Affiliations: [a]
AGAPLESION Bethanien Hospital / Geriatric Centre at the University of Heidelberg, Heidelberg, Germany
| [b] Network Aging Research, Heidelberg University, Heidelberg, Germany
| [c]
Institute of Medical Biometry und Informatics; Department of Medical Biometry at the University of Heidelberg, Heidelberg, Germany
| [d]
Maastricht University, Care and Public Health Research Institute, Department of Health Services Research, Maastricht, Netherlands
Correspondence:
[*]
Correspondence to: Prof. Klaus Hauer, AGAPLESION Bethanien Hospital/Geriatric Centre at the University of Heidelberg, Department of Geriatric Research, Rohrbacherstaße 149, 69126 Heidelberg, Germany. Tel.: +49 6221 319 1532; E-mail: khauer@bethanien-heidelberg.de. and Dr. Ilona Dutzi, AGAPLESION Bethanien Hospital/Geriatric Centre at the Heidelberg University, Rohrbacherstraße 149, 69126 Heidelberg, Germany. Tel.: +49 6221 319 1570; E-mail: idutzi@bethanien-heidelberg.de.
Abstract: Background:Match or mismatch of objective physiological and subjectively perceived fall risk may have serious consequences in patients with dementia (PwD) while research is lacking. Objective:To analyze mismatch of objective and subjective fall risk and associated factors in PwD. Method:Cohort study in a geriatric rehabilitation center. Objective and subjective risk of falling were operationalized by Tinetti’s Performance Oriented Mobility Assessment and the Falls Efficacy Scale-International. Four sub-groups according to objective and subjective fall risk were classified. Subgroups were compared for differences in clinical, cognitive, psychological, and behavioral variables. Results:In geriatric rehab patients with mild to moderate dementia (n = 173), two-thirds showed a mismatch of subjective versus objective risk of falling, independently associated with previous falls. Underestimation of objective fall risk (37.6%) was determined by lower activity avoidance (OR 0.39), less concerns about falling due to previous falls (OR 0.25), and higher quality of life (OR 1.10), while overestimation (28.9%) was determined by higher rate of support seeking strategies (OR 50.3), activity avoidance (OR 15.2), better executive (OR 21.0) and memory functions (OR 21.5), and lower quality of life (OR.75) in multivariate logistic regression. Conclusion:The majority of patients showed a mismatch between objective and subjective falls risk. Underestimation as well as overestimation of fall risk was associated with specific profiles based on cognitive- and psychological status, falls and fall-related behavioral consequences which should be included in the comprehensive assessment of fall risk, and planning of individualized fall prevention programs for this population.
Keywords: Cognitive impairment, dementia, elderly, fall risk, falls, fear of falling
