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

Entry to residential aged care following a first hospitalised fall 

Across all risk factor profiles of people living with dementia in the community, it was more common for those who had a first hospitalised fall to enter residential aged care within one year compared with those who did not fall (Figure 5, Table S11). This is consistent with the Australian Institute of Health and Welfare (AIHW) report Transitions to residential aged care after hospital for people living with dementia, which showed that people living with dementia often moved to residential aged care following a hospitalisation (AIHW 2023), and previous research which showed that among people experiencing injury-related hospitalisations, people living with dementia were more likely to enter residential aged care (Mitchell et al. 2017).

Community-based interventions and services for people living with dementia have been shown to be effective in delaying or avoiding admission to residential aged care (Luker et al. 2019). Specific interventions for people living in the community aimed at reducing the risk of falls include group and home-based exercise programs, and home safety assessments and modifications (Gillespie et al. 2012).

Mortality following a first hospitalised fall among people living with dementia in the community

The proportion of people who died within 12 months after a first hospitalised fall was highest among people living with dementia and multiple other health conditions (profile 5, 31%). However, mortality was also high in this profile for those with no fall (27%, Figure 5). This indicates that people in this multimorbidity profile were more likely to experience severe outcomes, even without being hospitalised for a fall.

People with generally low risk factors (profile 1) who had a first fall were 2.8 times more likely to die within one year compared with those who did not fall (Figure 5, Table S12). This was the largest increase seen across risk factor profiles and merits further investigation. This may indicate that people with lower risk factors would benefit from increased support following a fall. A similar, but less pronounced, pattern was also observed for people with polypharmacy and cardiovascular disease (profile 3) and people with diabetes and polypharmacy (profile 4).

These findings reflect trends shown more broadly in previous studies in which both falls and dementia individually increase mortality risk (Harvey et al. 2016; Sylliaas et al. 2009), and additionally demonstrates the increased mortality risk associated with falls in older people living with dementia.

Figure 5: Entry to residential aged care and mortality following first fall hospitalisations among people living with dementia in the community, by risk factor profile, age and sex

Further details on characteristics of fall hospitalisations and outcomes for people living with dementia in the community can be found in the supplementary tables, including the proportion of first falls that occurred in hospital (Table S6), length of stay of fall hospitalisation (Table S7), and whether the injuries were recorded as a principal or additional diagnosis (Table S8).