{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T10:20:52Z","timestamp":1792837252225,"version":"4.5.0"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"Importance<\/jats:title>Emerging evidence suggests that mild cognitive impairment, which is a precursor to Alzheimer disease and related dementias (ADRD), places older adults at increased risk for falls. However, the risk that an older adult develops dementia after experiencing a fall is unknown.<\/jats:p><\/jats:sec>Objective<\/jats:title>To determine the risk of new ADRD diagnosis after a fall in older adults.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective cohort study examined Medicare Fee-for-Service data from 2014 to 2015, with follow-up data available for at least 1 year after the index encounter. Participants included adults aged 66 years and older who experienced a traumatic injury that resulted in an emergency department (ED) or inpatient encounter and did not have a preexisting diagnosis of dementia. Data analysis was performed from August 2023 to July 2024.<\/jats:p><\/jats:sec>Exposures<\/jats:title>Experiencing a fall compared with other mechanisms of injury, defined by International Classification of Diseases, Ninth Revision (ICD-9)<\/jats:italic> and ICD-10<\/jats:italic> external cause of injury codes.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The hazard of new ADRD diagnosis within 1 year of a fall, assessed by performing a Cox multivariable competing risk model that controlled for potential confounders while accounting for the competing risk of death.<\/jats:p><\/jats:sec>Results<\/jats:title>The study included 2\u202f453\u202f655 older adult patients who experienced a traumatic injury; 1\u202f522\u202f656 (62.1%) were female; 124\u202f396 (5.1%) were Black and 2\u202f232\u202f102 (91.0%) were White; and the mean (SD) age was 78.1 (8.1) years. The mechanism of injury was a fall in 1\u202f228\u202f847 incidents (50.1%). ADRD was more frequently diagnosed within 1 year of a fall compared with other injury mechanisms (10.6% [129\u202f910 of 1\u202f228\u202f847] vs 6.1% [74\u202f799 of 1\u202f224\u202f808]; P<\/jats:italic>\u2009&amp;lt;\u2009.001). The unadjusted hazard ratio (HR) of incident dementia diagnosis after a fall was 1.63 (95% CI, 1.61-1.64; P<\/jats:italic>\u2009&amp;lt;\u2009.001). On multivariable Cox competing risk analysis, falling was independently associated with an increased risk of dementia diagnosis among older adults (HR, 1.21 [95% CI, 1.20-1.21]; P<\/jats:italic>\u2009&amp;lt;\u2009.001) after controlling for patient demographics, medical comorbidities, and injury characteristics, while accounting for the competing risk of death. Among the subset of older adults without a recent skilled nursing facility admission, the HR was 1.27 (95% CI, 1.26-1.28; P<\/jats:italic>\u2009&amp;lt;\u2009.001).<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>In this cohort study, new ADRD diagnoses were more common after falls compared with other mechanisms of injury, with 10.6% of older adults being diagnosed with ADRD in the first year after a fall. To improve the early identification of ADRD, this study\u2019s findings suggest support for the implementation of cognitive screening in older adults who experience an injurious fall that results in an ED visit or hospital admission.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2024.36606","type":"journal-article","created":{"date-parts":[[2024,9,30]],"date-time":"2024-09-30T15:32:25Z","timestamp":1727710345000},"page":"e2436606","source":"Crossref","is-referenced-by-count":28,"title":["Risk of Dementia Diagnosis After Injurious Falls in Older Adults"],"prefix":"10.1001","volume":"7","author":[{"given":"Alexander J.","family":"Ordoobadi","sequence":"first","affiliation":[{"name":"Department of Surgery, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"Center for Surgery and Public Health, Brigham and Women\u2019s Hospital, Boston, Massachusetts"},{"name":"The Gillian Reny Stepping Strong Center for Trauma Innovation, Boston, 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N, Biniek? JF, Freed? M, Damico? A, Published? TN. Medicare Advantage in 2023: enrollment update and key trends. KFF. Published August 9, 2023. Accessed April 11, 2024. https:\/\/www.kff.org\/medicare\/issue-brief\/medicare-advantage-in-2023-enrollment-update-and-key-trends\/"},{"key":"zoi241075r24","unstructured":"Hedegaard? H, Johnson? RL, Garnett? MF, Thomas? KE. The 2020 International Classification of Diseases, 10th Revision, Clinical Modification Injury Diagnosis Framework for Categorizing Injuries by Body Region and Nature of Injury. Centers for Disease Control and Prevention. Published December 28, 2020. 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