Falls and Dementia
Dementia entails a group of signs and symptoms that reflect diminished cognitive function. The cognitive abilities affected are thought comprehension and reasoning. Loss of these abilities usually interferes with routine activities conducted by the affected population. Some members of this population easily lose control over their emotions. This harms their personalities. Signs and symptoms: memory loss, disturbance with the ability to communicate, make judgments, problems solving, and remain attentive (Mehdizadeh et al., 2021). It has been implicated in older people. Studies indicate that approximately a third of persons aged above eighty-five years manifest signs and symptoms of dementia. Other risk factors include family history, race, cardiovascular problems, and traumatic brain injury. Older patients with dementia are prone to falls. This is an important clinical problem because it causes regular physical harm.
Progressive dementia predisposes a person to falls. This has been attributed to forgetfulness and unawareness of their surroundings. It has been estimated that sixty to eighty percent of the elderly population with dementia are affected by falls. The risk of falls is independent of the patient’s environment. Falls have been reported in various settings, such as nursing homes, at home, and the hospital (Sharma et al., 2018). Injuries from such falls decrease their physical health, lower their quality of life, decrease confidence, and lead to isolation in elderly institutions.
Furthermore, falls have financial implications. Hospital inpatient or outpatient services increase the financial burden from the regular purchase or refill of medications. Deaths resulting from these falls have a psychological impact and economic impact on family members.
Various risk factors have been implicated in falls. Advanced age is the first risk factor. Among the elderly population, the older ones are prone to falls. Others include having a prior history of falls, rural areas, and sex. Females with dementia demonstrated a higher risk for frequent falls compared to their male counterparts (Fernando et al., 2017). Other studies identify balance and visuospatial abilities as potential risk factors for falls in patients with dementia. A reduced balance and visuospatial ability increase the risk of falls in people with dementia.
PICOT Question: For dementia-related falls, does screening for prior history of falls, age, and visuospatial ability compared to screening for cognitive impairment level help to predict and prevent subsequent lifelong falls?
P: Dementia-related falls
I: screening for a history of falls, age, and visuospatial ability
C: screening for cognitive impairment
O: Predict and prevent falls
|Criteria||Article 1||Article 2||Article 3|
|APA-Formatted Article Citation with Permalink||Fernando, E., Fraser, M., Hendriksen, J., Kim, C. H., & Muir-Hunter, S. W. (2017). Risk factors associated with falls in older adults with dementia: A systematic review. Physiotherapy Canada, 69(2), 161–170. https://doi.org/10.3138/ptc.2016-14
|Mehdizadeh, S., Sabo, A., Ng, K. D., Mansfield, A., Flint, A. J., Taati, B., & Iaboni, A. (2021). Predicting Short-Term Risk of Falls in a High-Risk Group With Dementia. Journal of the American Medical Directors Association, 22(3), 689-695.e1. https://doi.org/10.1016/j.jamda.2020.07.030
|Meuleners, L. B., Fraser, M. L., Bulsara, M. K., Chow, K., & Ng, J. Q. (2016). Risk factors for recurrent injurious falls that require hospitalization for older adults with dementia: A population-based study. BMC Neurology, 16(1), 1–8. https://doi.org/10.1186/s12883-016-0711-3
|How Does the Article Relate to the PICOT Question?||The article identifies and explains potential risk factors associated with falls in older adults with dementia. Risk factors identified by the authors include vision, gait, dementia severity, age, functional status, and age. This relates to the PICOT question since it describes each risk factor and its impact on identifying and preventing potential falls in people with dementia.||The article identifies the short-term risk factors of falls in a high-risk group with dementia. This is relevant to the PICOT question because it will help identify how age, vision, cognitive impairment, and previous fall history relate to falls. Such information will facilitate the identification of the best intervention.||It identifies risk factors for recurrent injurious falls that necessitate hospitalization in older adults with dementia. This is relevant to the PICOT question since it helps to identify the key risk factors. This knowledge helps to take the best interventions in preventing future falls.|
|Quantitative, Qualitative (How do you know?)||Qualitative. The article’s findings are stated in words rather than statistically using numbers and graphs. Furthermore, data collection focused on the survey of published works.||Qualitative. The article’s findings are stated in words rather than statistically using numbers and graphs. Furthermore, data collection focused on observation.||Quantitative. The study’s findings are analyzed statistically and expressed in percentages and graphs.|
|Purpose Statement||To review and determine a fall risk for people with dementia.||To develop a predictive model to predict the probability of a short-term fall (within the next 7 to 30 days) in older adults with dementia.||To identify risk factors for recurrent injurious falls that require hospitalizations in older adults with dementia.|
|Research Question||What are the risk factors associated with fall risk in older adults with dementia?||What are the short-term risk predictors of falls in a high-risk group with dementia?||What are the risk factors for recurrent injurious falls requiring hospitalization among adults aged 60+ years with dementia?|
|Outcome||Risk factors can be demographic, based on vision, gait, and functional status. The risk factors varied with the living setting and were inconsistent within a setting.||Fall history and gait stability (estimated margin of stability) were statistically significant predictors of time to fall and were included in the final predictive model.||Increasing age, living in rural areas, and having a dangerous fall in the year before the index hospital admission with dementia also increased the risk of recurrent injurious falls, resulting in hospitalization.|
(Where did the study take place?)
