The Hidden Link Between Delirium and Falls in Older Adults
Falls are a significant health risk for older adults, but a lesser-known factor—delirium—may make them even more dangerous. While research has focused on delirium and falls in hospital settings, where delirium screening is part of the recommended falls pathway, the connection in community settings remains less understood.
A recent review led by researchers funded by the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM) at the University of Manchester, in collaboration with researchers from the Universities of Edinburgh, Glasgow, and Nottingham, aims to address this gap.
Published in Age and Ageing, the review explores the link between delirium and falls in older adults living in the community, shedding light on an important issue that could help prevent serious injuries.
Delirium is a sudden change in mental state that can cause confusion, disorientation, and difficulty concentrating. It can be triggered by infections, medications, or other medical conditions.
Unlike dementia, which develops gradually, delirium comes on suddenly and can fluctuate throughout the day. It is a serious condition that increases the risk of hospitalisation, long-term cognitive decline, and even death.
Unfortunately, delirium is often underdiagnosed, particularly in community settings where people live independently or in residential care. It is frequently mistaken for dementia, depression, or simply forgetfulness.
The review, which included data from over 3,500 community-dwelling participants aged 60 and older, examined two key questions:
- Does experiencing delirium increase the likelihood of future falls?
- Does falling increase the risk of developing delirium?
The findings revealed:
- Delirium may increase fall risk: One study found a significant increase in falls among individuals with delirium, with a risk ratio of 6.66 (95% CI: 2.16–20.53), though the evidence was rated as low certainty due to study limitations.
- Falls may increase delirium risk: A meta-analysis of three studies found that individuals who had fallen were twice as likely (OR 2.01, 95% CI: 1.52–2.66) to develop delirium later.
A key limitation identified in the review was the presence of confounding factors such as dementia, frailty, and medication use, which many studies did not adequately account for. This makes it difficult to establish a clear causal link. Future research should focus on using more rigorous methodologies to isolate the independent effects of delirium and falls.
These findings are significant because falls are a leading cause of serious injury in older adults, leading to thousands of hospital admissions each year. Delirium, however, often goes unnoticed until it leads to more severe problems. Recognising the link between delirium and falls could help clinicians and caregivers take proactive steps to prevent both conditions. Identifying older adults at risk of delirium may also help reduce their risk of falling—and vice versa.
While the review provides valuable insights, more high-quality research is needed to fully understand how delirium and falls are connected. Future studies should focus on identifying specific risk factors, developing better prevention strategies, and ensuring that both medical professionals and caregivers are equipped to address this issue.
Understanding and managing the connection between delirium and falls in community settings can help older adults stay safer, healthier, and more independent for longer.
Dr Charlotte Eost-Telling, Research Fellow in the NIHR ARC-GM Healthy Ageing Theme, said:
"Our review highlights a potentially bidirectional relationship between delirium and falls, but the current evidence remains limited, and there is still a lot we don’t fully understand. We need more methodologically robust studies to clarify the causal pathways and help develop targeted interventions that reduce risk in vulnerable older populations. Clinicians need to consider delirium as a key factor in fall risk, especially in older adults living in the community. Delirium isn’t just a hospital issue, and early detection and intervention could make a real difference in preventing falls and improving patient outcomes."
Read the paper in full here: https://doi.org/10.1093/ageing/afae270 [doi.org]
Published: 05/03/2025