First hospitalised falls among people living with dementia: risk factors and outcomes

The risk factors most associated with first hospitalised falls were different for people living with dementia in the community compared with those living in residential aged care at the time of their fall. In the community, vestibular, balance or gait issues increased the likelihood of experiencing a fall (odds ratio=1.5) while in residential aged care agitation increased the likelihood of experiencing a fall (odds ratio=1.4) (Figure 1). The top 5 risk factors by place of residence are shown in Figure 1 and a full list of all assessed risk factors and their association with falls can be found in Tables S2 and S3.

Figure 1: Top 5 risk factors most associated with first hospitalised falls for people living with dementia in the community and those living in residential aged care

The risk factors most associated with falls for each place of residence may be influenced by the environmental context itself. For example, within the community, vestibular, balance or gait issues increased the likelihood of experiencing a first hospitalised fall. However, this may not be a significant risk factor for falls among people living in residential aged care as the aged care environment mitigates the risk through modifications such as observation and mobility assistance.

Other risk factors, such as agitation, may be more prevalent in the residential aged care population due to people living with dementia in aged care potentially having more severe symptoms of dementia and a heightened response to changes in their physical environment.

While many of the risk factors associated with falls are chronic conditions (Table S3), a history of delirium, an acute and often preventable condition (Inouye et al. 2014), is one of the risk factors most associated with falls for people living with dementia in residential aged care. Delirium can initiate or be part of a cascade of events and medical complications which contribute to functional and cognitive decline (Fong et al. 2009). This highlights the importance of early detection and management of delirium among people living with dementia.

These results therefore provide some insight into which risk factors may be more readily managed through residential aged care settings, and those which may persist or emerge in aged care cohorts as a function of age and advanced disease, and thus may require interventions which seek to minimise likelihood of injury resulting from a fall if the fall itself cannot be prevented.

Dementia severity and frailty are also important risk factors for falls (Fernando et al. 2017; Yang et al. 2023) that could not be accounted for in this study due to data limitations.