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Meta-Analysis
. 2024 Nov 28;53(12):afae270.
doi: 10.1093/ageing/afae270.

The association between delirium and falls in older adults in the community: a systematic review and meta-analysis

Charlotte Eost-Telling  1   2   3 , Lucy McNally  4   5 , Yang Yang  2   3 , Chunhu Shi  1   2   3 , Gill Norman  6   7 , Saima Ahmed  1   2   3 , Brenda Poku  8 , Annemarie Money  1   2   3 , Helen Hawley-Hague  2   3 , Chris J Todd  1   2   3   9 , Susan Deborah Shenkin  10   11 , Emma R L C Vardy  1   3   12
Affiliations
Meta-Analysis

The association between delirium and falls in older adults in the community: a systematic review and meta-analysis

Charlotte Eost-Telling et al. Age Ageing. .

Abstract

Objective: Systematically review and critically appraise the evidence for the association between delirium and falls in community-dwelling adults aged ≥60 years.

Methods: We searched EMBASE, MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Evidence-Based Medicine Reviews databases in April 2023. Standard methods were used to screen, extract data, assess risk of bias (using Newcastle-Ottawa scale), provide a narrative synthesis and, where appropriate, conduct meta-analysis.

Results: We included 8 studies, with at least 3505 unique participants. Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (risk ratio 6.66; 95% confidence interval (CI) 2.16-20.53), but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled odds ratio 2.01; 95% CI 1.52-2.66); one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns.

Conclusions: We found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship and establish how and why this operates bidirectionally. Studies must consider confounding factors such as dementia, frailty and comorbidity in their design, to identify potential modifying factors involved. Clinicians should be aware of the potential relationship between these common presentations.

Keywords: community; delirium; falls; older adults; older people; systematic review.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
PRISMA flowchart of study selection process.
Figure 2
Figure 2
Forest plot of the association between prior delirium and number of falls.
Figure 3
Figure 3
Forest plot of the association between prior falls and delirium.
See this image and copyright information in PMC

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