The association between delirium and falls in older adults in the community: a systematic review and meta-analysis

Eost-Telling, Charlotte; McNally, Lucy; Yang, Yang; Shi, Chunhu; Norman, Gill; Ahmed, Saima; Poku, Brenda; Money, Annemarie; Hawley-Hague, Helen; Todd, Chris J.; Shenkin, Susan Deborah; Vardy, Emma R.L.C.

Abstract

Objective. Systematically review and critically appraise the evidence for the association between delirium and falls in community-dwelling adults aged ≥60years. Methods. We searched EMBASE, MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Evidence-Based Medicine Reviews databases in April 2023. Standard methods were used to screen, extract data, assess risk of bias (using Newcastle–Ottawa scale), provide a narrative synthesis and, where appropriate, conduct meta-analysis. Results. We included 8 studies, with at least 3505 unique participants. Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (risk ratio 6.66; 95% confidence interval (CI) 2.16–20.53), but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled odds ratio 2.01; 95% CI 1.52–2.66); one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns. Conclusions. We found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship and establish how and why this operates bidirectionally. Studies must consider confounding factors such as dementia, frailty and comorbidity in their design, to identify potential modifying factors involved. Clinicians should be aware of the potential relationship between these common presentations.

Citation

Eost-Telling, C., McNally, L., Yang, Y., Shi, C., Norman, G., Ahmed, S., Poku, B., Money, A., Hawley-Hague, H., Todd, C. J., Shenkin, S. D., & Vardy, E. R. (2024). The association between delirium and falls in older adults in the community: a systematic review and meta-analysis. Age and Ageing, 53(12), Article afae270. https://doi.org/10.1093/ageing/afae270

• Journal Article Type: Article
• Acceptance Date: Nov 11, 2024
• Online Publication Date: Dec 17, 2024
• Publication Date: 2024-12
• Deposit Date: Jan 7, 2025
• Publicly Available Date: Jan 8, 2025
• Journal: Age and Ageing
• Print ISSN: 0002-0729
• Electronic ISSN: 1468-2834
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 53
• Issue: 12
• Article Number: afae270
• DOI: https://doi.org/10.1093/ageing/afae270
• Keywords: delirium, falls, community, systematic review, older adults, older people
• Public URL: https://nottingham-repository.worktribe.com/output/43212014
• Publisher URL: https://academic.oup.com/ageing/article/53/12/afae270/7926160