Understanding risk of falls in people with cognitive impairment living in residential care.

ABSTRACT

OBJECTIVES: To better understand fall risk factors in older adults with cognitive impairment living in residential care. DESIGN: A prospective observational cohort study. SETTING: Residential care homes in South London, UK. PARTICIPANTS: Residents older than 60, with cognitive impairment who had a life expectancy of at least 6 months and were not bedbound or recently discharged from hospital. MEASUREMENTS Baseline assessments were undertaken in domains of demographics, medical history, medication use, behavior, affect, gait, balance, sensorimotor performance and neuropsychological function. Participants were followed for 6 months for falls using care home reporting systems. RESULTS: A total of 109 participants completed baseline assessment and had adequate falls follow-up. Fallers took more medications, were more likely to be taking antidepressants, had more functional impairment, poorer balance and gait, were more impulsive and anxious, exhibited more dementia-related behaviors, and performed worse on cognitive tests involving attention and orientation, memory, and fluency. Logistic regression analysis identified 4 significant and independent predictors of falls poor attention and orientation, increased postural sway with eyes closed, anxiety, and antidepressant use. The AUC for this model was 0.84 (95% CI 0.76-0.91). CONCLUSIONS: This study identified important risk factors for falls potentially amenable to intervention in older people with cognitive impairment living in residential care. This information may be useful in designing effective approaches to fall prevention in this high-risk population.