Predictors of Falls and Fractures Leading to Hospitalization in People With Dementia: A Representative Cohort Study.
Por:
Sharma S, Mueller C, Stewart R, Veronese N, Vancampfort D, Koyanagi A, Lamb SE, Perera G and Stubbs B
Publicada:
1 jul 2018
Ahead of Print:
9 may 2018
Resumen:
OBJECTIVES: Investigate predictors of falls and fractures leading to hospitalization in a large cohort of people with dementia. DESIGN: A retrospective cohort study. SETTING AND PARTICIPANTS: People with diagnosed dementia between January 2007 and March 2013, aged >65 years, were assembled using data from the Maudsley Biomedical Research Centre Case Register, from 4 boroughs in London serving a population of 1.3 million people. MEASURES: Falls and/or fractures leading to hospitalization were ascertained from linked national records. Demographic data, cognitive test scores, medications, and symptom and functioning scores from Health of the Nation Outcome Scales (HoNOS65+) were modeled in multivariate survival analyses to identify predictors of falls and fractures. RESULTS: Of 8036 people with dementia (63.9% female), 2500 (31.1%, incidence rate 125.5 per 1000 person-years) had a fall during a mean follow-up of 2.5 years and 1437 (17.7%, incidence rate 65.5 per 1000 person-years) had a fracture. In multivariable models, significant predictors of falls were increased age, female gender, physical health problems, previous fall or fracture, vascular dementia vs Alzheimer's disease, higher neighborhood deprivation, noncohabiting status, and problems with living conditions. Ethnic minority status was protective of falls (eg, Caribbean/Asian ethnicity). Medications (including psychotropic and antipsychotics), neuropsychiatric symptoms, cognitive (Mini-Mental State Examination scores), or functional problems did not predict hospitalized falls. Predictors of fractures were similar to those predicting falls. IMPLICATIONS: Over an average of 2.5 years, a third of people with dementia had a fall leading to hospitalization, necessitating action in clinical practice. Clinicians should consider that besides established demographic and physical health-related factors, the risk of hospitalization due to a fall or fractures in dementia is largely determined by environmental and socioeconomic factors. Interestingly, our data suggest that neuropsychiatric symptoms, cognitive status, functioning, or pharmacotherapy were not associated with falls/fractures.
Filiaciones:
Sharma S:
South London and Maudsley NHS Foundation Trust, London, United Kingdom
Mueller C:
South London and Maudsley NHS Foundation Trust, London, United Kingdom
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Stewart R:
South London and Maudsley NHS Foundation Trust, London, United Kingdom
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Veronese N:
Neuroscience Institute, Aging Branch, National Research Council, Padova, Italy
Vancampfort D:
Department of Rehabilitation Sciences, KU Leuven-University of Leuven, Leuven, Belgium
University Psychiatric Center, KU Leuven-University of Leuven, Leuven-Kortenberg, Belgium
Koyanagi A:
Research and Development Unit, Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Barcelona, Spain
Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
Lamb SE:
Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
Perera G:
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Stubbs B:
South London and Maudsley NHS Foundation Trust, London, United Kingdom
Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
Green Published, hybrid
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