Alarming rates of falls and fractures requiring hospitalisation in people with dementia

A new NIHR-funded research study has found alarming rates of falls and fractures requiring hospitalisation in people with dementia. The study suggests that women with dementia, and those with physical health problems, who live alone in deprived neighbourhoods and in problematic living conditions, are at a higher risk of having a fall leading to their hospitalisation.

The cohort study published today found that less important were symptoms of dementia such as memory loss or behaviour changes, cognition, ability to perform everyday tasks or medications prescribed.

In the largest ever study of its kind, the researchers followed more than 8,000 people with dementia (64% female) over an average of 2.5 years. They found that 31% (or 2,500 people) had a fall leading to hospitalisation, while almost one in five (18%) had a fracture.

Earlier smaller studies (with fewer than 300 people) have suggested that worse cognition and medication (particularly psychotropic medication) were key risk factors. 

The data indicate that vascular dementia, mixed dementia and dementia in other diseases are all associated with increased risk of falls compared to Alzheimer’s disease. 

Interestingly, people with dementia from ethnic minority groups, including Caribbean, African, and South Asian communities, had a decreased risk of falls.

The study was conducted using data from the NIHR Maudsley Biomedical Research Centre’s Case Register. The data were captured from the Clinical Record Interactive Search (CRIS) application, which enables an anonymised version of the South London and Maudsley NHS Foundation Trust’s electronic health record for research projects.

Study co-author, Dr Brendon Stubbs, post-doctoral research physiotherapist, Institute of Psychiatry, Psychology & Neuroscience, King's College London and Head of Physiotherapy, South London and Maudsley NHS Foundation Trust, said: ‘The results of our study are concerning.  Our research suggests that the risk of hospitalisation due to a fall or fractures in dementia is largely determined by environmental and socioeconomic factors and not poorer cognition or medication.’ 

‘Making environmental modifications such as putting in hand rails, raising toilet seats, are important interventions that may help reduce falls for people with dementia.  In addition, interventions that try to improve the physical health of people with dementia and improve balance may be important.  We must urgently find better ways to prevent people with dementia falling and sustaining fractures.’

Professor Robert Stewart, Professor of Psychiatric Epidemiology & Clinical Informatics, Institute of Psychiatry, Psychology & Neuroscience, at King’s College London, and an NIHR Senior Investigator and study co-author, said: ‘One of the most important issues in dementia care is the fact that people affected are often already having to manage other health conditions. The combination of these conditions can present substantial challenges. Using real-world information from routine healthcare has provided a valuable opportunity to highlight these important outcomes and try to help achieve better targeted services.’

Dr Christoph Mueller, NIHR Academic Clinical Lecturer in Old Age Psychiatry at King’s College London, study co-author, added: ‘Clearly falls and fractures often result in disruptive and expensive hospital admissions, as well as reducing people’s confidence in looking after themselves. Preventing falls requires input from multiple disciplines and won’t be achieved in dementia until there is better coordination across different health specialties and social care.’

The findings have been published today in JAMDA.  

Notes to Editors

The Clinical Records Interactive Search (CRIS) system was funded and developed by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London, and by a joint infrastructure grant from Guy’s and St Thomas’ Charity and the Maudsley Charity.

Dr Brendon Stubbs, Dr Christoph Mueller, Dr Gayan Perera, Professor Robert Stewart are part funded by the NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. Dr Brendon Stubbs is also supported, in part, by the NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South London, where he is part of a team investigating ways to help people with severe mental illness to improve their physical health.

Citation

Dr Brendon Stubbs et al, Predictors of falls and fractures leading to hospitalisation in people with dementia: a representative cohort study, JAMDA, https://doi.org/10.1016/j.jamda.2018.03.009

Contact

Alex Booth, Communications and Engagement Manager, NIHR Maudsley Biomedical Research Centre (BRC), at South London and Maudsley NHS Foundation Trust and King’s College London. alex.booth@kcl.ac.uk and 020 7848 0495.