Mortality following ground-level falls in trauma patients with dementia

Objective Dementia and falls are strongly associated, yet few studies have investigated outcomes in patients with dementia after falling. We evaluated differences in mortality, defined as in-hospital mortality or discharge to hospice, and additional outcomes in ground-level fall (GLF) patients with and without dementia. Methods Patients ≥65 years old were identified from the National Trauma Data Bank (2019–2022). Preliminary analyses examined characteristics between patients with and without pre-existing cases of dementia, documented at hospital admission. Upon identifying GLFs as the leading cause of hospital admission in patients with dementia, 1:1 propensity score-matched (PSM) models were used to examine outcomes in GLF patients with and without dementia. Results A total of 1 789 794 patients were included in the preliminary sample and 286 648 (16.0%) had dementia. Of 286 648 patients with dementia, 53.6% were admitted for GLFs. The PSM population consisted of 151 577 matched pairs of GLF patients with and without dementia. After matching, patients with dementia had significantly greater mortality (9.8% vs 6.3%, absolute risk difference (ARD) (95% CI) 3.5 percentage points (3.3 to 3.7); p<0.001) compared with patients without dementia. The proportion of patients with in-hospital mortality no longer significantly differed, but discharge to hospice remained significantly greater in patients with dementia (6.2% vs 2.7%, ARD (95% CI) 3.5 percentage points (3.3 to 3.7); p<0.001) compared with those without dementia. A greater proportion of patients with dementia were discharged to skilled nursing facilities or long-term care hospitals (40.6% vs 37.5%, p<0.001) and less were discharged to inpatient rehab or short-term care facilities (12.2% vs 18.1%, p<0.001) compared with those without dementia. Conclusions Findings from this retrospective study provide strong evidence that GLFs pose a significant health risk to patients with dementia. Implementing routine cognitive, exercise and fall-risk assessments in this population is needed. Level of evidence III.