Yaşlı popülasyondaki düşmeler, yaşlı yetişkinler arasında her yıl meydana gelen milyonlarca yaralanma ile halk sağlığı için artan bir endişe kaynağıdır. Demans ile yaşayanların düşme riski iki kat ve düşme nedeniyle ciddi yaralanma riski üç kat daha fazladır. Düşmeyle ilgili küçük yaralanmalar bile demansı olan yaşlı yetişkinler için hastaneye yatış veya bakımevine yatışla sonuçlanabilir. Drexel Üniversitesi Hemşirelik ve Sağlık Meslek Yüksekokulu tarafından yakın zamanda yapılan bir araştırma, topluluk ortamlarında yaşayan yaşlı yetişkinler arasında düşmeler için çeşitli risk faktörlerini ortaya çıkardı.
Belirli düşme riski faktörlerini hedeflemek, düşme tarama ve önleme stratejilerini iyileştirebilir.
Yaşlılar arasında düşmeler, giderek daha önemli bir halk sağlığı sorunu haline geliyor ve her yıl yaşlı yetişkinlerde milyonlarca yaralanmaya neden oluyor. Demans ile yaşayan yaşlı yetişkinler, demansı olmayanlara kıyasla iki kat daha fazla düşme riskine ve kırıklar gibi düşmeye bağlı ciddi yaralanmalara maruz kalma riskine üç kat daha sahiptir. Demansı olan yaşlı yetişkinler için, düşmeyle ilgili küçük yaralanmalar bile hastaneye yatışa ve bakımevine yatışa yol açabilir. Drexel Üniversitesi Hemşirelik ve Sağlık Meslek Yüksekokulundaki araştırmacılar tarafından yapılan yeni bir araştırma, toplu yaşam ortamlarında yaşlı yetişkinlerin karşılaştığı çok sayıda ve çeşitli düşme riski faktörlerine ışık tuttu.
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“Examining the multiple factors, including environmental ones like a person’s home or neighborhood, is necessary to inform fall-risk screening, caregiver education and support, and prevention strategies for this high-risk population of older adults,” said Okoye.
CDC Statistics on Older Adult Falls
- In 2019, falls among adults aged 65 and older resulted in over 34,000 deaths, making it the top cause of injury-related deaths for that demographic.
- Emergency departments recorded 3 million visits for older adult falls in 2019.
- Older adult falls cost $50 billion in medical costs annually, with 75% paid by Medicare and Medicaid.
Despite awareness of this elevated risk, there are very few studies that have examined fall-risk factors among people with dementia living in a community setting (not nursing homes or other residential facilities). The studies that do exist, overwhelmingly focus on health and function factors. According to the authors, this is the first nationally representative study to compare a comprehensive set of potential risk factors for falls for older Americans living with dementia to those without dementia.
The research team examined data from the 2015 and 2016 National Health and Aging Trends Study (NHATS), a population-based survey of health and disability trends and trajectories of adults 65 and older in the U.S. They were able to obtain potential sociodemographic, health and function predictors of falls, as well as potential social and physical environmental predictors.
Data from NHATS showed that nearly half (45.5%) of older adults with dementia had experienced one or more falls in 2016, compared to less than one-third (30.9%) of older adults without dementia.
Among older adults living with dementia, three characteristics stood out as significantly associated with a greater likelihood of falls: a history of falling the previous year; impaired vision; and living with others (versus alone). For older adults without dementia, financial hardship, a history of falling, fear of falling, poor lower extremity performance, depressive symptoms, and home disrepair were strongly associated with an increased risk of falls.
While prior history of falling and vision impairment are well-known risk factors for falls among older adults in general; the researchers’ findings indicate that these were strong risk factors for falls among people living with dementia. According to the team, this suggests that people living with dementia should be assessed for presence of these characteristics. If they’re present, the individuals should receive further assessment and treatment, including examining their feet and footwear, assessing their environment and ability to carry out daily living activities, among other items.
The finding that older adults living with dementia who lived with a spouse or with non-spousal others had higher odds of experiencing a fall, compared to those who lived alone, highlights that caregiver support and education are understudied components of fall prevention programs for older adults with dementia who live with family caregivers, and deserve greater attention from clinicians, researchers, and policymakers.
“Overall, our findings demonstrate the importance of understanding and addressing fall risk among older adults living with dementia,” said Okoye. “It confirms that fall risk is multidimensional and influenced by environmental context in addition to health and function factors.”
The results of the study indicate the need to further investigate and design fall-prevention interventions, specifically for people living with dementia.
“To decrease the high rates of falls among older adults with dementia, additional tailored fall-risk screening, and fall-prevention interventions should be developed and tested,” said Okoye.
Reference: 12 January 2023, Alzheimer s & Dementia.
DOI: 10.1002/alz.12916
Funding: NIH/National Institutes of Health