Research reveals a surprising connection between falls and dementia, suggesting falls may be an early warning sign of cognitive decline.
Older individuals experiencing injurious falls face a higher likelihood of developing dementia within a year, compared to those of the same age with other types of physical injuries, as indicated by a large study published in September.
While a direct causal link between falls and dementia remains unconfirmed, the research suggests that falls may serve as an early sign of cognitive decline leading to Alzheimer’s disease and other dementias.
“It is possible that falls serve as a sentinel event that marks a future risk for dementia,” stated physician Alexander Ordoobadi from Brigham and Women’s Hospital and colleagues in their paper.
The study’s findings highlight the potential benefits of cognitive screening for older adults following an injurious fall.
Falls represent the most common cause of injury among adults over 65, with nearly one-third of this age group sustaining injuries from a fall each year.
“One of the biggest challenges we face is the lack of ownership in the process of follow-up screening for cognitive impairment,” stated Ordoobadi, emphasizing the limitations of conducting such screenings in emergency departments or trauma centers.
Alexander Ordoobadi
Each year, nearly 10 million new cases of dementia are diagnosed, increasing the likelihood of facing cognitive decline within families and communities. Despite decades of research, no cure has been found, making early detection essential for implementing strategies that may slow progression.
A team led by Ordoobadi examined a year’s worth of US Medicare claims from individuals over 65 who sought medical care for traumatic injuries in 2014 or 2015. After excluding those with pre-existing dementia diagnoses, comparisons were made between patients who had fallen and those with other types of physical injuries.
The findings revealed that sustaining an injury from a fall was associated with a more than 20 percent higher likelihood of developing dementia within a year, compared to other forms of physical trauma.
“The relationship between falls and dementia appears to be a two-way street,” stated injury epidemiologist Molly Jarman from Brigham and Women’s Hospital.
“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.”
Molly Jarman
While this study establishes a pattern between falls and dementia, a direct causal link remains uncertain. Due to the absence of prescription data, potential medication effects could not be accounted for, possibly influencing the findings.
Previous research has demonstrated that individuals with cognitive impairments face a heightened risk of falling, further supporting the idea that falls may serve as an early warning sign of neurodegenerative conditions.
Additional potential indicators of cognitive decline leading to dementia include reduced visual sensitivity, poor mental health, and increased frequency of nightmares. However, cognitive impairments may also signal other treatable conditions, making comprehensive assessments essential.
“Our study highlights the opportunity to intervene early.”
Molly 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.”
Molly Jarman
https://www.doi.org/10.1001/jamanetworkopen.2024.36606
Key Points
Question What is the risk of developing dementia after an older adult experiences a fall compared with other mechanisms of injury?
Findings In this cohort study involving 2 453 655 older adults who sustained an injury, 10.6% of patients who experienced a fall were subsequently diagnosed with dementia within 1 year. Compared with other injury mechanisms, falling was associated with a 21% increased risk for future dementia diagnosis after controlling for potential confounders.
Meaning These results suggest that cognitive screening should be implemented for older adults who have experienced a fall that results in an emergency department visit or hospital admission.