Characteristics of falls in mild and moderate Alzheimer's disease

Kato-Narita, Eliane Mayumi; Radanovic, Marcia

doi:10.1590/S1980-57642009DN30400013

Abstract

The occurrence of falls in AD patients is frequent, and their consequences are cognitive decline, fractures and loss of independence. Many studies have addressed fall risk factors in order to establish effective prevention strategies.

Objectives:

We describe the frequency and characteristics of falls in a sample of AD patients and their main risk factors.

Methods:

We evaluated 40 subjects without cognitive impairment, and 45 AD patients, graded as CDR 1 and CDR 2.

Results:

Environmental hazard risks were the most frequent cause associated with falls in CDR 1 (41.4%) and CDR 2 (46.7%). Instability (31%) and dizziness (17.2%) were frequent causes of falls in the CDR 1 group, and this group showed the highest rate of recurrence (28%). In both groups of AD patients, indoors falls predominated (70.3 and 80% respectively for CDR 1 and 2). In our sample, the remaining factors studied were not associated with increasing risk for falls.

Conclusions:

These results reinforce the hypothesis that falls in AD are mutifactorial and that their risk factors are highly interconnected. Preventative strategies considering all aspects should be implemented most crucially eliminating environmental risks, maintaining constant presence of caregivers, and providing physical and functional stimulation, both in mild and moderate AD.

Key words:
falls; elderly; Alzheimer's disease.

Resumo

Fundamentos: A ocorrência de quedas entre idosos com a doença de Alzheimer (DA) é muito frequente, e traz consequências graves como a piora cognitiva, fraturas e perda da independência. Muitos estudos foram realizados com o objetivo de identificar os fatores de risco associados às quedas, com o fim de propor estratégias de prevenção.

Objetivos:

O presente estudo buscou descrever a frequência e características das quedas em uma amostra de pacientes com DA, e seus principais fatores de risco.

Métodos:

Foram analisados 40 idosos sem alterações cognitivas e 45 com DA, classificados em CDR 1 e CDR 2.

Resultados:

Riscos ambientais foram associados às quedas tanto no grupo CDR 1 (41.4%) como CDR 2 (46.7%). Instabilidade (31%) e tontura (17.2%) foram frequentes no grupo CDR 1, sendo este o grupo que apresentou o maior índice de recorrência (28%). Em ambos os grupos com DA, as quedas ocorreram mais frequentemente dentro de casa (70,30 e 80% respectivamente para os grupos CDR 1 e 2).

Conclusões:

Estes resultados reforçam a hipótese de que as quedas em pacientes com DA são multifatoriais e seus fatores de risco altamente interconectados. Medidas preventivas devem ser realizadas, principalmente quanto a retirada de riscos ambientais, a presença constante de cuidador, e a estimulação física e funcional do paciente, tanto na fase leve como na moderada da DA.

Palavras-chave:
idosos; doença de Alzheimer.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

