Association of falls with risk of dementia and all-cause mortality: a cohort study of Japanese older adults with a 9-year follow-up

Xiangbin ZHONG; Keyang LIU; Yao YAO; Honglin CAI; Baoqing HUANG; Xiaojing YUAN; Kokoro SHIRAI; Katsunori KONDO; Liqi GUAN; Qiqing CHEN; Xinlei WANG; Yuting LI

doi:10.1007/s41999-024-01149-w

Association of falls with risk of dementia and all-cause mortality: a cohort study of Japanese older adults with a 9-year follow-up

Xiangbin ZHONG, Keyang LIU, Yao YAO, Honglin CAI, Baoqing HUANG, Xiaojing YUAN, Kokoro SHIRAI, Katsunori KONDO, Liqi GUAN, Qiqing CHEN, Xinlei WANG, Yuting LI^*

^*Corresponding author for this work

Research output: Journal Publications › Journal Article (refereed) › peer-review

Abstract

Objective: Many risk factors affect dementia and all-cause mortality. However, whether falls are a risk factor for dementia and all-cause mortality is unclear. The study examines the association of falls with the risk of dementia and all-cause mortality, and whether dementia mediates the association of falls with all-cause mortality.

Methods: Data were taken from the Japanese Gerontological Evaluation Study (JAGES) with a 9-year follow-up. Falls information was collected through a questionnaire and categorized into no falls, single and multiple falls. Dementia and all-cause mortality data were obtained from the long-term care insurance (LTCI) system. The Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs), and causal mediation analysis (CMA) was used to assess the mediating effects of dementia.

Results: A total of 52,076 participants were included in the study. Compared to participants with no falls, participants with single and multiple falls had an increased risk of dementia (single fall, HRs = 1.18, 95% CIs 1.12–1.24; multiple falls, HRs = 1.66, 95% CIs 1.56–1.77) and all-cause mortality (single fall, HRs = 1.09, 95% CIs 1.04–1.15; multiple falls, HRs = 1.34, 95% CIs 1.26–1.43), and the risk increased with the number of falls (P for trend < 0.01). In addition, dementia significantly mediated the association between falls and risk of all-cause mortality (NIE: HRs = 1.02, 95% CIs 1.00–1.04, PM = 15.0%).

Conclusion: Falls are associated with the risk of dementia and all-cause mortality. Dementia has important mediating effects in the association between falls and the risk of all-cause mortality.

Original language	English
Article number	900315
Number of pages	10
Journal	European Geriatric Medicine
DOIs	https://doi.org/10.1007/s41999-024-01149-w
Publication status	E-pub ahead of print - 14 Jan 2025
Externally published	Yes

Bibliographical note

Publisher Copyright:
© The Author(s), under exclusive licence to European Geriatric Medicine Society 2025.

Funding

This work was supported by Science and Technology Projects in Guangzhou (No. 2023A04J1147). The Japan Gerontological Evaluation Study (JAGES) is supported by the following: Grant-in-Aid for Scientific Research (18KK0057) from the Japan Society for the Promotion of Science; Ministry of Education, Culture, Sports, Science and Technology-Japan-Supported Program for the Strategic Research Foundation at Private Universities (2009-2013); the Japan Society for the Promotion of Science; KAKENHI Grant Numbers JP18390200, JP22330172, JP22390400, JP23243070, JP23590786, JP23790710, JP24390469, JP24530698, JP24683018, JP25253052, JP25870573, JP25870881, JP26285138, JP26882010 and JP15H01972; Health Labour Sciences Research Grants H22-Choju-Shitei-008, H24-Junkanki-Ippan-007, H24-Chikyukibo-Ippan-009, H24-Choju-Wakate-009, H25-Kenki-Wakate-015, H25-Choju-Ippan-003, H26-Irryo-Shitei-003 [Fukkou] H26-Choju-Ippan-006, H27-Ninchisyou-Ippan-001, H28-Choju-Ippan-002, H28-Ninchisho-Ippan-002, H30-Kenki-Ippan-006 and H30-Junkankitou-Ippan-004; the Japan Agency for Medical Research and Development (JP17dk0110017, JP18dk0110027, JP18ls0110002, JP18le0110009); and Research Funding for Longevity Sciences from the National Center for Geriatrics and Gerontology (24-17, 24-23, 29-42). The funding sources had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Keywords

All-cause mortality
Dementia
Falls
Longitudinal study

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1007/s41999-024-01149-w

Cite this

ZHONG, X., LIU, K., YAO, Y., CAI, H., HUANG, B., YUAN, X., SHIRAI, K., KONDO, K., GUAN, L., CHEN, Q., WANG, X., & LI, Y. (2025). Association of falls with risk of dementia and all-cause mortality: a cohort study of Japanese older adults with a 9-year follow-up. European Geriatric Medicine, Article 900315. Advance online publication. https://doi.org/10.1007/s41999-024-01149-w

