New Study Finds ‘Two-Way Street’ Between Falls, Dementia Diagnoses

A diagnosis of dementia was more frequently made within one year of an older adult falling compared to other types of injuries.

That’s according to a recent study published in the Journal of the American Medical Association (JAMA) led by Molly P. Jarman, PhD, MPH, Center for Surgery and Public Health, Brigham and Women’s Hospital.

Researchers analyzed Medicare claims data and found 10.6% of patients who had experienced a fall were later diagnosed with dementia. Compared to different types of injuries, falls were associated with a 21% increased dementia diagnosis risk.

These findings support the importance of implementing cognitive screenings for older adults who have experienced a fall that resulted in an emergency department visit or hospitalization. Over 14 million older adults report falls annually, according to the Centers for Disease Control and Prevention, with falls now the leading cause of injury in older adults.

“I often see patients admitted after falls, which are among the most common reasons for trauma center admissions and can lead to severe injuries. This raises an important question: Why are these falls happening in the first place?” said first author Alexander Ordoobadi, MD, a resident physician in the Department of Surgery at the Brigham.

While physicians treat injuries and offer rehabilitation toward recovery, Ordoobadi said the health care system often overlooks underlying factors that contribute to falls, contrary to mounting evidence that could show a link between falls and cognitive decline.

Fall injuries can occur in older adults as motor function loss emerges and are often a sign of cognitive decline, even as cognitive health is currently not considered in relevant fall prevention guidelines.

“The relationship between falls and dementia appears to be a two-way street,” said senior author Molly Jarman, PhD, MPH, 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 act as precursor events that can help us identify people who need further cognitive screening.”

By conducting cognitive screenings in older adults following a fall, dementia could be detected sooner, but that’s not an easy task—one complicated by disparities in access to primary care services.

“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 Ordoobadi. “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.”

The study shows the need for more clinicians who are able to care for older adults and improve access to cognitive assessments after falls resulting in injury, Jarman said.

“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.”

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