Abstract
Objectives
Falls and neuropsychiatric symptoms (NPS) are common among long-term care residents
with cognitive impairment. Despite the high prevalence of falls and NPS, little is
known about their association. The aim of our study was to explore how NPS, particularly
the severity of NPS and specific NPS subgroups, are associated with falls and how
psychotropics modify this association.
Design
Longitudinal cohort study.
Setting and Participants
In total, 532 long-term care residents aged 65 years or older in Helsinki, Finland.
Methods
NPS were measured with Neuropsychiatric Inventory (NPI) at baseline. Participants
were grouped into 3 groups: no significant NPS (NPI points 0‒3), low NPS burden (NPI
4‒12), and high NPS burden (NPI >12). The number of falls, injuries, fractures, and
hospitalizations were collected from medical records over 12 months following baseline
assessment.
Results
Altogether, 606 falls occurred during the follow-up year. The falls led to 121 injuries,
42 hospitalizations, and 20 fractures. Falls and injuries increased significantly
with NPS burden (P < .001): 330 falls in the high NPS group (n = 184), 188 falls in the low NPS group
(n = 181), and 88 falls in the no significant NPS group (n = 167). The risk of falling
showed a curvilinear association with NPI total score. Of NPS subgroups, psychosis
and hyperactivity were associated with a higher incidence rate ratio of falls, whereas
apathy had a protective association even after adjustment for age, sex, and mobility.
Affective symptoms were not associated with falls. Psychotropics did not modify the
association between NPS burden and falls.
Conclusions and Implications
The results of this study show that NPS, especially NPS severity, may predict falls
and fall-related negative consequences. Severity of NPS should be taken into account
when assessing fall risk in long-term care residents with cognitive impairment.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the American Medical Directors AssociationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Factors associated with falls among older, cognitively impaired people in geriatric care settings a population-based study.Am J Geriatr Psychiatry. 2005; 13: 501-509
- The role of cognitive impairment in fall risk among older adults: A systematic review and meta-analysis.Age Ageing. 2012; 41: 299-308
- Fall determinants in older long-term care residents with dementia: A systematic review.International Int Psychogeriatr. 2013; 25: 549-563
- Factors related to the high fall rate in long-term care residents with dementia.Int Psychogeriatr. 2015; 27: 803-814
- Risk factors for falls among elderly persons living in the community.N Engl J Med. 1988; 319: 1701-1707
- Risk factors associated with falls in older adults with dementia: A systematic review.Physiother Can. 2017; 69: 161-170
- Incidence and prediction of falls in dementia: A prospective study in older people.PLoS One. 2009; 4: e5521
- Dementia as a risk factor for falls and fall injuries among nursing home residents.J Am Geriatr Soc. 2003; 51: 1213-1218
- Identification of high risk fallers among older people living in residential care facilities: A simple screen based on easily collectable measures.Arch Gerontol Geriatr. 2012; 55: 690-695
- Understanding risk of falls in people with cognitive impairment living in residential care.J Am Med Dir Assoc. 2012; 13: 535-540
- Gait, falls, and dementia.J Am Med Dir Assoc. 2016; 17: 467-470
- Falls and long-term care: A report from the care by design observational cohort study.BMC Fam Pract. 2018; 19: 73
- The prevalence and course of neuropsychiatric symptoms in nursing home patients with dementia: A systematic review.J Am Med Dir Assoc. 2013; 14: 161-169
- Exploring the prevalence and variance of cognitive impairment, pain, neuropsychiatric symptoms and ADL dependency among persons living in nursing homes; A cross-sectional study.BMC Geriatr. 2016; 16: 154
- Prevalence of neuropsychiatric symptoms in dementia and mild cognitive impairment: Results from the cardiovascular health study.JAMA. 2002; 288: 1475-1483
- Neuropsychiatric syndromes in dementia.Dement Geriatr Cogn Disord. 2007; 24: 457‒463
- Urinary incontinence and behavioral symptoms are independent risk factors for recurrent and injurious falls, respectively, among residents in long-term care facilities.Arch Gerontol Geriatr. 2010; 50: 77‒81
- Impact of fall-related behaviors as risk factors for falls among the elderly patients with dementia in a geriatric facility in Japan.Am J Alzheimers Dis. 2012; 27: 439-446
- Do behavioral disturbances predict falls among nursing home residents?.Aging Clin Exp Res. 2012; 24: 251-256
- Differences between moderate to severely cognitively impaired fallers versus nonfallers in nursing homes.Am J Alzheimers Dis Other Demen. 2018; 33: 247-252
- Relationship of neuropsychiatric symptoms with falls in Alzheimer’s disease–Does exercise modify the risk?.J Am Geriatr Soc. 2018; 66: 2377-2381
- Predicting falls from behavioral and psychological symptoms of dementia in older people residing in facilities.Geriatr Gerontol Int. 2018; 18: 1573-1577
- A new method of classifying prognostic comorbidity in longitudinal studies: Development and validation.J Chronic Dis. 1987; 40: 373-383
- Functional evaluation: The Barthel index.Md State Med J. 1965; 14: 61-65
- The 15D instrument of health-related quality of life: Properties and applications.Ann Med. 2001; 33: 328-336
- “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- A new clinical scale for the staging of dementia.Br J Psychiatry. 1982; 140: 566-572
- The Anatomical Therapeutic Chemical Classification System. ATC/DDD Index.(Available at:)
- The Neuropsychiatric Inventory: assessing psychopathology in dementia patients.Neurology. 1997; 48: S10-S16
- The efficacy of donepezil in the treatment of neuropsychiatric symptoms in Alzheimer disease.Neurology. 2004; 63: 214-219
- Risk assessment of wandering behavior in mild dementia.Int J Geriatr Psychiatry. 2016; 31: 367-374
- The prevalence of psychiatric symptoms and behavioural disturbances and the use of psychotropic drugs in Norwegian nursing homes.Int J Geriatr Psychiatry. 2007; 22: 843-849
- Increased risk for falling associated with subtle cognitive impairment: Secondary analysis of a randomized clinical trial.Dement Geriatr Cogn Disord. 2009; 27: 557-563
- Antipsychotic deprescription for older adults in long-term care: The HALT study.J Am Med Dir Assoc. 2018; 19: 592-600.e7
- The clinical course and interrelations of dementia related symptoms.Int Psychogeriatr. 2018; 30: 859-866
- Psychotropic medications and falls in nursing homes: A cross-sectional study.J Am Med Dir Assoc. 2013; 14: 213-217
- Psychotropic drugs and the risk of fall injuries, hospitalisations and mortality among older adults.Int J Geriatr Psychiatry. 2017; 32: 414-420
- Fall-risk-increasing drugs: A systematic review and meta-analysis: II.Psychotropics. J Am Med Dir Assoc. 2018; 19: 371.e11-371.e17
- Falls in older people: Epidemiology, risk factors and strategies for prevention.Age Ageing. 2006; 35: ii37-ii41
- Physical restraint and antipsychotic medication use among nursing home residents with dementia.J Am Med Dir Assoc. 2016; 17: 184.e9-184.e14
- Factors associated with the trend of physical and chemical restraint use among long-term care facility residents in Hong Kong: Data from an 11-year observational study.J Am Med Dir Assoc. 2017; 18: 1043-1048
Article info
Publication history
Published online: May 25, 2020
Footnotes
Funded by Suomen lääketieteen säätiö.
The authors declare no conflicts of interest.
Identification
Copyright
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
