Dementia as a Risk Factor for Falls and Fall Injuries Among Nursing Home Residents

Carol van Doorn, PhD, Ann L. Gruber-Baldini, PhD, Sheryl Zimmerman, PhD, J. Richard Hebel, PhD, Cynthia L. Port, PhD, Mona Baumgarten, PhD, Charlene C. Quinn, PhD, George Taler, MD, Conrad May, MD, Jay Magaziner, PhD, MSHyg


J Am Geriatr Soc. 2003;51(9) 

In This Article

Abstract and Introduction

Objectives: To compare rates of falling between nursing home residents with and without dementia and to examine dementia as an independent risk factor for falls and fall injuries.
Design: Prospective cohort study with 2 years of follow-up.
Setting: Fifty-nine randomly selected nursing homes in Maryland, stratified by geographic region and facility size.
Participants: Two thousand fifteen newly admitted residents aged 65 and older.
Measurements: During 2 years after nursing home admission, fall data were collected from nursing home charts and hospital discharge summaries.
Results: The unadjusted fall rate for residents in the nursing home with dementia was 4.05 per year, compared with 2.33 falls per year for residents without dementia (P<.0001). The effect of dementia on the rate of falling persisted when known risk factors were taken into account. Among fall events, those occurring to residents with dementia were no more likely to result in injury than falls of residents without dementia, but, given the markedly higher rates of falling by residents with dementia, their rate of injurious falls was higher than for residents without dementia.
Conclusion: Dementia is an independent risk factor for falling. Although most falls do not result in injury, the fact that residents with dementia fall more often than their counterparts without dementia leaves them with a higher overall risk of sustaining injurious falls over time. Nursing home residents with dementia should be considered important candidates for fall-prevention and fall-injury-prevention strategies.

Approximately half of nursing home residents fall annually, a proportion that is two to three times that of community residents.[1,2,3] About 4% of falls occurring each year result in fractures, and 11% result in soft tissue and other types of injuries.[2,4] Other consequences of falling include loss of function, self-imposed functional limitations caused by fear of falling,[5] and discouragement of activity by care providers.[6] Higher healthcare costs are another potentially serious consequence of falling;[7] annual expenditures for fall-related fractures in the community alone are in the billions of dollars,[8] whereas noninjurious falls can increase the costs of nursing home care because of staff time required for assessment, observation, and reporting.[9]

Dementia can increase the risk of falling by impairing judgment, gait, visual-spatial perception, and the ability to recognize and avoid hazards.[2,10] Most falls by elderly nursing home residents do not result in serious injury, although several factors place nursing home residents at particular risk of sustaining fall injuries: female sex, functional independence, a higher number of falls, and the use of mechanical restraints.[2,11]

The purpose of this study, using data from a first-time admission cohort of nursing home residents entering a large and representative group of nursing homes, was to examine the relationship between dementia, falling, and fall-related injury. The specific aims were to compare rates of falling of nursing home residents with and without dementia and to examine dementia as an independent risk factor for falls and fall injuries, taking into account other known risk factors.


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