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Influence of cognitive impairment on fall risk among elderly nursing home residents

Published online by Cambridge University Press:  08 September 2016

M. Seijo-Martinez ,
J. M. Cancela ,
C. Ayán ,
S. Varela  and
H. Vila
M. Seijo-Martinez
Affiliation:
SERGAS (Servicio Gallego de Salud - Galician Health Service), Spain
J. M. Cancela
Affiliation:
Faculty of Education and Sport Sciences, University of Vigo, Galician, Spain
C. Ayán*
Affiliation:
Faculty of Education and Sport Sciences, University of Vigo, Galician, Spain
S. Varela
Affiliation:
Faculty of Education and Sport Sciences, University of Vigo, Galician, Spain
H. Vila
Affiliation:
Faculty of Education and Sport Sciences, University of Vigo, Galician, Spain
*
Correspondence should be addressed to: Dr. Carlos Ayán, Faculty of Education Sciences and Sport, University of Vigo, Campus A Xunqueira s/n, 36005 Pontevedra, Spain. Phone: +0034986802056. Email: ghi22@uvigo.es.
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Abstract

Background:

Information relating the severity of cognitive decline to the fall risk in institutionalized older adults is still scarce. This study aims to identify potential fall risk factors (medications, behavior, motor function, and neuropsychological disturbances) depending on the severity of cognitive impairment in nursing home residents.

Methods:

A total of 1,167 nursing home residents (mean age 81.44 ± 8.26 years; 66.4% women) participated in the study. According to the MEC, (the Spanish version of the Mini-Mental State Examination) three levels of cognitive impairment were established: mild (20–24) “MCI”, moderate (14–19) “MOCI”, and severe (≤14) “SCI”. Scores above 24 points indicated the absence cognitive impairment (NCI). Information regarding fall history and fall risk during the previous year was collected using standardized questionnaires and tests.

Results:

Sixty falls (34%) were registered among NCI participants and 417 (43%) among people with cognitive impairment (MCI: 35%; MOCI: 40%; SCI: 50%). A different fall risk model was observed for MCI, MOCI, SCI, and NCI patients. The results imply that the higher the level of cognitive impairment, the greater the number of falls (F1,481 = 113.852; Sig = 0.015), although the level of significance was not maintained when MOCI and SCI participants were compared. Depression, neuropsychiatric disturbances, autonomy constraints in daily life activity performance, and low functional mobility were factors closely associated with fall risk.

Conclusion:

This study provides evidence indicating that fall risk factors do not hold a direct correlation with the level of cognitive impairment among elderly nursing home care residents.

Keywords

fall risk factorscognitive impairmentnursing home residentselderly
Type
Research Article
Information
International Psychogeriatrics , Volume 28 , Issue 12 , December 2016 , pp. 1975 - 1987
Copyright
Copyright © International Psychogeriatric Association 2016 

