Prevalence of falls and associated risk factors in institutionalized older adults with cognitive impairment: A meta-analysis

Background: Older adult population is increasing year by year. Moreover, physical, psychological, emotional, social, financial, and spiritual well-being of older adults alter as they age while diseases and disabilities are also common among older adults with cognitive impairment being one of the major issues among this population. Older adults who suffer cognitive decline can be higher risk of falling because cannot maintain a role in gait control. Moreover, the setting is also an extremely common risk that influences falls among older adults, such as community and institutions. Falls are a serious and major concern among institutionalized older adults.
Objective: This meta-analysis study aims to explore the prevalence of falls and associated risk factors among institutionalized older adults with cognitive impairment.
Methods: Inclusion criteria based on PEOS format as follows: population (P) was older adult aged 65 years old with cognitive impairment living in institution; exposure (E) was falls; outcome (O) was either prevalence or epidemiology or proportion; study design (S) was prospective or retrospective cohort study. Exclusion criteria as follows: irrelevant topic, non-research article, irrelevant study design, irrelevant outcome, studies from same data set (duplicate publication), insufficient data, falls due to physical disabilities (stroke, Parkinson’s disease, and delirium), and home-based study. This current meta-analysis was conducted by Embase, OVID-Medline, Scopus, PubMed, Web of Science, CINAHL and manual search. The pooled prevalence of falls was examined using the logit transformation random-effects model in R-Software, while DerSimonian-Lard random-effects model in Comprehensive Meta-Analysis (CMA), presenting odds ratio (OR) and corresponding 95% confidence interval (CI), was used to analyze associated risk factors of falling. Risk of bias was performed based on Hoy criteria. The Cohen’s Kappa statistic was performed after judgement two independent reviewer’s agreement.
Results: A total of twenty-four studies with 18,500 participants were included. The pooled prevalence of falls was 44% (95%CI: 36%-52%) among older adults with cognitive impairment. Among them, older adults with dementia diagnosis have prevalence of falls was 47% (95%CI: 37%-56%). Psychotropic medications OR: 4.01 (95%CI: 1.64-9.81), behavioural disturbances OR: 1.45 (95%CI: 1.14-1.86), physical dependence OR: 2.40 (95%CI: 1.48-3.91), poor functional mobility OR: 2.21 (95%CI: 1.10-4.45), arthrosis OR: 1.79 (95%CI: 1.30-2.47), and cardiopathy OR: 2.67 (95%CI: 1.40-5.12) were associated with increased risk of falls. Immediate memory evaluation OR: 0.52 (95%CI: 0.39-0.71) was associated with reduced risk of falls. Heterogeneity was partially explained by gender (female): 36% (95%CI: 30%-43%), institutions (residential home): 23% (95%CI: 3%-44%), multiple falls: 4% (95%CI: 1%-7%), performance ADLs: 27% (95%CI: 9%-44%), fracture: 12% (95%CI: 9%-15%), urinary incontinence: 3% (95%CI: 0%-6%), visual impairment: 7% (95%CI: 5%-10%), and hearing impairment: 4% (95%CI: 3%-5%).
Conclusions: Around half of institutionalized older adults with cognitive impairment experience falls. To conclude, the variations among the included studies were partially influenced by gender, institutions, multiple falls, performance activity daily living, fracture, urinary incontinence, visual impairment and hearing impairment. Furthermore, an elevated risk of falling was linked to psychotropic medications, behavioral disturbances, physical dependence, poor functional mobility, arthrosis and cardiopathy. Conversely, a reduced risk of falling was associated with the immediate memory evaluation. Therefore, healthcare providers should early assessment of falls among institutionalized older adults with cognitive impairment to prevent falls-related injuries and be cautious related to the associated risk factors of falls.