References

¹
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701-1707.
²
Moura RN, Santos FC, Dremier M, Santos LM, Ramos LR. Quedas em idosos: fatores de risco associados. Gerontologia 1999;7:15-21.
³
Ramos LR, Simões EJ, Albert MS. Dependence in activities of daily living and cognitive impairment strongly predicted mortality in older urban residents in Brazil: a 2-year follow-up. J Am Geriatr Soc 2001;49:1168-1175.
⁴
Perracini MR. Fatores associados a quedas em coorte de idosos residentes na comunidade. Rev Saúde Pública 2002;36:709-716.
⁵
Härlein J, Dassen T, Halfens RJ, Heinze C. Fall risk factors in older people with dementia or cognitive impairment: a systematic review. J Adv Nurs 2009;65:922-933.
⁶
Pelfolk T, Gustafsson T, Gustafsson Y, Larlsson S. Risk factors for falls among residents with dementia living in group dwelling. Int Psychogeriatr 2009;21:187-194.
⁷
Camicioli R, Licis L. Motor impairment predicts falls in specialized Alzheimer care unit. Alzheimer Dis Assoc Disord 2004;18:214-218.
⁸
Verghese J, Buschke H, Viola L, et al. Validity of divided attention tasks in predicting falls in older individuals: a preliminary study. J Am Geriatr Soc 2002;50:1572-1576.
⁹
Thapa PB, Gideon P, Fought RL, Ray WA. Psychotropic drugs and risk of falls in ambulatory nursing home residents. Am J Epidemiol 1995;142:2002-2011.
¹⁰
Sterke CS, Verhangen AP, van Beeck EF, van der Cammen TJ. The influence of drug use on fall incidents among nursing home residents: a systematic review. Int Psychogeriatr 2008; 20:890-910.
¹¹
Detweiller MB, Murphy PF, Kim KY, Myers LC, Ashai A. Schedule medications and falls in dementia patients utilizing a wander garden. Am J Alzheimers' Dis Other Dement 2009;24:322-332.
¹²
Brody EM, Kleban MH, Moss MS, Kleban F. Predictors of falls among institutionalized women with Alzheimer's disease. J Am Geriatr Soc 1984;32:877-882.
¹³
van Doorn C, Gruber-Baldini AL, Zimmerman S, et al. Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc 2003;51:1213-1218.
¹⁴
Eriksson S, Gustafson Y, Lundin-Olsson L. Risk factors for falls in people with and without a diagnose of dementia living in residential care facilities: a prospective review. Archives of Gerontology and Geriatrics 2008;46:293-306.
¹⁵
Neyens JCL, Dijcks BPJ, van Haastregt JCM, et al. The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands. BMC Public Health 2006;6:74-81.
¹⁶
Oliver D, Connelly JB, Victor CR, et al. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ 2006;doi 10.1136/bmj.39049.706493.55.
¹⁷
Mckhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of the Department of Health an Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
¹⁸
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Bri J Psychiatry 1982;140:566-572;updated by Morris J. The CDR: current version and scoring rules. Neurology. 1993;43:2412-2413.
¹⁹
Smith GE, Ivnik RJ. Normative Neuropsychology. In: Petersen RC. Mild Cognitive Impairment. New York: Oxford 2003:63-88.
²⁰
Gélinas I, Gauthier L, Mcintyre M, Gauthier S. Development of a functional measure for persons with Alzheimer's Disease: the disability assessment for dementia. Am J Occup Ther 1999;53:471-481.
²¹
Alexopoulos GS, Abrans RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988; 23:271-284.
²²
Bueno-Cavanillas A, Padilla-Ruiz F, Jiménez-Moleón JJ, Peinado-Alonso CA, Gálvez-Vargas R. Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol 2000;16:849-859.
²³
Stalenhoef PA, Diederiks JPM, Knottnerus JA, Kester ADM, Crebolder HFJM. A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J Clin Epidemiol 2002;55:1088-1094.
²⁴
Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med 1994;121:442-451.
²⁵
Buchner DM, Larson EB. Falls and fractures in patients with Alzheimer-type dementia. J Am Med Assoc 1987;257:1492-1495.
²⁶
Asada T, Kariya T, Kinoshita T, et al. Predictors of Fall-related injuries among community-dwelling elderly people with dementia. Age Aging 1996;25:22-28.
²⁷
Ballard CG, Shaw F, Lowery K, McKeith I, Kenny R. The prevalence, assessment and associations of falls in dementia with Lewy bodies and Alzheimer's disease. Dement Geriatr Cogn Disord 1999;10:97-103.
²⁸
Kenny RA, Richardson DA, Steen IN, Mckeith IG, Bond J, Shaw FE. Predictors of further falls in patients with cognitive impairment and dementia attending the casualty department. Age Ageing 2000;29:A23.
²⁹
Bassiony MM, Rosenblatt A, Baker A, et al. Falls and age in patients with Alzheimer's Disease. J Nerv Ment Dis 2004; 192:570-572.
³⁰
Horikawa E, Matsui T, Arai H, Seki T, Iwasaki K, Sasaki H. Risk of falls in Alzheimer's disease: a prospective study. Intern Med 2005;44:717-721.
³¹
Rahkonen T, Eloniemi-Sulkava U, Riassanen S;et al. Dementia with Lewy bodies according to the consensus criteria in a general population aged 75 years or older. J Neurol Neurosurg Psychiatry 2003;74:720-724.
³²
Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN international workshop. Neurology 1993; 43:250-260.
³³
Camarano, AM. Envelhecimento da população brasileira: uma contribuição demográfica. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML. Tratado de Geriatria e Gerontologia. Rio de Janeiro: Editora Guanabara Koogan; 2006;10:88-105.
³⁴
Diogo, MJD. Modalidades de assistência ao idoso e à família: impacto sobre a qualidade de vida. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML. Tratado de Geriatria e Gerontologia. Rio de Janeiro: Guanabara Koogan; 2006:1383-1387.
³⁵
Born T, Boechat NS. A qualidade dos cuidados ao idoso institucionalizado. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML, (editors). Tratado de Geriatria e Gerontologia. Rio de Janeiro: Guanabara Koogan; 2006:1131-1141.
³⁶
Lemos ND, Medeiros, SL. Suporte social ao idoso dependente. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML, (editors). Tratado de Geriatria e Gerontologia. Rio de Janeiro: Guanabara Koogan; 2006:1227-1233.
³⁷
Krueger PD, Brazil K, Lohfeld LH. Risk factors for falls and injuries in a long-term care facility in Ontario. Can J Public Health 2001;92:117-120.
³⁸
Allan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS ONE 2009;4:e5521-8.
³⁹
Kolanowski A, Fick , Waller JL, Ahern F. Outcomes of antipsychotic drug use in community-dwelling elders with dementia. Arch Psychiatr Nurs 2006;20:217.
⁴⁰
Soriano TA, DeCherrie LV, Thomas DC. Falls in the community-dwelling older adult: a review for primary-care providers. Clin Interv Aging 2007;2:545-553.
⁴¹
Yamaguchi K. Falls in patients with dementia. Clin Calcium 2008;18:1588.
⁴²
Holmes C, Lovestone S. Long-term cognitive and functional decline in late onset Alzheimer's disease: therapeutic implications. Age Aging 2003;32:200-204.
⁴³
Fitzgerald TG, Hadjistavropoulos t, MacNab YC. Caregiver fear of falling and functional ability among seniors residing in long-term care facilities. Gerontology 2009;55:460-467.

