Specific motor and cognitive performances predict falls during ward-based geriatric rehabilitation in patients with dementia

• Verfasst von: Hauer, Klaus [VerfasserIn]
• Verfasst von: Dutzi, Ilona [VerfasserIn]
• Verfasst von: Gordt-Oesterwind, Katharina [VerfasserIn]
• Verfasst von: Schwenk, Michael [VerfasserIn]
• Titel: Specific motor and cognitive performances predict falls during ward-based geriatric rehabilitation in patients with dementia
• Verf.angabe: Klaus Hauer, Ilona Dutzi, Katharina Gordt and Michael Schwenk
• E-Jahr: 2020
• Jahr: 20 September 2020
• Umfang: 17 S.
• Titel Quelle: Enthalten in: Sensors
• Ort Quelle: Basel : MDPI, 2001
• Jahr Quelle: 2020
• Band/Heft Quelle: 20(2020,18) Artikel-Nummer 5385, 17 Seiten
• ISSN Quelle: 1424-8220
• DOI: doi:10.3390/s20185385
• Datenträger: Online-Ressource
• Sprache: eng
• Sach-SW: dementia
• Sach-SW: discriminative validity
• Sach-SW: fall prediction
• Sach-SW: hospitalization
• Sach-SW: instrumented motor assessment
• Sach-SW: neuro-psychological assessment
• Sach-SW: predictive validity
• K10plus-PPN: 1734510552

Abstract

The aim of this study was to identify in-hospital fall risk factors specific for multimorbid hospitalized geriatric patients with dementia (PwD) during hospitalization. Geriatric inpatients during ward-based rehabilitation (n = 102; 79.4% females; 82.82 (6.19) years of age; 20.26 (5.53) days of stay) were included in a comprehensive fall risk assessment combining established clinical measures, comprehensive cognitive testing including detailed cognitive sub-performances, and various instrumented motor capacity measures as well as prospective fall registration. A combination of unpaired t-tests, Mann&ndash;Whitney-U tests, and Chi-square tests between patients with (&ldquo;in-hospital fallers&rdquo;) and without an in-hospital fall (&ldquo;in-hospital non-fallers&rdquo;), univariate and multivariate regression analysis were used to explore the best set of independent correlates and to evaluate their predictive power. In-hospital fallers (n = 19; 18.63%) showed significantly lower verbal fluency and higher postural sway (p < 0.01 to 0.05). While established clinical measures failed in discriminative as well as predictive validity, specific cognitive sub-performances (verbal fluency, constructional praxis, p = 0.01 to 0.05) as well as specific instrumented balance parameters (sway area, sway path, and medio-lateral displacement, p < 0.01 to 0.03) significantly discriminated between fallers and non-fallers. Medio-lateral displacement and visuospatial ability were identified in multivariate regression as predictors of in-hospital falls and an index combining both variables yielded an accuracy of 85.1% for fall prediction. Results suggest that specific cognitive sub-performances and instrumented balance parameters show good discriminative validity and were specifically sensitive to predict falls during hospitalization in a multimorbid patient group with dementia and an overall high risk of falling. A sensitive clinical fall risk assessment strategy developed for this specific target group should include an index of selected balance parameters and specific variables of cognitive sub-performances.