. (2006). A high-intensity functional weight-bearing exercise program for older people dependent in activities of daily living and living in residential care facilities: evaluation of the applicability with focus on cognitive function. Physical Therapy, 86, 489–498.CrossRefGoogle ScholarPubMed
McMurdo, M. E. and Gaskell, A. (1991). Dark adaptation and falls in the elderly. Gerontology, 37, 221–224.CrossRefGoogle ScholarPubMed
Neyens, J. C. L. et al. (2009). A multifactorial intervention for the prevention of falls in psychogeriatric nursing home patients, a randomised controlled trial (RCT). Age and Ageing, 38, 194–199.CrossRefGoogle ScholarPubMed
Nyberg, L., Gustafson, Y., Janson, A., Sandman, P.-O. and Eriksson, S. (1997). Incidence of falls in three different types of geriatric care: a Swedish prospective study. Scandinavian Journal of Social Medicine, 25, 8–13.CrossRefGoogle Scholar
Oliver, D. et al. (2007). Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ, 334, 82.CrossRefGoogle ScholarPubMed
Pellfolk, T., Gustafsson, T., Gustafson, Y. and Karlsson, S. (2009). Risk factors for falls among residents with dementia living in group dwellings. International Psychogeriatrics, 21, 187–194.CrossRefGoogle ScholarPubMed
Rapp, K., Lamb, S. E., Buchele, G., Lall, R., Lindemann, U. and Becker, C. (2008). Prevention of falls in nursing homes: subgroup analyses of a randomized fall prevention trial. Journal of the American Geriatrics Society, 56, 1092–1097.CrossRefGoogle ScholarPubMed
Reisberg, B. (1988). Functional assessment staging (FAST). Psychopharmacology Bulletin, 24, 653–659.Google ScholarPubMed
Reisberg, B., Borenstein, J., Salob, S. P., Ferris, S. H., Franssen, E., Georgotas, A. (1987). Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. Journal of Clinical Psychiatry, 48 (Suppl.), 9–15.Google ScholarPubMed
Shaw, F. E. (2002). Falls in cognitive impairment and dementia. Clinics in Geriatric Medicine, 18, 159–173.CrossRefGoogle ScholarPubMed
Shaw, F. E. et al. (2003). Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial. BMJ, 326, 73.CrossRefGoogle Scholar
Stenvall, M. et al. (2007). A multidisciplinary, multifactorial intervention program reduces postoperative falls and injuries after femoral neck fracture. Osteoporosis International, 18, 167–175.CrossRefGoogle ScholarPubMed
Sterke, C. S., Verhagen, A. P., van Beeck, E. F. and Van Der Cammen, T. J. (2008). The influence of drug use on fall incidents among nursing home residents: a systematic review. International Psychogeriatrics, 20, 890–910.CrossRefGoogle ScholarPubMed
Tinetti, M. E. (2003). Clinical practice. Preventing falls in elderly persons. New England Journal of Medicine, 348, 42–49.CrossRefGoogle ScholarPubMed
van Dijk, P. T., Meulenberg, O. G., van de Sande, H. J. and Habbema, J. D. (1993). Falls in dementia patients. Gerontologist, 33, 200–204.CrossRefGoogle ScholarPubMed
van Doorn, C. et al. (2003). Dementia as a risk factor for falls and fall injuries among nursing home residents. Journal of the American Geriatrics Society, 51, 1213–1218.CrossRefGoogle ScholarPubMed