Publication Dates

Publication in this collection
Oct-Dec 2009

History

Received
03 Oct 2009
Accepted
13 Nov 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med 1988;319:1701-1707.

[2] ²
Moura RN, Santos FC, Dremier M, Santos LM, Ramos LR. Quedas em idosos: fatores de risco associados. Gerontologia 1999;7:15-21.

[3] ³
Ramos LR, Simões EJ, Albert MS. Dependence in activities of daily living and cognitive impairment strongly predicted mortality in older urban residents in Brazil: a 2-year follow-up. J Am Geriatr Soc 2001;49:1168-1175.

[4] ⁴
Perracini MR. Fatores associados a quedas em coorte de idosos residentes na comunidade. Rev Saúde Pública 2002;36:709-716.

[5] ⁵
Härlein J, Dassen T, Halfens RJ, Heinze C. Fall risk factors in older people with dementia or cognitive impairment: a systematic review. J Adv Nurs 2009;65:922-933.

[6] ⁶
Pelfolk T, Gustafsson T, Gustafsson Y, Larlsson S. Risk factors for falls among residents with dementia living in group dwelling. Int Psychogeriatr 2009;21:187-194.

[7] ⁷
Camicioli R, Licis L. Motor impairment predicts falls in specialized Alzheimer care unit. Alzheimer Dis Assoc Disord 2004;18:214-218.

[8] ⁸
Verghese J, Buschke H, Viola L, et al. Validity of divided attention tasks in predicting falls in older individuals: a preliminary study. J Am Geriatr Soc 2002;50:1572-1576.

[9] ⁹
Thapa PB, Gideon P, Fought RL, Ray WA. Psychotropic drugs and risk of falls in ambulatory nursing home residents. Am J Epidemiol 1995;142:2002-2011.

[10] ¹⁰
Sterke CS, Verhangen AP, van Beeck EF, van der Cammen TJ. The influence of drug use on fall incidents among nursing home residents: a systematic review. Int Psychogeriatr 2008; 20:890-910.

[11] ¹¹
Detweiller MB, Murphy PF, Kim KY, Myers LC, Ashai A. Schedule medications and falls in dementia patients utilizing a wander garden. Am J Alzheimers' Dis Other Dement 2009;24:322-332.

[12] ¹²
Brody EM, Kleban MH, Moss MS, Kleban F. Predictors of falls among institutionalized women with Alzheimer's disease. J Am Geriatr Soc 1984;32:877-882.

[13] ¹³
van Doorn C, Gruber-Baldini AL, Zimmerman S, et al. Dementia as a risk factor for falls and fall injuries among nursing home residents. J Am Geriatr Soc 2003;51:1213-1218.

[14] ¹⁴
Eriksson S, Gustafson Y, Lundin-Olsson L. Risk factors for falls in people with and without a diagnose of dementia living in residential care facilities: a prospective review. Archives of Gerontology and Geriatrics 2008;46:293-306.

[15] ¹⁵
Neyens JCL, Dijcks BPJ, van Haastregt JCM, et al. The development of a multidisciplinary fall risk evaluation tool for demented nursing home patients in the Netherlands. BMC Public Health 2006;6:74-81.

[16] ¹⁶
Oliver D, Connelly JB, Victor CR, et al. Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses. BMJ 2006;doi 10.1136/bmj.39049.706493.55.

[17] ¹⁷
Mckhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of the Department of Health an Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.

[18] ¹⁸
Hughes CP, Berg L, Danziger WL, Coben LA, Martin RL. A new clinical scale for the staging of dementia. Bri J Psychiatry 1982;140:566-572;updated by Morris J. The CDR: current version and scoring rules. Neurology. 1993;43:2412-2413.

[19] ¹⁹
Smith GE, Ivnik RJ. Normative Neuropsychology. In: Petersen RC. Mild Cognitive Impairment. New York: Oxford 2003:63-88.

