Farup Per G, Hestad Knut, Engedal Knut
Department of Research and Innovation, Innlandet Hospital Trust, P.O. Box 104, N-2381 Brumunddal, Norway.
Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, N-7491 Trondheim, Norway.
Geriatrics (Basel). 2025 May 28;10(3):74. doi: 10.3390/geriatrics10030074.
BACKGROUND/OBJECTIVES: Old age and cognitive impairment/dementia are risk factors for falling and fall-related injuries. We have, in a previous study in persons with cognitive impairment, shown that falls were associated with frailty, reduced physical fitness, and cognitive reduction. Falls were independent of the disorders causing the impaired functions. Because most falls are innocent, knowledge of predictors of fall-related injuries seems more clinically relevant than the predictors of falls. Predictors of falls and fall-related injuries are not necessarily identical. The aim of this follow-up study to our previous one in the same population was to explore predictors of fall-related injuries in fallers and compare these predictors with those of falls.
This study and our previous study used data from the "The Norwegian Registry of Persons Assessed for Cognitive Symptoms" (NorCog), a Norwegian research and quality registry with a biobank. The registry included consecutive home-dwelling persons referred to Norwegian specialist healthcare units for assessment of cognitive decline. This study included 3774 persons from our previous study who experienced falls last year and compared persons with and without a fall-related injury. A fall-related injury was defined as admittance to a hospital for the injury.
The annual incidence of fall-related injuries in the fallers was 884/3774 (23.4%). Female sex, older age, lower BMI, in need of public health service and walking assistance, and low Hb and Ca were independent predictors of fall-related injuries, indicating reduced physical fitness and state of health and a high burden of comorbidity. Injuries were not associated with the degree of cognitive impairment or the dementia diagnosis.
In home-dwelling persons with impaired cognitive functions and falls, fall-related injuries were associated with reduced physical fitness and state of health. In contrast to predictors of falls, neither the degree of cognitive impairment nor the dementia diagnosis was associated with fall-related injuries. The difference is comprehensible. Persons with cognitive impairment or dementia might have reduced power of judgment and be inattentive, unconcerned and careless, which increases the fall incidence but not the risk of injury once falling. Prevention of fall-related injuries should focus on relieving comorbidities, improving physical fitness and general health rather than on cognitive improvement.
背景/目的：老年以及认知障碍/痴呆是跌倒及跌倒相关损伤的危险因素。在之前一项针对认知障碍患者的研究中，我们发现跌倒与身体虚弱、体能下降以及认知能力减退有关。跌倒与导致功能受损的疾病无关。由于大多数跌倒并无大碍，因此了解跌倒相关损伤的预测因素在临床上似乎比了解跌倒的预测因素更为重要。跌倒和跌倒相关损伤的预测因素不一定相同。本随访研究是我们之前在同一人群中所做研究的后续，旨在探究跌倒者跌倒相关损伤的预测因素，并将这些预测因素与跌倒的预测因素进行比较。
本研究以及我们之前的研究使用了来自“挪威认知症状评估人员登记处”（NorCog）的数据，这是一个拥有生物样本库的挪威研究和质量登记处。该登记处纳入了连续被转介至挪威专科医疗单位进行认知功能减退评估的居家人员。本研究纳入了我们之前研究中的3774名去年有跌倒经历的人员，并比较了有和没有跌倒相关损伤的人员。跌倒相关损伤被定义为因该损伤而住院。
跌倒者中跌倒相关损伤的年发生率为884/3774（23.4%）。女性、年龄较大、体重指数较低、需要公共卫生服务和行走辅助、血红蛋白和钙水平较低是跌倒相关损伤的独立预测因素，表明体能和健康状况下降以及合并症负担较重。损伤与认知障碍程度或痴呆诊断无关。
在认知功能受损且有跌倒情况的居家人员中，跌倒相关损伤与体能和健康状况下降有关。与跌倒的预测因素不同，认知障碍程度和痴呆诊断均与跌倒相关损伤无关。这种差异是可以理解的。认知障碍或痴呆患者可能判断力下降、注意力不集中、漠不关心且粗心大意，这会增加跌倒发生率，但不会增加跌倒后受伤的风险。预防跌倒相关损伤应侧重于缓解合并症、改善体能和总体健康状况，而非改善认知功能。
