Falls may increase risk by 21% in older adults

• Older adults who have experienced a traumatic injury as a result of falling are 21 percent more likely to later receive a diagnosis of Alzheimer’s disease or another related dementia.
• A new study examined data from more than 2 million older adults who had sustained a traumatic injury; more than 10 percent of them later received a diagnosis of some form of dementia.
• Experts say pinpointing the direct association with falls and dementia is difficult, but suggest that older adults who have been hospitalized as a result of a fall should undergo cognitive testing.

Older adults who have experienced a traumatic injury as a result of falling are more than 20 percent likely to later receive a diagnosis of Alzheimer’s disease or another related dementia, according to a new study published in JAMA Network Open.

The retrospective cohort study, conducted by researchers at Brigham and Women’s Hospital, a founding member of the Mass General Brigham healthcare system, examined data from more than 2 million older adults who had sustained a traumatic injury. More than 10 percent of them later received a diagnosis of some form of dementia in the year after their fall.

From the study cohort, the average age of patients who experienced a fall was 78; more women fell than men. In general, adults over 65 who sustain traumatic injury after a fall are more subject to already developing cognitive decline.

Some types of dementia, such as Alzheimer’s disease, result from the progressive death of brain cells and neurons. It develops and worsens over time. But head injuries can contribute to dementia through the damage to cells directly. Some types of traumatic brain injury — particularly if repetitive, which can happen in some sports — may increase the risk of certain types of dementia later in life.

A loss of motor skills is part of the progression of Alzheimer’s disease in general. People may have difficulty with their balance, trip over, or spill things more often, or they may have difficulty orienting clothing to their body when getting dressed.

In a press release, senior author Molly Jarman, PhD, MPH, assistant professor in the Department of Surgery and deputy director of the Center for Surgery and Public Health at Brigham, said the connection between falling and the development of any cognitive disease can be a “two-way street.”

However, Alexander Ordoobadi, MD, a resident physician in the Department of Surgery at Brigham and Women’s Hospital and first author of the study, told Medical News Today that the study’s results couldn’t provide a direct association between falls and dementia.

“Some of the patients may have had some degree of mild cognitive impairment at the time of the fall and subsequently progressed to develop dementia over the course of the year after the fall. Other patients may have had dementia at the time of the fall that had gone undiagnosed prior to the fall and was formally diagnosed in the aftermath of the fall due to increased exposure to the healthcare system,” Ordoobadi said.

“We think that it is less likely that the trauma from the fall itself is leading to dementia, since the risk of developing dementia was lower after other types of injury. Either way, the results of our study highlight that all older adults who are hospitalized because of a fall should undergo cognitive screening to aid in the early diagnosis of dementia,” he said.

Clifford Segil, DO, neurologist at Providence Saint John’s Health Center in Santa Monica, CA, who was not involved in the study, gave MNT a similar view.

“It is challenging to assign how a ground-level fall could worsen dementia, which is a complicated disease process unless the fall caused bruising in an older person’s brain in the form of a subdural hematoma or another type of brain bruise,” Segil said., but added that certain types of dementia such as lewy body dementia or Parkinson’s dementia may increase the risk of falls.

Ordoobadi said that any decline in cognition can affect motor skills, and mild declines are precursor conditions to more serious forms of dementia.

“Walking requires substantial cognitive capacity to coordinate motor movements, maintain balance, and safely navigate the environment. Impairments in motor domains involving gait often precedes the formal diagnosis of dementia and would place patients at risk for falling,” Ordoobadi said.

“We think that many of the patients who experienced a fall and subsequently were diagnosed with dementia in the year after the fall may have had mild cognitive impairment—a precursor condition to dementia—at the time of the fall. This would place patients at risk both for falling and for developing dementia.”
— Alexander Ordoobadi, MD

Segil said that a number of conditions associated with aging can result in falls, which, again, can be linked to the development of dementia but can also be a sign of it.

“Older patients often have medical comorbidities making them fall risks which are extremely varied and common. Heart disease can make some pass out or having a syncopal episode. Diabetes can cause neuropathy, causing people to be unsteady and fall. Parkinson’s Disease may cause unsteadiness due to a tremor or stiffness,” Segil explained.

“Only some of these can result in increased dementia. Movement disorder patients who fall may be at risk for Lewy Body Dementia. Stroke patients who fall may be at risk for vascular dementia or multi-infarct dementia,” he said.

Segil added that he would be “in support of advising patients with ground-level falls to obtain a simple outpatient cognitive screening with something like a mini-mental status exam as the data is convincing that patients with frequent falls are at a point in their lives when this screening would be valuable.”