Risk factors associated with first hospitalised falls
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
See the following extended description for details about the data contained in this image.
For people living with dementia in the community, one of the risk factors most associated with experiencing first hospitalised falls was being dispensed nervous system-acting drugs. While for those living in residential aged care, being dispensed SSRIs (selective serotonin reuptake inhibitors, a common type of antidepressant medication) was one of the top risk factors most associated with experiencing first hospitalised falls.
‘Odds’ is the numerical expression for the likelihood of an event occurring. The odds of an event occurring is defined as the ratio of the probability that the event will occur over the probability that the event will not occur.
Here, the odds ratio represents the likelihood of someone experiencing a first hospitalised fall, given they have a particular risk factor.
- An odds ratio of 1 means that the presence of the risk factor does not affect the odds of experiencing a first hospitalised fall.
- An odds ratio of greater than 1 means that the presence of the risk factor is associated with higher odds (or higher likelihood) of experiencing a first hospitalised fall.
- An odds ratio of less than 1 means that the presence of the risk factor is associated with lower odds (or less likelihood) of the experiencing a first hospitalised fall.
Odds ratios can be found in Table S3. Adjusted odds ratios are shown in Figure 1 which represent the magnitude of the association between the risk factor and a first hospitalised fall while controlling for all other risk factors. The confidence interval is also presented which is a statistical term describing the range of values within which there is a 95% ‘confidence’ that the true value lies. Further information can be found in the technical notes.
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.
Fernando E, Fraser M, Hendriksen J, Kim CH, Muir-Hunter SW (2017) ‘Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review’, Physiotherapy Canada, 69(2), 161–170, doi:10.3138/ptc.2016-14.
Fong TG, Tulebaev SR and Inouye SK (2009) ‘Delirium in elderly adults: diagnosis, prevention and treatment’, Nature Reviews Neurology, 5, 210–220, doi:10.1038/nrneurol.2009.24.
Inouye SK, Westendorp RG, & Saczynski JS (2014) ‘Delirium in elderly people’, Lancet (London, England), 383(9920), 911–922, doi:10.1016/S0140-6736(13)60688-1.
Yang ZC, Lin H, Jiang GH, Chu YH, Gao JH, Tong ZJ, Wang Z (2023) ‘Frailty Is a Risk Factor for Falls in the Older Adults: A Systematic Review and Meta-Analysis’, The Journal of nutrition, health and aging, 27 (6), 487–495, doi:10.1007/s12603-023-1935-8.