A new study has found that older adults who have experienced a fall are significantly more likely to be diagnosed with dementia afterward compared to those who experienced other types of injuries.

The research, published in JAMA Network Open, analyzed Medicare data from nearly 2.5 million adults over age 66 who had been hospitalized or visited the emergency room for an injury. About half of these injuries were the result of a fall.

One year after the injury, researchers followed up and discovered that 10.6% of those who had fallen were later diagnosed with dementia. In contrast, only 6.1% of participants with other injuries developed dementia. Falling was linked to a 21% higher risk of future dementia diagnosis.

The risk was especially elevated in individuals who were hospitalized after a fall, as opposed to those who were only treated in the ER. The data also showed that a significant portion of participants—about 22%—had been in a nursing home in the year before their injury. This group was more likely to experience falls compared to other injuries.

In the U.S., more than 14 million older adults—approximately one in four—experience a fall each year.

Experts say falls could serve as early indicators that someone is at risk for dementia and may benefit from cognitive screening.

Which Comes First: Dementia or the Fall?

The relationship between falling and dementia is complex. According to researchers, it may be a "two-way street."

On one hand, falling might be an early sign of undiagnosed dementia or mild cognitive impairment (MCI), a condition that often precedes dementia. In fact, 11% of the dementia diagnoses in the study were made while the patient was still in the hospital following their injury—suggesting the dementia may have been present before the fall.

Even if dementia hadn’t yet been diagnosed, it’s possible that early cognitive changes were already impairing balance, judgment, or attention. These subtle issues could make it harder to assess risks or react quickly, increasing the chances of falling.

On the other hand, the fall itself could contribute to or accelerate cognitive decline. Head injuries or trauma from falls may worsen brain health and potentially lead to faster development of dementia symptoms.

At this stage, it’s unclear whether the fall causes the cognitive issues, or if early cognitive decline leads to the fall. It could be both. More research is needed to better understand this connection.

The Importance of Screening and Fall Prevention

Falls become more common after the age of 65. While they can’t always be avoided, there are ways to reduce the risk.

Experts recommend that older adults ask their doctors or pharmacists to review their medications, as some drugs may increase the likelihood of falling. Engaging in regular physical activity, keeping the home environment safe, and staying mentally engaged are also effective ways to lower the risk of both falls and cognitive decline.

If a fall does occur—especially if it results in a hospital visit—experts suggest that older adults should undergo cognitive screening. Assessing memory, decision-making, and attention shortly after a fall can help identify early signs of dementia or related conditions.

However, routine cognitive screening after a fall is not yet standard practice. It can be challenging to perform assessments during a hospital stay or to ensure follow-up appointments take place—especially since many older adults lack access to a regular healthcare provider or geriatric specialist.

Researchers hope that their findings will encourage more healthcare professionals to monitor cognitive health in older adults who experience falls, offering an opportunity for earlier diagnosis and potentially better outcomes.