The association between delirium and falls in older adults in the community: a systematic review
What did we do?
Both delirium and falls are common in older people. They share many common risk factors including older age, previous history of cognitive impairment, sensory impairment and use of multiple medications. A systematic review exploring the overlap between falls and delirium in hospital published in 2019 showed that there is a two-way relationship between these conditions and they frequently occurred together. There has been no similar review of falls in community settings in relation to delirium. The aim of this project was to examine the association between delirium and falls in the community and to identify robust evidence to inform practice
Why was this important?
The prevalence of delirium in the community is between 1–2% and may be as high as 14% in people aged over 85 years, but it is often underdiagnosed or misdiagnosed. Falls in the community are a major issue, affecting 1 in 3 community dwelling adults older than 65 and nearly half of those over 80. We wanted to know if an increase in delirium mirrored an increase in falls. Our aim was to systematically examine the evidence on the association between delirium and falls. We hope this will contribute to enhanced detection, patient assessment and care. By detecting and treating delirium early, there is a potential to prevent hospital admissions related to falls.
How did we do it?
We systematically reviewed the available evidence about delirium and falls in older people with the aim of identifying any association between them. We carried out a detailed search of a range of databases for any published studies that:
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Included adults aged 60+ years living in community or supported living/residential care settings (hospital inpatient settings were excluded)
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Reported evidence on the association between delirium and falls variables, regardless of which happened first
The systematic review was registered on PROSPERO https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022309982
What did we find?
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We found a limited amount of evidence that an increase in delirium is associated with an increase in falls. Also that an increase in falls is associated with an increase in delirium.
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We cannot tell if delirium causes falls, or falls cause delirium, but the risk does rise together.
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It is often not clear how long before or after a fall delirium occurs.
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The relationship between delirium and falls is complex and more work is needed to understand this.
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History of both falls and delirium should be taken when assessing an older person after a fall or delirium episode and the community.
Who are we working with?
More information
Programme Manager
Gill Rizzello
gill.rizzello@manchester.ac.uk