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References

Allan, L. M., Ballard, C. G., Rowan, E. N. and Kenny, R. A. (2009). Incidence and prediction of falls in dementia: a prospective study in older people. PloS One, 4, e5521. doi: 10.1371/journal.pone.0005521.CrossRefGoogle ScholarPubMed
Álvarez, M. et al. (1992). Capacidad funcional de pacientes mayores de 65 años, según el índice de Katz. Fiabilidad del método. Atención Primaria, 10, 812–815.Google Scholar
Amar, K., Stack, E., Fitton, C., Ashburn, A. and Roberts, H. C. (2015). Fall frequency, predicting falls and participating in falls research: similarities among people with Parkinson's disease with and without cognitive impairment. Parkinsonism & Related Disorders, 21, 55–60. doi: 10.1016/j.parkreldis.2014.11.001.CrossRefGoogle ScholarPubMed
Ayan, C., Cancela, J. M., Gutiérrez, A. and Prieto, I. (2013). Influence of the cognitive impairment level on the performance of the timed “up & go” test (TUG) in elderly institutionalized people. Archives of Gerontology and Geriatrics, 56, 44–49.Google Scholar
Boada, M., Tárraga, L., Modinos, G., López, O. L. and Cummings, J. L. (2005). Neuropsychiatric inventory-nursing home version (NPI-NH): Spanish validation. Neurología, 20, 665–673.Google 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.Google Scholar
Cabanero-Martínez, M. J., Cabrero-García, J., Richart-Martínez, M. and Muñoz-Mendoza, C. L. (2009). The Spanish versions of the barthel index (BI) and the katz index (KI) of activities of daily living (ADL): a structured review. Archives of Gerontology and Geriatrics, 49, e77–e84. doi: 10.1016/j.archger.2008.09.006. Google Scholar
Capezuti, E., Evans, L., Strumpf, N. and Maislin, G. (1996). Physical restraint use and falls in nursing home residents. Journal of the American Geriatrics Society, 44, 627–633.CrossRefGoogle ScholarPubMed
Chen, T. Y., Peronto, C. L. and Edwards, J. D. (2012). Cognitive function as a prospective predictor of falls. The Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 67, 720–728. doi: 10.1093/geronb/gbs052.CrossRefGoogle ScholarPubMed
Cummings, J. L., Tribanek, M. and Hoerr, R. (2014). Sensitivity to change of composite and frequency scores of the neuropsychiatric inventory in mild cognitive impairment. International Psychogeriatrics, 26, 1871–1874. doi: 10.1017/S1041610214001185. Epub 2014 Jul 3.CrossRefGoogle ScholarPubMed
Davis, J. C., Robertson, M. C., Ashe, M. C., Liu-Ambrose, T., Khan, K. M. and Marra, C. A. (2010). International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporosis International, 21, 1295–1306. doi: 10.1007/s00198-009-1162-0 Google Scholar
de Jong, M. R., Van der Elst, M. and Hartholt, K. A. (2013). Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Therapeutic Advances in Drug Safety, 4, 147–154. doi: 10.1177/2042098613486829.CrossRefGoogle ScholarPubMed
Delbaere, K. et al. (2012). Mild cognitive impairment as a predictor of falls in community-dwelling older people. The American Journal of Geriatric Psychiatry, 20, 845–853. doi: 10.1097/JGP.0b013e31824afbc4.CrossRefGoogle ScholarPubMed
DeSure, A. R., Peterson, K., Gianan, F. V. and Pang, L. (2013). An exercise program to prevent falls in institutionalized elderly with cognitive deficits: a crossover pilot study. Hawai'i Journal of Medicine & Public Health, 72, 391–395.Google Scholar
Gleason, C. E., Gangnon, R. E., Fischer, B. L. and Mahoney, J. E. (2009). Increased risk for falling associated with subtle cognitive impairment: secondary analysis of a randomized clinical trial. Dementia and Geriatric Cognitive Disorders, 27, 557–563. doi: 10.1159/000228257.CrossRefGoogle ScholarPubMed
González-Palau, F. et al. (2013). Clinical utility of the hopkins verbal test-revised for detecting Alzheimer's disease and mild cognitive impairment in Spanish population. Archives of clinical Neuropsychology: The Official Journal of the National Academy of Neuropsychologists, 28, 245–253. doi: 10.1093/arclin/act004. Epub 2013 Feb 5.Google Scholar
Grundman, M. et al. (2004). Mild cognitive impairment can be distinguished from Alzheimer disease and normal aging for clinical trials. Archives of Neurology, 61, 59–66.CrossRefGoogle ScholarPubMed
