title: Fall determinants in older long-term care residents with dementia: a systematic review.
abstract: BACKGROUND
  Persons with dementia are two to three times more likely to fall compared to persons without dementia. In long-term care settings, the dementia prevalence is highest. Therefore, older long-term care residents with dementia can be considered a high-risk group for falls. Nevertheless, no systematic evaluation of fall determinants in this population was found. The purpose of this study was to identify fall determinants among older long-term care residents with dementia or cognitively impaired persons in long-term care, by conducting a systematic literature review.
  
  
  METHODS
  We searched English, French, Dutch, and German articles listed in: CINAHL, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, and Web of Science. Additionally, references of included articles were screened. Studies were included if determinants or circumstances of falls in older persons with dementia living in long-term care were assessed.
  
  
  RESULTS
  Eight studies met the inclusion criteria. Three studies were excluded from detailed analysis because of insufficient quality. Use of psychotropic drugs, a "fair or poor" general health, gait impairments, and age were associated with an increased fall risk. Also trunk restraints were associated with an increased number of falls while full bedrails and wandering behavior were protective against falls.
  
  
  CONCLUSIONS
  Fall risk factors known from other populations, e.g. use of psychotropic drugs, physical restraints, and health conditions, are found in long-term care residents with dementia as well. Due to the limited evidence available, future studies with adequate sample sizes and prospective designs are required to determine specific fall risk factors and verify existing results in this population.
authors.affiliation: Department for Health Services Research, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, the Netherlands. t.kroepelin@student.maastrichtuniversity.nl
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Kröpelin
authors.forename: Jacques C L
authors.initials: JC
authors.lastname: Neyens
authors.forename: Ruud J G
authors.initials: RJ
authors.lastname: Halfens
authors.forename: Gertrudis I J M
authors.initials: GI
authors.lastname: Kempen
authors.forename: Jan P H
authors.initials: JP
authors.lastname: Hamers
mesh_terms: D000058:Accidental Falls; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis / Q000523:psychology; D003704:Dementia / Q000188:drug therapy*; D005260:Female; D005684:Gait; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011619:Psychotropic Drugs / Q000009:adverse effects* / Q000627:therapeutic use; D012149:Restraint, Physical; D012307:Risk Factors
chemical_list: D011619:Psychotropic Drugs