International Psychogeriatrics

Review Article

Fall determinants in older long-term care residents with dementia: a systematic review

Tobias F. Kröpelina1 c1, Jacques C. L. Neyensa1, Ruud J. G. Halfensa1, Gertrudis I. J. M. Kempena1 and Jan P. H. Hamersa1

a1 Department for Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands

ABSTRACT

Background: Persons with dementia are two to three times more likely to fall compared to persons without dementia. In long-term care settings, the dementia prevalence is highest. Therefore, older long-term care residents with dementia can be considered a high-risk group for falls. Nevertheless, no systematic evaluation of fall determinants in this population was found. The purpose of this study was to identify fall determinants among older long-term care residents with dementia or cognitively impaired persons in long-term care, by conducting a systematic literature review.

Methods: We searched English, French, Dutch, and German articles listed in: CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, and Web of Science. Additionally, references of included articles were screened. Studies were included if determinants or circumstances of falls in older persons with dementia living in long-term care were assessed.

Results: Eight studies met the inclusion criteria. Three studies were excluded from detailed analysis because of insufficient quality. Use of psychotropic drugs, a “fair or poor” general health, gait impairments, and age were associated with an increased fall risk. Also trunk restraints were associated with an increased number of falls while full bedrails and wandering behavior were protective against falls.

Conclusions: Fall risk factors known from other populations, e.g. use of psychotropic drugs, physical restraints, and health conditions, are found in long-term care residents with dementia as well. Due to the limited evidence available, future studies with adequate sample sizes and prospective designs are required to determine specific fall risk factors and verify existing results in this population.

(Received June 20 2012)

(Reviewed August 01 2012)

(Revised October 14 2012)

(Accepted October 17 2012)

(Online publication December 20 2012)

Key words:

  • falls;
  • risk factors;
  • dementia;
  • long-term care;
  • systematic review;
  • older people;
  • physical restraints;
  • psychotropic drugs;
  • gait

Correspondence:

c1 Correspondence should be addressed to: Tobias F. Kröpelin, BA, Department for Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands. Phone: +31 68 334 2092; Fax: +31 43 388 4162. Email: t.kroepelin@student.maastrichtuniversity.nl.