[20] ²⁰
Gélinas I, Gauthier L, Mcintyre M, Gauthier S. Development of a functional measure for persons with Alzheimer's Disease: the disability assessment for dementia. Am J Occup Ther 1999;53:471-481.

[21] ²¹
Alexopoulos GS, Abrans RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988; 23:271-284.

[22] ²²
Bueno-Cavanillas A, Padilla-Ruiz F, Jiménez-Moleón JJ, Peinado-Alonso CA, Gálvez-Vargas R. Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol 2000;16:849-859.

[23] ²³
Stalenhoef PA, Diederiks JPM, Knottnerus JA, Kester ADM, Crebolder HFJM. A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J Clin Epidemiol 2002;55:1088-1094.

[24] ²⁴
Rubenstein LZ, Josephson KR, Robbins AS. Falls in the nursing home. Ann Intern Med 1994;121:442-451.

[25] ²⁵
Buchner DM, Larson EB. Falls and fractures in patients with Alzheimer-type dementia. J Am Med Assoc 1987;257:1492-1495.

[26] ²⁶
Asada T, Kariya T, Kinoshita T, et al. Predictors of Fall-related injuries among community-dwelling elderly people with dementia. Age Aging 1996;25:22-28.

[27] ²⁷
Ballard CG, Shaw F, Lowery K, McKeith I, Kenny R. The prevalence, assessment and associations of falls in dementia with Lewy bodies and Alzheimer's disease. Dement Geriatr Cogn Disord 1999;10:97-103.

[28] ²⁸
Kenny RA, Richardson DA, Steen IN, Mckeith IG, Bond J, Shaw FE. Predictors of further falls in patients with cognitive impairment and dementia attending the casualty department. Age Ageing 2000;29:A23.

[29] ²⁹
Bassiony MM, Rosenblatt A, Baker A, et al. Falls and age in patients with Alzheimer's Disease. J Nerv Ment Dis 2004; 192:570-572.

[30] ³⁰
Horikawa E, Matsui T, Arai H, Seki T, Iwasaki K, Sasaki H. Risk of falls in Alzheimer's disease: a prospective study. Intern Med 2005;44:717-721.

[31] ³¹
Rahkonen T, Eloniemi-Sulkava U, Riassanen S;et al. Dementia with Lewy bodies according to the consensus criteria in a general population aged 75 years or older. J Neurol Neurosurg Psychiatry 2003;74:720-724.

[32] ³²
Román GC, Tatemichi TK, Erkinjuntti T, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN international workshop. Neurology 1993; 43:250-260.

[33] ³³
Camarano, AM. Envelhecimento da população brasileira: uma contribuição demográfica. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML. Tratado de Geriatria e Gerontologia. Rio de Janeiro: Editora Guanabara Koogan; 2006;10:88-105.

[34] ³⁴
Diogo, MJD. Modalidades de assistência ao idoso e à família: impacto sobre a qualidade de vida. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML. Tratado de Geriatria e Gerontologia. Rio de Janeiro: Guanabara Koogan; 2006:1383-1387.

[35] ³⁵
Born T, Boechat NS. A qualidade dos cuidados ao idoso institucionalizado. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML, (editors). Tratado de Geriatria e Gerontologia. Rio de Janeiro: Guanabara Koogan; 2006:1131-1141.

[36] ³⁶
Lemos ND, Medeiros, SL. Suporte social ao idoso dependente. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML, (editors). Tratado de Geriatria e Gerontologia. Rio de Janeiro: Guanabara Koogan; 2006:1227-1233.

[37] ³⁷
Krueger PD, Brazil K, Lohfeld LH. Risk factors for falls and injuries in a long-term care facility in Ontario. Can J Public Health 2001;92:117-120.

[38] ³⁸
Allan LM, Ballard CG, Rowan EN, Kenny RA. Incidence and prediction of falls in dementia: a prospective study in older people. PLoS ONE 2009;4:e5521-8.

[39] ³⁹
Kolanowski A, Fick , Waller JL, Ahern F. Outcomes of antipsychotic drug use in community-dwelling elders with dementia. Arch Psychiatr Nurs 2006;20:217.

[40] ⁴⁰
Soriano TA, DeCherrie LV, Thomas DC. Falls in the community-dwelling older adult: a review for primary-care providers. Clin Interv Aging 2007;2:545-553.

[41] ⁴¹
Yamaguchi K. Falls in patients with dementia. Clin Calcium 2008;18:1588.

[42] ⁴²
Holmes C, Lovestone S. Long-term cognitive and functional decline in late onset Alzheimer's disease: therapeutic implications. Age Aging 2003;32:200-204.

[43] ⁴³
Fitzgerald TG, Hadjistavropoulos t, MacNab YC. Caregiver fear of falling and functional ability among seniors residing in long-term care facilities. Gerontology 2009;55:460-467.

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