Defining Falls Risk Factors in Older Adults with Cognitive Impairment Living in Residential Care

Abstract

Introduction Falls are common among older people and those with dementia are at higher risk of falls and injury. In cognitively intact older people, interventions targeted at specific risk factors have proved effective at reducing falls. There is limited evidence of effective interventions for those with dementia. In order to design effective interventions for those with dementia, better understanding of risk factors is required. The aim of this study was to define falls risk factors in older people with cognitive impairment. Methods Participants from residential care homes underwent baseline collection of demographics and medical factors, sensorimotor, balance and gait function, behavioural and psychiatric symptoms and neuropsychological performance and were followed up for 6 months to determine faller status. Data were analysed for differences between fallers and non-fallers. Results Study 1 collected readily available data from 240 residential care dwellers and found 7 independent predictors of falls which were used to develop a falls risk assessment tool. These were: use of a walking frame, poor standing balance, mini mental state examination <17, use of antidepressants or hypnotic/anxiolytics, previous falls and impulsivity. Study 2 collected detailed baseline data from 109 residential care dwellers and found 4 independent predictors of falls which were anxiety, impaired postural sway with eyes closed, poor attention and concentration and use of antidepressants. New scales to measure physical activity and impulsivity in this population were validated and used as baseline variables. A further test to measure judgement of balance abilities was developed but did not predict faller status. Conclusion Two new valid and reliable scales to measure impulsivity and physical activity were developed as well as a falls risk screening tool that accurately identified those at high risk of falls. Detailed data collection identified risk factors amenable to intervention. Targeted interventions are described in the discussion.

Date of Award	2013
Original language	English
Awarding Institution	King's College London
Supervisor	Stephen Jackson (Supervisor) & Michael Hurley (Supervisor)