Pilot study into impaired judgement, self-toileting behaviour in fallers and non-fallers

Falls are a significant cause of morbidity and mortality in older people. There is an increased frequency of falls in older adults with cognitive impairment and dementia which may be due to impaired judgement of self capability to mobilise safely. This case control study assessed 53 Aged Care subjects aged 75+ years that were hospitalised post fall, from January 2008-December 2009, and compared these subjects' responses to those of 26 non-fallers to a standard question: 'While you are in the hospital, what would you do if you need to go to the toilet later?' This hypothetical scenario question was designed to assess judgement based on self-toileting behaviour and mobility. The study group and control group were similar in age (83.9 ± 4.7 vs. 82.0 ± 4.6 years respectively, p = 0.081) but the study group had statistically lower MMSE results when compared to controls (median 23 vs. 26.5 respectively, p = 0.031). Impaired judgement, defined as an unsafe/inappropriate response to the scenario question, was significantly more prevalent in the study group (fallers) compared to the control group (non-fallers) (41.5 vs. 15.4 %, p = 0.020). Impaired judgement was also more common with lower MMSE scores with 80.9 % of unsafe/inappropriate responses given by participants with MMSE of ≤20. The authors suggest there may be an association between impaired judgement, evidenced by responses to a standardised question, and falls history in older subjects, particularly in those with cognitive impairment or dementia. Ultimately, this may lead to identification of people at increased risk of falls and possibly effective falls prevention strategies in this population.