A study by researchers in Drexel University's College of Nursing and Health Professions sheds light on the many and varied fall-risk factors facing older adults in community-living environments. The team examined data from the 2015 and 2016 National Health and Aging Trends Study (NHATS), a population-based survey of health and disability trends and trajectories of adults 65 and older in the US. The researchers obtained potential sociodemographic, health and function predictors of falls, as well as potential social and physical environmental predictors.

Nearly half (45.5%) of older adults with dementia had experienced one or more falls in 2016, compared to less than one third (30.9%) of those without dementia. Among older adults living with dementia, three characteristics stood out as significantly associated with a greater likelihood of falls: a history of falling the previous year, impaired vision, and living with others (versus alone). 

According to the team, this suggests that people living with dementia should be assessed for presence of these characteristics. If they're present, the individuals should receive further assessment and treatment, including examining their feet and footwear, assessing their environment and ability to carry out daily living activities, among other items.

The finding that older adults with dementia who lived with a spouse or with non-spousal others had higher odds of experiencing a fall, compared to those who lived alone, highlights that caregiver support and education are understudied components of fall-prevention programs for older adults with dementia who live with family caregivers, and deserve greater attention from clinicians, researchers and policy makers, the researchers say.

For older adults without dementia, financial hardship, a history of falling, fear of falling, poor lower extremity performance, depressive symptoms and home disrepair were strongly associated with increased risk of falls.

Overall, the authors say, the findings confirm "that fall-risk is multidimensional and influenced by environmental context in addition to health and function factors." The results indicate the need to further investigate and design fall-prevention interventions, specifically for people living with dementia.

To read an abstract of the study, published in Alzheimer's & Dementia, click here