With Alzheimers Disease Fall? Falls In The FINALEX Study Niko - - PowerPoint PPT Presentation

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Sep 01, 2022 185 likes •337 views

How Do Community-dwelling Persons With Alzheimers Disease Fall? Falls In The FINALEX Study Niko Perttila University of Helsinki CONFLICT OF INTEREST DISCLOSURE I have no potential conflict of interest to report Falls and dementia 60 %

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How Do Community-dwelling Persons With Alzheimer’s Disease Fall? Falls In The FINALEX Study

Niko Perttila University of Helsinki

SLIDE 2

CONFLICT OF INTEREST DISCLOSURE

I have no potential conflict of interest to report

SLIDE 3

Falls and dementia

60 % of people with dementia fall annually
Few studies have investigated falls among participants with

dementia

SLIDE 4

To investigate how community-dwelling

persons with Alzheimer’s disease (AD) fall

– When? Why? How? Consequences?

FINALEX study was 1-year RCT exercise

intervention study among AD patients

– Home-based/group-based exercise (N=129) 2x/wk – Controls: normal community care (N=65)

Aim and introduction

SLIDE 5

Methods

Participants in the FINALEX study:

– Alzheimer Disease – An ability to walk independently with/without mobility aid – Sign of frailty:

≥1 fall / previous 12 months OR
unintentional weight loss OR
slow gait speed

Pitkala et al. JAMA Intern Med. 2013 ;173:894-901.

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Participants’ (N=194) falls were followed up for one year by diaries kept by

their spouses.

Groups formed for participants with 0 (N=103), 1 (N=34) and ≥2 (N=57)

falls

We investigated various features and risk factors behind the falls.

Methods

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Results: Falls: when, why, consequences

Altogether 355 falls:
Half of them at midday, rest equally during morning, evening, and

night time

The most common reasons for falls were stumbling (N=61),

dizziness (N=37), and weakness of legs (N=18)

In most cases, the spouses were unable to state the reason for

falling

Of 355 falls, 123 led to injuries, 50 to emergency department visits,

and 13 to fractures

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Results: Associated baseline risk factors for falls

0 falls N=103 1 fall N=34 ≥2 falls N=57 P for linearity* Age, mean (SD) 77 (5) 78 (6) 80 (4) 0.003 MNA, mean (SD) 23 (2) 23 (1) 22 (3) 0.037 Blood pressure, systolic 153 (24) 154 (28) 143 (27) 0.016 CDR, n (%) <0.001 0.5-1 44 (43) 12 (35) 10 (18) 2 47 (46) 17 (50) 31 (54) 3 12 (12) 5 (15) 16 (28) FIM total, mean (SD) 92.6 (17.3) 92.0 (14.0) 77.2 (18.6) <0.001 SPPB total, mean (SD) 10.2 (2.1) 9.7 (1.8) 8.7 (2.4) <0.001 Vision problem, n (%) 6 (6) 2 (6) 9 (16) 0.042 Fall history, n (%) 32 (31) 38 (24) 35 (61) <0.001

SD = standard deviation; MNA = Mini Nutritional Assessment; CDR = Clinical Dementia Rating scale; FIM = Functional Independence Measure; SPPB = Short Physical Performance Battery

No significant difference: Intervention, gender, education, BMI, Diastolic blood pressure, Charlson comorbidity index

Perttila et al. Dement Geriatr Cogn Dis Extra 2017 Jun 19;7(2):195-203.

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Results: MMSE / polypharmacy vs. falls

MMSE

5 10 15 20 25 30

Incidence of falls per person years

0,0 0,5 1,0 1,5 2,0 2,5 3,0

Number of drugs

2 4 6 8 10 12 14 16 18 20

Incidence of falls per person years

0,0 0,5 1,0 1,5 2,0 2,5 3,0

A B

Incidence of falls per person years Incidence of falls per person years Number of drugs Mini Mental State Examination score

Perttila et al. Dement Geriatr Cogn Dis Extra 2017 Jun 19;7(2):195-203.

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Falls: Protective and risk factors for falls

IRR (per 1-SD)

0,2 0,3 0,4 0,5 0,6 0,7 0,8 0,9 1,0 1,1 1,2 FIM mot SPPB Up&Go Walking speed Balance MNA

IRR

0,5 1,0 1,5 2,0 2,5 3,0 3,5 4,0 4,5 5,0 Osteoarthritis Heart failure DM CHD Claudication COPD Myocardial infarction Stroke Hypertension Cancer

IRR

0,5 1,0 1,5 2,0 2,5 3,0 3,5 4,0 4,5 5,0 5,5 6,0 6,5 7,0 Opioid Psychotropic Anticholinergic drug Antihypertensive

A B C Perttila et al. Dement Geriatr Cogn Dis Extra 2017 Jun 19;7(2):195-203.

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Strenghts

Participants had confirmed diagnosis of

Alzheimer’s Disease

Diary is the best method to accurately record falls
Prospective and detailed follow-up

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The participants were motivated caucasians

living at home with their spouses - generalization?

The number of participants was small
Intervention reduced the number of falls

– the number of falls is underestimate of real life – modifying falls also?

Limitations

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Alzheimer’s Disease patients have increased fall risk
Polypharmacy, anticholinergic drugs, psychotropics, and
pioids increase the fall risk – confounding by indication?
Individuals with MMSE ~10 are at greatest risk
COPD, diabetes, osteoarthritis increase fall risk
Good physical functioning protects against falls
In this study hypertension and antihypertensive medication

were protective factors –mechanism?

Conclusions

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Co-workers: Hanna Öhman Timo Strandberg Hannu Kautiainen Minna Raivio Marja-Liisa Laakkonen Nina Savikko Reijo Tilvis Kaisu Pitkala This study was supported by: the Social Insurance Institution of Finland, the Central Union for the Welfare of the Aged, the Sohlberg Foundation, King Gustaf V and Queen Victoria’s Foundation, Paulo Foundation, The Finnish Medical Foundation, The Finnish Association for General Practice, Finnish foundation Avohoidon tutkimussäätiö, University of Helsinki chancellor's travel grant Thank you! Merci!