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. 2024 Sep 3;7(9):e2436606.
doi: 10.1001/jamanetworkopen.2024.36606.

Risk of Dementia Diagnosis After Injurious Falls in Older Adults

Alexander J Ordoobadi  1   2   3 , Hiba Dhanani  2   4 , Samir R Tulebaev  5 , Ali Salim  1   2   3 , Zara Cooper  1   2 , Molly P Jarman  1   2   3
Affiliations

Risk of Dementia Diagnosis After Injurious Falls in Older Adults

Alexander J Ordoobadi et al. JAMA Netw Open. .

Abstract

Importance: Emerging evidence suggests that mild cognitive impairment, which is a precursor to Alzheimer disease and related dementias (ADRD), places older adults at increased risk for falls. However, the risk that an older adult develops dementia after experiencing a fall is unknown.

Objective: To determine the risk of new ADRD diagnosis after a fall in older adults.

Design, setting, and participants: This retrospective cohort study examined Medicare Fee-for-Service data from 2014 to 2015, with follow-up data available for at least 1 year after the index encounter. Participants included adults aged 66 years and older who experienced a traumatic injury that resulted in an emergency department (ED) or inpatient encounter and did not have a preexisting diagnosis of dementia. Data analysis was performed from August 2023 to July 2024.

Exposures: Experiencing a fall compared with other mechanisms of injury, defined by International Classification of Diseases, Ninth Revision (ICD-9) and ICD-10 external cause of injury codes.

Main outcomes and measures: The hazard of new ADRD diagnosis within 1 year of a fall, assessed by performing a Cox multivariable competing risk model that controlled for potential confounders while accounting for the competing risk of death.

Results: The study included 2 453 655 older adult patients who experienced a traumatic injury; 1 522 656 (62.1%) were female; 124 396 (5.1%) were Black and 2 232 102 (91.0%) were White; and the mean (SD) age was 78.1 (8.1) years. The mechanism of injury was a fall in 1 228 847 incidents (50.1%). ADRD was more frequently diagnosed within 1 year of a fall compared with other injury mechanisms (10.6% [129 910 of 1 228 847] vs 6.1% [74 799 of 1 224 808]; P < .001). The unadjusted hazard ratio (HR) of incident dementia diagnosis after a fall was 1.63 (95% CI, 1.61-1.64; P < .001). On multivariable Cox competing risk analysis, falling was independently associated with an increased risk of dementia diagnosis among older adults (HR, 1.21 [95% CI, 1.20-1.21]; P < .001) after controlling for patient demographics, medical comorbidities, and injury characteristics, while accounting for the competing risk of death. Among the subset of older adults without a recent skilled nursing facility admission, the HR was 1.27 (95% CI, 1.26-1.28; P < .001).

Conclusions and relevance: In this cohort study, new ADRD diagnoses were more common after falls compared with other mechanisms of injury, with 10.6% of older adults being diagnosed with ADRD in the first year after a fall. To improve the early identification of ADRD, this study's findings suggest support for the implementation of cognitive screening in older adults who experience an injurious fall that results in an ED visit or hospital admission.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Cooper reported grants from the National Institutes of Health (3R01AG070252, R01AG067507, 1R01NR020439-01, 1R38AG085422-01), Clin-STAR Coordinating Center, and John A. Hartford Foundation; honoraria for visiting professorships at Dell Medical School, University of Alabama Birmingham, University of Colorado, University of North Carolina, University of San Francisco, Johns Hopkins Hospital, Atrium Health, National Medical Association, University of Chicago, New York University, Indiana University, University of Utah, and Yale University; support for attending meetings from American College of Surgeons Annual Clinical Congress, American Association for the Surgery of Trauma Annual Meeting, American College of Surgeons Quality and Safety Conference, Academic Surgical Congress, Clin-STAR Perioperative Summit, and American Surgical Association Annual Meeting; and administrative support from Associate Editor for Annals of Surgery; Chair of Palliative Care Committee, American Association for the Surgery of Trauma; Board of Advisors, Northwestern University School of Communications; and Board of Trustees, Shady Hill School, Mass General Brigham, Brigham and Women's Hospital. Dr Jarman reported grants from the National Institute on Minority Health and Health Disparities and grants from Department of Defense outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Kaplan-Meier Curves for Incident Dementia Diagnosis in First Year After a Fall Compared With Other Mechanisms of Injury
See this image and copyright information in PMC

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