In a study that included 2 million older adults who sustained a traumatic injury, 10.6 percent of patients who experienced a fall were subsequently diagnosed with Alzheimer’s disease and related dementias. Falls also increased the risk of a future dementia diagnosis by 21 percent, according to researchers at Brigham and Women’s Hospital.

Results are published in JAMA Network Open. 

The researchers analyzed Medicare Fee-for-Service data from 2014 to 2015, which included 2,453,655 older adult patients who experienced a traumatic injury, as well as follow-up data for one year after the initial fall. The researchers found that half of the patients in the study received their injuries in a fall, and that these patients were significantly likelier to be diagnosed with dementia within one year after their injuries. 

“The relationship between falls and dementia appears to be a two-way street,” said senior author Molly Jarman, assistant professor in the Department of Surgery and deputy director of the Center for Surgery and Public Health at the Brigham. “Cognitive decline can increase the likelihood of falls, but trauma from those falls may also accelerate dementia’s progression and make a diagnosis more likely down the line. Thus, falls may be able to act as precursor events that can help us identify people who need further cognitive screening.”  

More than 14 million older adults, or one in four, report falls each year, according to the Centers for Disease Control and Prevention, and falls are also the leading cause of injury in older adults. These injuries can have long-lasting or permanent consequences, including declines in functional status, overall loss of independence, or risk of death.

To improve the early identification of dementia, the researchers recommend implementing cognitive screenings in older adults who experience an injurious fall that results in either an emergency department visit or admission to the hospital. 

The research suggests that completing cognitive screenings in older patients after a fall could help detect dementia sooner. However, this is easier said than done, particularly in light of disparities in access to primary care among older adults. 

“One of the biggest challenges we face is the lack of ownership in the process of follow-up screening for cognitive impairment, because there may not be adequate time for these screenings in an emergency department or trauma center setting,” said Alexander J. Ordoobadi, the first author of the study and a resident physician in the Department of Surgery at the Brigham. 

“Ideally, after an injury, older adults should receive follow-up care with a primary care provider or geriatrician who can monitor their cognitive health and long-term functional recovery after the injury, but many older adults don’t have a regular primary care provider and lack access to a geriatrician,” he added. 

The study results additionally highlight the need for more clinicians who can provide care for older adults, including cognitive assessments after fall injuries. 

“Our study highlights the opportunity to intervene early and the need for more clinicians who can provide comprehensive care for older adults,” said Jarman. “If we can establish that falls serve as early indicators of dementia, we could identify other precursors and early events that we could intervene on, which would significantly improve our approach to managing cognitive health in older adults.” 

 
This study was supported by the National Institute on Aging and the National Institutes of Health under award number K01AG065414. 

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