Guo, J. L., Tsai, Y. Y., Liao, J. Y., Tu, H. M. and Huang, C. M. (2014). Interventions to reduce the number of falls among older adults with/without cognitive impairment: an exploratory meta-analysis. International Journal of Geriatric Psychiatry, 29, 661–669. doi: 10.1002/gps.4056.Google Scholar
Härlein, J., Dassen, T., Halfens, R. J. and Heinze, C. (2009). Fall risk factors in older people with dementia or cognitive impairment: a systematic review. Journal of Advanced Nursing, 65, 922–933. doi: 10.1111/j.1365-2648.2008.04950.x.CrossRefGoogle ScholarPubMed
Hartikainen, S., Lönnroos, E. and Louhivuori, K. (2007). Medication as a risk factor for falls: critical systematic review. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 62, 1172–1181.Google Scholar
Kenny, R. A. et al. (2011). Summary of the updated American geriatrics society/British geriatrics society clinical practice guideline for prevention of falls in older persons. Journal of the American Geriatrics Society, 59, 148–157. doi: 10.1111/j.1532-5415.2010.03234.x.Google Scholar
Klein, D. et al. (2013). Blood pressure and falls in community-dwelling people aged 60 years and older in the VHM&PP cohort. BMC Geriatrics, 13, 50. doi: 10.1186/1471-2318-13-50.CrossRefGoogle ScholarPubMed
LaRue, A., Romero, L. J., Ortiz, I. E., Liang, H. C. and Lindeman, R. D. (1999). Neuropsychological performance of hispanic and non-hispanic older adults: an epidemiologic survey. The Clinical Neuropsychologist, 13, 474–486.CrossRefGoogle Scholar
Lobo, A. et al. (1999). Revalidation and standardization of the cognition mini-exam (first Spanish version of the mini-mental status examination) in the general geriatric population. Medicina Clínica, 112, 767–74.Google Scholar
Lobo, A., Ezquerra, J., Gómez, F., Sala, J., and Seva, A. (1975). El Mini-Examen cognoscitivo: un test sencillo, práctico, para detectar alteraciones intelectivas en pacientes médicos. Actas Luso-Españolas de Neurología, Psiquiatría y Ciencias Afines, 3, 189–202.Google Scholar
Loewenstein, D. A. et al. (2009). Severity of medial temporal atrophy and amnestic mild cognitive impairment: selecting type and number of memory tests. The American Journal of Geriatric Psychiatry: Official Journal of the American Association for Geriatric, 17, 1050–1058.Google Scholar
Martin, K. L. et al. (2013). Cognitive function modifies the effect of physiological function on the risk of multiple falls—a population-based study. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 68, 1091–1097. doi: 10.1093/gerona/glt010.CrossRefGoogle ScholarPubMed
Mirelman, A. et al. (2012). Executive function and falls in older adults: new findings from a five-year prospective study link fall risk to cognition. PLoSOne. 7, e40297. doi: 10.1371/journal.pone.0040297.Google Scholar
Muir, S. W., Gopaul, K. and Odasso, M. M. (2012). The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis. Age and Ageing, 41, 299–308. doi: 10.1093/ageing/afs012.Google Scholar
Nazir, A., Mueller, C., Perkins, A. and Arling, G. (2012). Falls and nursing home residents with cognitive impairment: new insights into quality measures and interventions. Journal of the American Medical Directors’ Association, 13, 819.e1–6. doi: 10.1016/j.jamda.2012.07.018.Google ScholarPubMed
Nordin, E., Rosendahl, E. and Lundin-Olsson, L. (2006). Timed “up & go” test: reliability in older people dependent in activities of daily living–focus on cognitive state. Physical Therapy, 86, 646–655.Google Scholar
Peláez, V. C., Ausín, L., Mambrilla, M. R., Gonzalez-Sagrado, M. and Pérez Castrillón, J. L. (2014). Prospective observational study to evaluate risk factors for falls in institutionalized elderly people: the role of cystatin C. Aging Clinical and Experimental Research, 27, 419–424. doi: 10.1007/s40520-014-0304-1.Google Scholar
Podsiadlo, D. and Richardson, S. (1991). The timed “up & go”: a test of basic functional mobility for frail elderly persons. Journal of the American Geriatrics Society, 39, 142–148.Google Scholar
Pujol, J., De Azpiazu, P., Salamero, M. and Cuevas, R. (2001). Depressive symptoms in dementia. The cornell scale: validation of the Spanish version. Revista de Neurologia, 33, 397–398.Google Scholar
