Injurious falls before, during, and after dementia diagnosis: A population‐based study.

Background: Falls are common among older adults with dementia, but the timing of incident injurious falls at different stages of dementia diagnosis is unclear. We aimed to examine injurious falls before, during, and after dementia diagnosis to detect when the occurrence of falls starts to increase prior to dementia onset, when people with dementia are at highest risk of falls, and which factors are associated with falls among people with dementia. Method: This study included 4874 participants aged ≥55, consisting of 2437 incident dementia cases detected in a dementia‐free cohort from the Swedish Twin Registry and 2437 1:1 matched (i.e., same birth year and sex) non‐demented controls from the cohort. Dementia diagnosis and date of onset were identified from the National Patient Registry (NPR) and the Swedish Cause of Death Register. Information on injurious falls, including date of occurrence and history of chronic disease, was obtained from the NPR. Data on demographics, lifestyle, and anthropometrics were collected through a self‐reported questionnaire. Data were analyzed using conditional Poisson regression and generalized estimating equation (GEE) models. Result: In Poisson regression analysis, the adjusted incidence rates of injurious falls among dementia cases and controls were similar (around 3.65‐9.08 per 1,000 person‐years) in the 6‐10 years preceding dementia diagnosis. Compared to controls, the incidence of falls in dementia cases started to increase beginning 5 years prior to dementia diagnosis (incidence rate ratio [IRR] 1.50, 95% confidence interval [CI] 1.11‐2.03), reaching a peak (IRR 3.37, 95% CI 2.85–3.97) in the year of dementia diagnosis, and declining rapidly 3 years after dementia diagnosis (IRR 1.38, 95% CI 1.05–1.79). In multi‐adjusted GEE models, alcohol consumption, living alone, and stroke were significantly associated with incident falls among people with dementia. Conclusion: Compared to dementia‐free people, those with dementia have a greater incidence of injurious falls that increases in the 5 years leading up to dementia diagnosis and peaks during the year of dementia diagnosis. Alcohol consumption, living alone, and stroke may predict falls among people with dementia. Our findings highlight the importance of a tailored preventive strategy against falls among people with dementia, especially in the diagnosis stage. [ABSTRACT FROM AUTHOR]