A Meta-analysis of the Risk Factors related to Falls among Elderly Patients with Dementia

SunYoung Hong; Heeok Park

doi:10.7469/kjan.2017.29.1.51

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Hong and Park: A Meta-analysis of the Risk Factors related to Falls among Elderly Patients with Dementia

Original Article

Korean J Adult Nurs 2017;29(1):51-62.

Published online: NaN February 2017

DOI: https://doi.org/10.7469/kjan.2017.29.1.51

A Meta-analysis of the Risk Factors related to Falls among Elderly Patients with Dementia

SunYoung Hong, PhD Candidate, RN¹, Heeok Park, Ph.D., RN^2,

^¹Assistant Professor, Department of Nursing, Teagu Science University, Daegu

^²Assistant Professor, College of Nursing, Keimyung University, Daegu, Korea

Corresponding author: Park, Heeok College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Dalseo-gu, Daegu 42601, Korea. Tel: +82-53-580-3924, Fax: +82-53-580-3916, E-mail: hopark@kmu.ac.kr

Received 1 December 201620 February 2017 Accepted 26 February 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to provide data about the risk factors related to falls among elderly patients with dementia using meta-analysis.

Methods

Key words used for search through electronic database (CINAHL, PubMed, Ovid-MEDLINE, RISS, KISS, DBPIA, National Assembly Library) included ‘dementia’, ‘Alzheimer’, ‘fall’. Twenty studies met the inclusion criteria for the meta-analysis and 'R' version 3.2.2 was used to analyze the correlated effect size.

Results

Study results showed that risk factors related to falls were identified as the demographic (age, gender, education), dementia-related (disease duration, cognition), physical (body mass index, walking, balance, activity of daily living, use of walking aids, number of medications including psychotropic drugs, musculoskeletal problems, parkinsonism, comorbidity), psychological (neuropsychiatric symptom, depression), environmental (Physical environment), and fall-related (fall history, high risk group of fall) factors. The effect size of risk factors such as high risk group of fall (r=.35), use of walking aids (r=.33), depression (r=.31), psychotropic drugs (r=.27), Musculoskeletal problems (r=.25) were higher than the other risk factors.

Conclusion

Based on the findings of this study, strategies to improve elderly patient's depression, intensive care for high risk group of fall, and adequate training with walking aids are needed for prevention of falls in elderly patients with dementia.

Keywords: Fall, Dementia, Meta-analysis

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Figure 1.

Flowchart of study.

Figure 2.

Forest plots of the effects size of variables related to falls among elderly patients with dementia.

Table 1.

Characteristics of Studies Included in Meta-analysis

Author (year)	Publication	Sample size	Setting	Risk factors	Quality assessment
Buchner et al-a (1987)	Journal	157	Community	Balance, Number of medications, Musculoskeletal problems	10
Buchner et al-b (1988)	Journal	157	Community	Cognition	9
Nakamura et al (1996)	Journal	97	Nursing home	Age, Disease duration, Cognition, Walking, Musculoskeletal problems	8
Kanemura et al (2000)	Journal	110	Long term facility	Age, Cognition	9
Lowery et al (2000)	Journal	65	Community & Nursing home	Parkinsonism, Physical environment	9
Chung et al (2001)	Journal	182	Nursing home	Age, Gender, Cognition, ADL	8
Bassiony et al (2004)	Journal	326	Community	Age, Cognition, Comorbidity, Neuropsychiatric symptom	9
Camicioli et al (2004)	Journal	42	Long term facility	Age, Cognition, Walking, ADL, Parkinsonism, Comorbidity, Neuropsychiatric symptom, High risk group of fall	9
Horikawa et al (2005)	Journal	104	Outpatient clinic	Age, Gender, Cognition, BMI, Balance, Psychotropic drugs	9
Kudo et al (2009)	Journal	78	Community	Age, Gender, Disease duration, Cognition, Psychotropic drugs, Parkinsonism, Neuropsychiatric symptom	9
Pelfolk et al (2009)	Journal	160	Long term facility	Age, Cognition, Walking, ADL, Use of walking aids, Neuropsychiatric symptom, Depression, High risk group of fall	10
Maggio et al (2010)	Journal	110	Outpatient clinic	Age, Education, Cognition, BMI, ADL, Number of medications, Comorbidity, Neuropsychiatric symptom	8
Kato-Narita et al (2011)	Journal	48	Outpatient clinic	Cognition, Balance, ADL	8
Lee et al (2011)	Journal	159	Community	Age, Education, Cognition, Walking, Balance, ADL, Number of medications, Depression	9
Ryan et al (2011)	Journal	43	Community	Age, ADL, Use of walking aids	9
Salvà et al (2012)	Journal	626	Community	Age, Cognition, BMI, ADL, Neuropsychiatric symptom, Depression, Fall history	10
Suzuki et al (2012)	Journal	135	Long term facility	Cognition, ADL, Number of medications, Neuropsychiatric symptom	8
Schwenk et al (2014)	Journal	77	Long term facility	Age, Gender, Cognition, Walking, ADL, Balance, Comorbidity, Depression, Fall history	9
Eshkoor et al (2014)	Journal	1210	Community	Age, Gender, Education, Walking, Physical environment	8
Lim (2015)	Thesis	252	Long term facility	Age, Disease duration, Cognition, Walking, ADL, Use of walking aids, Psychotropic drugs, Musculoskeletal problems, Parkinsonism, Neuropsychiatric symptom, Depression, Fall history, High risk group of fall	8

ADL=activity of daily living, BMI=body mass index.

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