|Articles published on PubMed, EMBASE, CINAHK, and PsycINFO||Specialized dementia inpatient unit.||Western Australian Hospital Morbidity Data System and Western Australian Death Registrations from 2001 to 2013|
|Sample||Participants aged 55 years and above.||Fifty-one individuals with dementia.||Adults aged 60+ years with dementia.|
|Method||Prospective Cohort study focusing on detailed fall definition.||Prospective observational study. Vision-based motion capture was used to record the natural gait of participants over a 2-week baseline.||This retrospective study.|
|Key Findings of the Study||Falls in older adults with dementia are associated with multiple intrinsic and extrinsic factors. Risk factors vary between communities and institutions.||The model’s predicted survival probabilities were close to observed values at 7 and 30 days. Gait stability and recent fall history predicted an imminent fall.||Screening those with dementia for injurious fall history could help to identify those most at risk of recurrent injurious falls.|
|Recommendations of the Researcher||More studies must be conducted because factors related to increased fall risk are poorly understood.||Another study that uses a larger sample might improve the predictive ability of the model and its generalizability.||Improvement of health care and fall prevention services for those with dementia who live in rural areas may also reduce recurrent injurious falls.|
|Criteria||Article 4||Article 5||Article 6|
|APA-Formatted Article Citation with Permalink||Oki, M., Matsumoto, M., Yoshikawa, Y., Fukushima, M., Nagasawa, A., Takakura, T., & Suzuki, Y. (2021). Risk Factors for Falls in Patients with Alzheimer Disease: A Retrospective Study of Balance, Cognition, and Visuospatial Ability. Dementia and Geriatric Cognitive Disorders Extra, 11(1), 58–63. https://doi.org/10.1159/000514285||Peach, T., Pollock, K., Van Der Wardt, V., Das Nair, R., Logan, P., & Harwood, R. H. (2017). Attitudes of older people with mild dementia and mild cognitive impairment and their relatives about falls risk and prevention: A qualitative study. PLoS ONE, 12(5), 1–15. https://doi.org/10.1371/journal.pone.0177530
|Sharma, S., Mueller, C., Stewart, R., Veronese, N., Vancampfort, D., Koyanagi, A., Lamb, S. E., Perera, G., & Stubbs, B. (2018). Predictors of Falls and Fractures Leading to Hospitalization in People With Dementia: A Representative Cohort Study. Journal of the American Medical Directors Association, 19(7), 607–612. https://doi.org/10.1016/j.jamda.2018.03.009
|How Does the Article Relate to the PICOT Question?||It identifies risk factors for recurrent injurious falls that necessitate hospitalization in older adults with dementia. This is relevant to the PICOT question since it helps to identify the key risk factors.||It helps to identify how cognitive impairment impacts falls among people with dementia. It will provide insight into the importance of screening for cognitive impairment.||The article identifies the short-term risk factors of falls in a high-risk group with dementia. This is relevant to the PICOT question because it will help identify how age, vision, cognitive impairment, and previous fall history relate to falls. Such information will facilitate the identification of the best intervention.|
|Quantitative, Qualitative (How do you know?)||Quantitative. The study’s findings are analyzed statistically and expressed in percentages and graphs.||Qualitative. The article’s findings are stated in words rather than statistically using numbers and graphs.||Quantitative. The study’s findings are analyzed statistically and expressed in percentages and graphs.|
|Purpose Statement||To determine the main risk factors for falls in patients with Alzheimer’s disease||To explore the perceptions of older people with mild dementia and mild cognitive impairment and their family carers about falling and fall risk.||Investigate predictors of falls and fractures leading to hospitalization in a large cohort of people with dementia.|
|Research Question||How do balance, cognition, and visuospatial ability contribute to falls in patients with dementia?||What is the impact of mild cognitive impairment in patients with dementia on falls?||What are the predictors of falls and fractures among people with dementia?|
|Outcome||Balance and cognition are key risk factors for falls.||Mild cognitive impairment in patients with dementia has little impact on falls.||Significant predictors of falls were increased age, female gender, physical health problems, previous fall or fracture, and vascular dementia vs Alzheimer’s disease.|
(Where did the study take place?)
|Patients are admitted to a ward for patients with dementia.||Memory Assessment Services and Falls Prevention Services in the United Kingdom.||Data from the Maudsley Biomedical Research Centre Case Register from 4 boroughs in London|
|Sample||22 men and 25 women||20 patients and relatives.||People with diagnosed dementia between January 2007 and March 2013, aged >65 years,|
|Method||The Mini-Mental State Examination-Japanese (MMSE-J) for cognition; the Functional Reach Test (FRT), one-leg standing duration, and the Timed Up and Go Test (TUG) for balance;||A qualitative study involving thematic analysis of semi-structured interviews with patients and relative dyads.
|A Retrospective Cohort Study|
|Key Findings of the Study||Balance and visuospatial abilities are risk factors for falls in AD patients. In contrast, cognitive impairment was not a risk factor for falls.||Participants did not generally see fall prevention interventions as currently relevant to themselves.||Neuropsychiatric symptoms, cognitive status, functioning, or pharmacotherapy were not associated with falls/fractures.|
|Recommendations of the Researcher||FRT could be an appropriate risk predictor for falls in AD patients||Individualized interventions that focus on maintaining independence and preserving the quality of life are more likely to be acceptable by supporting a positive self-image for patients and their relatives.||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.|
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Please follow the guidelines on the PICOT question and literature. The professor gives a detailed outline of what to write. My PICOT question is related to the topic of Falls and Dementia. Use six articles, three qualitative research, and three quantitative research. Provide the Permalink of these articles. I also attached the Literature Evaluation Table to document all six articles on the table and a summary of 200-250 words.
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