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title = "Association of falls with risk of dementia and all-cause mortality: a cohort study of Japanese older adults with a 9-year follow-up",

abstract = "Objective: Many risk factors affect dementia and all-cause mortality. However, whether falls are a risk factor for dementia and all-cause mortality is unclear. The study examines the association of falls with the risk of dementia and all-cause mortality, and whether dementia mediates the association of falls with all-cause mortality. Methods: Data were taken from the Japanese Gerontological Evaluation Study (JAGES) with a 9-year follow-up. Falls information was collected through a questionnaire and categorized into no falls, single and multiple falls. Dementia and all-cause mortality data were obtained from the long-term care insurance (LTCI) system. The Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs), and causal mediation analysis (CMA) was used to assess the mediating effects of dementia. Results: A total of 52,076 participants were included in the study. Compared to participants with no falls, participants with single and multiple falls had an increased risk of dementia (single fall, HRs = 1.18, 95% CIs 1.12–1.24; multiple falls, HRs = 1.66, 95% CIs 1.56–1.77) and all-cause mortality (single fall, HRs = 1.09, 95% CIs 1.04–1.15; multiple falls, HRs = 1.34, 95% CIs 1.26–1.43), and the risk increased with the number of falls (P for trend < 0.01). In addition, dementia significantly mediated the association between falls and risk of all-cause mortality (NIE: HRs = 1.02, 95% CIs 1.00–1.04, PM = 15.0%). Conclusion: Falls are associated with the risk of dementia and all-cause mortality. Dementia has important mediating effects in the association between falls and the risk of all-cause mortality.",

keywords = "All-cause mortality, Dementia, Falls, Longitudinal study",

author = "Xiangbin ZHONG and Keyang LIU and Yao YAO and Honglin CAI and Baoqing HUANG and Xiaojing YUAN and Kokoro SHIRAI and Katsunori KONDO and Liqi GUAN and Qiqing CHEN and Xinlei WANG and Yuting LI",

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doi = "10.1007/s41999-024-01149-w",

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TY - JOUR

T1 - Association of falls with risk of dementia and all-cause mortality: a cohort study of Japanese older adults with a 9-year follow-up

AU - ZHONG, Xiangbin

AU - LIU, Keyang

AU - YAO, Yao

AU - CAI, Honglin

AU - HUANG, Baoqing

AU - YUAN, Xiaojing

AU - SHIRAI, Kokoro

AU - KONDO, Katsunori

AU - GUAN, Liqi

AU - CHEN, Qiqing

AU - WANG, Xinlei

AU - LI, Yuting

PY - 2025/1/14

Y1 - 2025/1/14

N2 - Objective: Many risk factors affect dementia and all-cause mortality. However, whether falls are a risk factor for dementia and all-cause mortality is unclear. The study examines the association of falls with the risk of dementia and all-cause mortality, and whether dementia mediates the association of falls with all-cause mortality. Methods: Data were taken from the Japanese Gerontological Evaluation Study (JAGES) with a 9-year follow-up. Falls information was collected through a questionnaire and categorized into no falls, single and multiple falls. Dementia and all-cause mortality data were obtained from the long-term care insurance (LTCI) system. The Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs), and causal mediation analysis (CMA) was used to assess the mediating effects of dementia. Results: A total of 52,076 participants were included in the study. Compared to participants with no falls, participants with single and multiple falls had an increased risk of dementia (single fall, HRs = 1.18, 95% CIs 1.12–1.24; multiple falls, HRs = 1.66, 95% CIs 1.56–1.77) and all-cause mortality (single fall, HRs = 1.09, 95% CIs 1.04–1.15; multiple falls, HRs = 1.34, 95% CIs 1.26–1.43), and the risk increased with the number of falls (P for trend < 0.01). In addition, dementia significantly mediated the association between falls and risk of all-cause mortality (NIE: HRs = 1.02, 95% CIs 1.00–1.04, PM = 15.0%). Conclusion: Falls are associated with the risk of dementia and all-cause mortality. Dementia has important mediating effects in the association between falls and the risk of all-cause mortality.

AB - Objective: Many risk factors affect dementia and all-cause mortality. However, whether falls are a risk factor for dementia and all-cause mortality is unclear. The study examines the association of falls with the risk of dementia and all-cause mortality, and whether dementia mediates the association of falls with all-cause mortality. Methods: Data were taken from the Japanese Gerontological Evaluation Study (JAGES) with a 9-year follow-up. Falls information was collected through a questionnaire and categorized into no falls, single and multiple falls. Dementia and all-cause mortality data were obtained from the long-term care insurance (LTCI) system. The Cox proportional hazard models were used to calculate the hazard ratios (HRs) and 95% confidence intervals (95% CIs), and causal mediation analysis (CMA) was used to assess the mediating effects of dementia. Results: A total of 52,076 participants were included in the study. Compared to participants with no falls, participants with single and multiple falls had an increased risk of dementia (single fall, HRs = 1.18, 95% CIs 1.12–1.24; multiple falls, HRs = 1.66, 95% CIs 1.56–1.77) and all-cause mortality (single fall, HRs = 1.09, 95% CIs 1.04–1.15; multiple falls, HRs = 1.34, 95% CIs 1.26–1.43), and the risk increased with the number of falls (P for trend < 0.01). In addition, dementia significantly mediated the association between falls and risk of all-cause mortality (NIE: HRs = 1.02, 95% CIs 1.00–1.04, PM = 15.0%). Conclusion: Falls are associated with the risk of dementia and all-cause mortality. Dementia has important mediating effects in the association between falls and the risk of all-cause mortality.

KW - All-cause mortality

KW - Dementia

KW - Falls

KW - Longitudinal study

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U2 - 10.1007/s41999-024-01149-w

DO - 10.1007/s41999-024-01149-w

M3 - Journal Article (refereed)

C2 - 39809971

AN - SCOPUS:85217560995

SN - 1878-7649

JO - European Geriatric Medicine

JF - European Geriatric Medicine

M1 - 900315

ER -

Association of falls with risk of dementia and all-cause mortality: a cohort study of Japanese older adults with a 9-year follow-up

Abstract

Bibliographical note

Funding

Keywords

UN SDGs

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