University of Oulu

Hanna-Maria Roitto, Hannareeta Öhman, Karoliina Salminen, Hannu Kautiainen, Jouko Laurila, Kaisu H. Pitkälä, Neuropsychiatric Symptoms as Predictors of Falls in Long-Term Care Residents With Cognitive Impairment, Journal of the American Medical Directors Association, Volume 21, Issue 9, 2020, Pages 1243-1248, ISSN 1525-8610,

Neuropsychiatric symptoms as predictors of falls in long-term care residents with cognitive impairment

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Author: Roitto, Hanna-Maria1,2; Öhman, Hannareeta1,2; Salminen, Karoliina1;
Organizations: 1Department of General Practice, University of Helsinki, Helsinki, Finland
2Department of Social Services and Health Care, Helsinki Hospital, Helsinki, Finland
3Unit of Primary Health Care, Helsinki University Hospital, Helsinki, Finland
4Center for Life-Course Health Research, University of Oulu, Oulu, Finland
Format: article
Version: accepted version
Access: open
Online Access: PDF Full Text (PDF, 0.1 MB)
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Language: English
Published: Elsevier, 2020
Publish Date: 2022-03-01


Objectives: Falls and neuropsychiatric symptoms (NPS) are common among long-term care residents with cognitive impairment. Despite the high prevalence of falls and NPS, little is known about their association. The aim of our study was to explore how NPS, particularly the severity of NPS and specific NPS subgroups, are associated with falls and how psychotropics modify this association.

Design: Longitudinal cohort study.

Setting and Participants: In total, 532 long-term care residents aged 65 years or older in Helsinki, Finland.

Methods: NPS were measured with Neuropsychiatric Inventory (NPI) at baseline. Participants were grouped into 3 groups: no significant NPS (NPI points 0‒3), low NPS burden (NPI 4‒12), and high NPS burden (NPI >12). The number of falls, injuries, fractures, and hospitalizations were collected from medical records over 12 months following baseline assessment.

Results: Altogether, 606 falls occurred during the follow-up year. The falls led to 121 injuries, 42 hospitalizations, and 20 fractures. Falls and injuries increased significantly with NPS burden (P < .001): 330 falls in the high NPS group (n = 184), 188 falls in the low NPS group (n = 181), and 88 falls in the no significant NPS group (n = 167). The risk of falling showed a curvilinear association with NPI total score. Of NPS subgroups, psychosis and hyperactivity were associated with a higher incidence rate ratio of falls, whereas apathy had a protective association even after adjustment for age, sex, and mobility. Affective symptoms were not associated with falls. Psychotropics did not modify the association between NPS burden and falls.

Conclusions and Implications: The results of this study show that NPS, especially NPS severity, may predict falls and fall-related negative consequences. Severity of NPS should be taken into account when assessing fall risk in long-term care residents with cognitive impairment.

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Series: Journal of the American Medical Directors Association
ISSN: 1538-9375
ISSN-E: 1525-8610
ISSN-L: 1538-9375
Volume: 21
Issue: 9
Pages: 1243 - 1248
DOI: 10.1016/j.jamda.2020.04.003
Type of Publication: A1 Journal article – refereed
Field of Science: 3124 Neurology and psychiatry
Copyright information: © 2020. This manuscript version is made available under the CC-BY-NC-ND 4.0 license by