Is Fall Risk Systematically Evaluated in Memory Clinics? A National Survey of Practice in France

Article type: Research Article

Authors: Leroy, Victoire^{a; b} | Chen, Yaohua^{b; c; d; *} | Demnitz, Naiara^d | Pasquier, Florence^c | Krolak-Salmon, Pierre^{e; f} | Fougère, Bertrand^{a; g} | Puisieux, Françcois^{b; h}

Affiliations: [a] Division of Geriatric Medicine, Tours University Hospital, Tours, France | [b] Department of Geriatrics, CHU Lille, Lille, France | [c] University Lille, Inserm UMR-S 1172, Vascular and Degenerative Cognitive Disorders, CHU Lille, Memory Clinic, Distalz, Licend, Lille, France | [d] Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland | [e] Hospices Civils de Lyon, Lyon Institute for Elderly, I-Vie, INSERM 1048, University Hospital of Lyon, Lyon, France | [f] University of Lyon, Lyon, France | [g] Education, Éthique, Santé (EA 7505), Tours University, Tours, France | [h] University Lille, EA2694, Lille, France

Correspondence: [*] Correspondence to: Dr. Yaohua Chen, Univ Lille CHU Lille, U1172, Memory Clinic and Department of Geriatrics, F-59000 Lille, France. Tel.: +0033320446021; E-mail: yaohua.chen@chru-lille.fr.

Abstract: Background:Falls are a major health problem in older persons but are still under-diagnosed and challenging to prevent. Current guidelines do not target high-risk populations, especially people living with dementia. In France, people with neurocognitive disorders are mainly referred to memory clinics (MCs). Objective:We aimed to survey the routine practice of physicians working in MCs regarding fall risk assessment. Methods:We conducted a cross-sectional survey in France from January to May 2019 among physicians working in MCs, through an anonymous online questionnaire: twenty-seven questions about the physician’s background and their practice of fall risk assessment, especially use of clinical and paraclinical tools. We compared the results according to the age and the specialty of the physician. Results:We obtained 171 responses with a majority of women (60%) and geriatricians (78%). All age classes and all French regions were represented. Most of respondents (98.8%) stated that they address gait and/or falls in outpatient clinic and 95.9%in day hospitals. When asked about how they assess fall risk, fall history (83%) and gait examination (68.4%) were the most widely used, while orthostatic hypotension (24%) and clinical standardized tests (25.7%) were less common. Among standardized tests, One-leg Balance, Timed Up and Go Test, and gait speed measurements were the most used. Geriatricians had more complete fall risk assessment than neurologists (e.g., 56%versus 13%for use of standardized tests, p < 0.0001). Conclusion:Almost all physicians addressed the question of fall in MC, but practices are widely heterogeneous. Further investigations are needed to standardize fall risk assessment in MCs.

Keywords: Assessment, fall risk, memory clinic, routine practice, survey

DOI: 10.3233/JAD-201585

Journal: Journal of Alzheimer's Disease, vol. 81, no. 4, pp. 1483-1491, 2021