A Meta-Analysis of Fall Risk in Older Adults With Alzheimer's Disease

Prevalence and risk factors of falls in people on hemodialysis: a systematic review and meta-analysis

OBJECTIVES

This study aims to systematically quantify the prevalence of falls in people on hemodialysis and to assess risk factors associated with falls by synthesizing emerging best evidence.

METHODS

A comprehensive search was conducted across ten databases from their inception to February 27, 2025. The research team independently conducted study selection, quality assessments, data extraction, and analyses of all included studies. Meta-analysis was performed using random-effects and fixed-effects models. The PRISMA guidelines were used to report the systematic review and meta-analysis.

RESULTS

A total of 31 studies, comprising 191,800 individuals, were included in the analysis. The pooled prevalence of falls in people on hemodialysis was 27.1%. The meta-analysis of risk factors included 19 studies. After controlling for confounding variables, 12 risk factors were associated with falls, including older age, female gender, longer dialysis duration, diabetes mellitus, peripheral vascular disease, paralysis, antidepressant use, frailty, use of walking aids, malnutrition, intradialytic hypotension, and low hemoglobin levels.

CONCLUSIONS

This study provides an updated, evidence-based assessment of the prevalence and risk factors of falls in people on hemodialysis, confirming their multifactorial etiology. Screening and interventions should be implemented promptly to mitigate the adverse outcomes of falls in people on hemodialysis.

REGISTRATION NUMBER

PROSPERO CRD42024525375.

Risk of Home Falls Among Older Adults After Acute Care Hospitalization: A Cohort Study

BACKGROUND

Acute care hospitalization has been associated with older adult home falls after discharge, but less is known about the effects of hospital- and patient-related factors on home fall risk.

OBJECTIVES

This study compares the effects of hospital length of stay, medical condition, history of falls, and home health care on period rates of home falls after discharge from acute care hospitalization.

METHODS

This was a retrospective cohort study comparing period rates of home injury falls among older adults (age ≥ 65) occurring after discharge from an acute care hospitalization. Data were collected from state health care utilization administrative records between January 1, 2016, and December 31, 2018. We used log-linear Poisson regression to model post-discharge injury fall incidence rates as a function of days since discharge and patient-level covariates.

RESULTS

A total of 736,230 older adults were included in the study cohort. Absolute risk for post-discharge home falls was 7%. Fall rates were highest the first week after discharge at 0.05 per 100 person-days, with a period incidence rate 74.29 times higher than the >90-day discharge period. Fall risk increased with age, with the highest risk in the ≥85 age group. Fall risk increased for a 2-day hospital stay but decreased for 5- to 30-day stays, compared to a 1-day length of stay. Discharge to home health care and history of falls were associated with increased risk.

CONCLUSIONS

Older adults are at highest risk for a home fall the first 7 days after discharge from acute care hospitalization. These findings describe patient-related risk factors that acute care hospitals can use to develop geriatric-specific discharge guidelines intended to reduce home fall risk during the early care transition to home.

Alzheimer's Disease: Understanding Motor Impairments

Alzheimer's disease (AD), the most prevalent neurodegenerative disorder and the leading cause of dementia worldwide, profoundly impacts health and quality of life. While cognitive impairments-such as memory loss, attention deficits, and disorientation-predominate in AD, motor symptoms, though common, remain underexplored. These motor symptoms, including gait disturbances, reduced cardiorespiratory fitness, muscle weakness, sarcopenia, and impaired balance, are often associated with advanced stages of AD and contribute to increased mortality. Emerging evidence, however, suggests that motor symptoms may be present in earlier stages and can serve as predictive markers for AD in older adults. Despite a limited understanding of the underlying mechanisms driving these motor symptoms, several key pathways have been identified, offering avenues for further investigation. This review provides an in-depth analysis of motor symptoms in AD, discussing its progression, potential mechanisms, and therapeutic strategies. Addressing motor symptoms alongside cognitive decline may enhance patient functionality, improve quality of life, and support more comprehensive disease management strategies.

Meta-Analysis-Based Comparison of Annual Fall Risk between Older Adults with Alzheimer's Disease and Mild Cognitive Impairment

Background

Falls are a primary cause of injuries and hospitalization in older adults. It has been reported that cognitive impairments and dementia can increase fall risk in the older population; however, it remains unknown if fall risk differs among subgroups of dementia. This meta-analysis summarized previous studies reporting the annual fall risk of people with Alzheimer's disease (AD) or mild cognitive impairment (MCI) and compared the fall risk between these two groups of people with dementia.

Methods

Thirty-five studies enrolling 7844 older adults with AD or MCI were included. The annual fall prevalence and average number of falls of the included studies were meta-analyzed and compared by random-effects models with inverse variance weights.

Results

The annual fall prevalence in people with AD (43.55%) was significantly higher than MCI (35.26%, p < 0.001). A χ2 test indicated that the pooled fall prevalence is significantly higher in people with AD than MCI χ2 = 158.403, p < 0.001). Additionally, the yearly average number of falls in AD was higher than in MCI (1.30 vs 0.77 falls/person).

Conclusions

The results showed that older people with AD experience a higher annual fall prevalence with a larger number of falls than older adults with MCI. The results suggested that the fall risk measurements should be reported separately between people with AD and MCI. The findings could provide preliminary guidance for the identification of individuals with dementia who experience a high fall risk.