Characteristics associated with recurrent falls among the elderly within aged-care wards in a tertiary hospital : the effect of cognitive impairment

In this study, we aimed to determine the factors associated with recurrent falls in aged-care inpatients at a tertiary hospital, with a focus on the cognitive domains of recurrent fallers. We retrospectively examined the characteristics of 70 aged-care inpatients who sustained ≥ 2 falls; 269 patients who sustained 1 fall; and 69 non-fallers during their hospital admission. We also analyzed the available Mini Mental State Examination (MMSE) scores and sub-scores of 37 recurrent fallers, 163 single fallers, and 37 non-fallers. The independent risk factors for recurrent falls were a history of dementia, stroke, or atrial fibrillation; and patients’ hospital length of stay >5 weeks. Protective factors were the patients’ ability to speak English and a history of depression. Recurrent fallers had significantly lower MMSE scores than single fallers and non-fallers (17.3±6.7, 20.2±6.2, 24.0±5.1, respectively, p <0.01); and a larger proportion of recurrent fallers had MMSE <18 than in the other two groups (54.1%, 34.4% and 10.8%, respectively, p <0.01). In addition, patients with recurrent falls were more likely to have significantly lower scores in the 'registration', 'attention and calculation', 'recall' and 'praxis' domains of the MMSE than single fallers. The findings from this study suggest that cognitive impairment particularly affecting short-term memory, recall and visuospatial perception may contribute to recurrent falls in the inpatient population. Prospective studies to elucidate a causal relationship may be worthwhile.