Ramirez, D., Wood, R. C., Becho, J., Owings, K., Markides, K. and Espino, D. V. (2010). Mini-mental state exam domains predict falls in an elderly population: follow-up from the hispanic established populations for epidemiologic studies of the elderly (H-EPESE) study. Ethnicity & Disease, 20, 48–52.Google Scholar
Ramos-Nino, M., MacLean, C. and Littenberg, B. (2007). Association between cancer prevalence and use of thiazolidinediones: results from the vermont diabetes information system. BMC Medicine, 5, 17. doi: 10.1186/1741-7015-5-17.Google Scholar
Rodrigues, I. G., Fraga, G. P. and Barros, M. B. A. (2014). Falls among the elderly: risk factors in a population-based study. Revista Brasileira de Epidemiologia, 17, 705–718. doi 10.1590/1809-4503201400030011.Google Scholar
Ruopp, M. D., Perkins, N. J., Whitcomb, B. W. and Schisterman, E. F. (2008). Youden index and optimal cut-point estimated from observations affected by a lower limit of detection. Biometrical Journal, 50, 419–430.Google Scholar
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. doi: http://dx.doi.org/10.1136/bmj.326.7380.73.Google Scholar
Smith, A. (2002). Symbol Digit Modalities Test: Manual.. Madrid, Spain: TEA Ediciones S.A. Google Scholar
Sylliaas, H., Selbæk, G. and Bergland, A. (2012). Do behavioral disturbances predict falls among nursing home residents?. Aging Clinical and Experimental Research, 24, 251–256.Google Scholar
Taylor, M. E., Delbaere, K., Lord, S. R., Mikolaizak, A. S., Brodaty, H. and Close, J. C. (2014). Neuropsychological, physical, and functional mobility measures associated with falls in cognitively impaired older adults. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences, 69, 987–995. doi: 10.1093/gerona/glt166.CrossRefGoogle ScholarPubMed
Taylor, M. E., Delbaere, K., Lord, S. R., Mikolaizak, A. S. and Close, J. C. (2013). Physical impairments in cognitively impaired older people: implications for risk of falls. International Psychogeriatrics, 25, 148–156. doi: 10.1017/S1041610212001184.Google Scholar
Towsley, G., Neradilek, M. B., Snow, A. L. and Ersek, M. (2012). Evaluating the cornell scale for depression in dementia as a proxy measure in nursing home residents with and without dementia. Aging & Ment Health, 16, 892–901. doi: 10.1080/13607863.2012.667785. Epub 2012 Apr 10.Google Scholar
Ungar, A. et al. (2013). Fall prevention in the elderly. Clinical cases in Mineral and Bonemetabolism. 10, 91–95.Google Scholar
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.Google Scholar
Van Schoor, N. M., Smit, J. H., Pluijm, S. M., Jonker, C. and Lips, P. (2002). Different cognitive functions in relation to falls among older persons: immediate memory as an independent risk factor for falls. Journal of Clinical Epidemiology,55, 855–862.CrossRefGoogle ScholarPubMed
Vassallo, M., Mallela, S. K., Williams, A., Kwan, J., Allen, S. and Sharma, J. C. (2009). Fall risk factors in elderly patients with cognitive impairment on rehabilitation wards. Geriatrics & Gerontology International, 9, 41–46. doi: 10.1111/j.1447-0594.2008.00506.x.Google Scholar
Voyer, P., Verreault, R., Mengue, P. and Azizah, G. (2007). Prevalence of falls with minor and major injuries and their associated factors among older adults in long-term care facilities. International Journal of Older People Nursing, 2, 119–130. doi: 10.1111/j.1748-3743.2007.00070.x.CrossRefGoogle ScholarPubMed
Whitney, J., Close, J. C., Jackson, S. H. and Lord, S. R. (2012). Understanding risk of falls in people with cognitive impairment living in residential care. Journal of the American Medical Directors’ Association, 13, 535–540. doi: 10.1016/j.jamda.2012.03.009.Google Scholar
Winter, H., Watt, K. and Peel, N. M. (2013). Falls prevention interventions for community-dwelling older persons with cognitive impairment: a systematic review. International Psychogeriatrics, 25, 215–227. doi: 10.1017/S1041610212001573.Google Scholar
Vidán Astiz, M. T. et al. (1993). WHO questionnaire for the study of falls in the elderly. Revista Española de Geriatría yGgerontología, 28, 41–48.Google Scholar