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Korean J Adult Nurs : Korean Journal of Adult Nursing

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Original Article

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

SunYoung Hong, PhD Candidate, RN1, Heeok Park, Ph.D., RN2
Korean Journal of Adult Nursing 2017;29(1):51-62.
Published online: February 28, 2017

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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: December 1, 2016   • Accepted: February 26, 2017

Copyright © 2017 Korean Society of Adult Nursing

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.

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  • 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.
  • Key Words: Fall; Dementia; Meta-analysis
Figure 1.
Flowchart of study.
kjan-29-51f1.jpg
Figure 2.
Forest plots of the effects size of variables related to falls among elderly patients with dementia.
kjan-29-51f2a.jpgkjan-29-51f2b.jpg
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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    Citations to this article as recorded by  
    • Development and Effects of a Person-Centered Fall Prevention Program for Older Adults with Dementia in Long-Term Care Hospitals: For Older Adults with Dementia and Caregivers in Long-Term Care Hospitals
      Jeong Ok Lim, Mee Ock Gu
      Journal of Korean Academy of Nursing.2022; 52(3): 341.     CrossRef
    • Understanding and Prevention of Fall-related Injuries in Older Adults in South Korea: A Systematic Review
      Ki-taek Lim, Ji-eun Lee, Ha-eun Park, Su-young Park, Woochol Joseph Choi
      Physical Therapy Korea.2019; 26(2): 34.     CrossRef

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    A Meta-analysis of the Risk Factors related to Falls among Elderly Patients with Dementia
    Korean J Adult Nurs. 2017;29(1):51-62.   Published online February 28, 2017
    DOI: https://doi.org/10.7475/kjan.2017.29.1.51
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    A Meta-analysis of the Risk Factors related to Falls among Elderly Patients with Dementia
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    DOI: https://doi.org/10.7475/kjan.2017.29.1.51
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    A Meta-analysis of the Risk Factors related to Falls among Elderly Patients with Dementia
    Image Image
    Figure 1. Flowchart of study.
    Figure 2. Forest plots of the effects size of variables related to falls among elderly patients with dementia.

    Figure 1.

    Figure 2.

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

    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.
    Table 1. Characteristics of Studies Included in Meta-analysis

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

    Table 1.

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