Prevalence of falls with minor and major injuries and their associated factors among older adults in long-term care facilities

Evaluating the discriminatory power of the velocity field diagram and timed-up-and-go test in determining the fall status of community-dwelling older adults: a cross-sectional observational study

BACKGROUND

Systematic reviews demonstrated that gait variables are the most reliable predictors of future falls, yet are rarely included in fall screening tools. Thus, most tools have higher specificity than sensitivity, hence may be misleading/detrimental to care. Therefore, this study aimed to determine the validity, and reliability of the velocity field diagram (VFD -a gait analytical tool), and the Timed-up-and-go test (TUG)-commonly used in Nigeria as fall screening tools, compared to a gold standard (known fallers) among community-dwelling older adults.

METHOD

This is a cross-sectional observational study of 500 older adults (280 fallers and 220 non-fallers), recruited by convenience sampling technique at community health fora on fall prevention. Participants completed a 7-m distance with the number of steps and time it took determined and used to compute the stride length, stride frequency, and velocity, which regression lines formed the VFD. TUG test was simultaneously conducted to discriminate fallers from non-fallers. The cut-off points for falls were: TUG times ≥ 13.5 s; VFD's intersection point of the stride frequency, and velocity regression lines (E1) ≥ 3.5velots. The receiver operating characteristic (ROC) area under the curves (AUC) was used to explore the ability of the E1 ≥ 3.5velots to discriminate between fallers and non-fallers. The VFD's and TUG's sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were determined. Alpha was set at p < 0.05.

RESULTS

The VFD versus TUG sensitivity, specificity, PPV and NPV were 71%, 27%, 55%, and 42%, versus 39%, 59%, 55%, and 43%, respectively. The ROC's AUC were 0.74(95%CI:0.597,0.882, p = 0.001) for the VFD. The optimal categorizations for discrimination between fallers/non-fallers were ≥ 3.78 versus ≤ 3.78 for VFD (fallers versus non-fallers prevalence is 60.71% versus 95.45%, respectively), with a classification accuracy or prediction rate of 0.76 unlike TUG with AUC = 0.53 (95% CI:0.353,0.700, p = 0.762), and a classification accuracy of 0.68, and optimal characterization of ≥ 12.81 s versus ≤ 12.81 (fallers and non-fallers prevalence = 92.86% versus 36.36%, respectively).

CONCLUSION

The VFD demonstrated a fair discriminatory power and greater reliability in identifying fallers than the TUG, and therefore, could replace the TUG as a primary tool in screening those at risk of falls.

Association Between Cognitive Status and Falls With and Without Injury During a Skilled Nursing Facility Short Stay

OBJECTIVES

To examine the relationship between cognitive status and falls with and without injury among older adults during the first 18 days of a skilled nursing facility (SNF) and determine if this association is mediated by limitations in activities of daily living (ADL) and impaired balance.

DESIGN

Cohort study of Medicare fee-for-service beneficiaries admitted to an SNF between October 1, 2016, and September 31, 2017.

SETTINGS AND PARTICIPANTS

815,927 short-stay nursing home residents admitted to an SNF within 3 days of hospital discharge.

METHODS

Cognitive status at SNF admission was classified as intact, mild, moderate, or severe impairment. Residents were classified as having no falls, a fall without injury, and a fall with a minor or major injury. We used ordinal logistic regression to model the association between cognitive status and falls adjusting for resident and facility characteristics. A causal mediation analysis was used to test for the mediating effects of ADL limitations and impaired balance on the association between cognitive status and falls with an injury.

RESULTS

Mild, moderate, and severe cognitive impairment were associated with 1.72 (95% CI: 1.68-1.75), 2.72 (95% CI: 2.66-2.78), and 2.61 (95% CI: 2.48-2.75) higher odds of being in a higher fall severity category, respectively, compared to being cognitively unimpaired. Greater ADL limitations and impaired balance were significantly associated with falls, but each mediated the association between cognitive status and falls by less than 2%.

CONCLUSIONS AND IMPLICATIONS

Older adults with cognitive impairment are more likely to experience a fall during an SNF stay. ADL limitations and impaired balance are risk factors for falls but may not contribute to the increased fall risk for SNF residents with cognitive impairment. Continued research is needed to better understand the risk factors for falls among SNF residents with cognitive impairment.

Environmental hazards increase the fall risk among residents of long-term care facilities: a prospective study in Shanghai, China

BACKGROUND

Falls are one of the most common safety concerns in long-term care facilities (LTCFs).

OBJECTIVE

To evaluate the associations between the environmental hazards and the fall risk in LTCF residents.

DESIGN

Prospective study with 12-month follow-up.

SETTING

Twenty-five LTCFs in a central district of Shanghai.

SUBJECTS

A total of 739 older people participated and 605 were followed up for 1 year.

METHODS

Environmental hazards were measured using a 75-item Environment Assessment Checklist, and the associations between environmental hazards and falls were analysed using univariate and multilevel logistic regressions.

RESULTS

The incidence of falls was 0.291 per person with 11 items/LTCF of hazards on average. The most common hazard items were inadequate/inappropriate handrails (96% LTCFs; odds ratio (OR) for falls: 1.88 [95% confidence interval: 1.13-3.13]), unsafe floors (92% LTCFs; 2.50 [1.11-5.61]) and poor lighting (84% LTCFs; 2.01 [1.10-3.66]). Environmental hazards were most frequently distributed in bedrooms (96% LTCFs), shared toilets/showers (80% LTCFs) and individual toilets/showers (68%LTCFs) and accounted for 20% of the differences in falls occurrence among the LTCFs. After adjusting for individual intrinsic and fall-related behavioural factors, it is found that having more than eight environmental hazard items increased the fall risk among older residents (adjusted OR = 4.01 [1.37-11.73]). Environmental hazards and toilet visits at night showed significant associations with falls (adjusted OR = 5.97 [1.10-32.29]).

CONCLUSIONS

The high prevalence of environmental hazards associated with falls highlights the urgency of improving environmental safety in LTCFs and the need of environmental safety policies, resource allocation and interventions in falls prevention.

Falls and Fall-Related Consequences among Older People Living in Long-Term Care Facilities in a Megacity of China

INTRODUCTION

Falls are currently the top safety problem in long-term care facilities (LTCFs) in China. Due to the increasing number of residents living in LTCFs, more evidence is needed to give a foundation for fall prevention.

OBJECTIVE

This study aimed to explore the epidemiological characteristics of falls in LTCFs in central Shanghai.

METHODS

The study was conducted in 21 LTCFs in a central district in Shanghai, with a capacity of 3,065 residents. A two-stage sampling method was applied in participant recruitment. Falls were recorded by LTCF staff over a 12-month period. Details of falls were obtained by face-to-face interviews. The χ2 test was used in data analyses.

RESULTS

The incidence of falls was 13.5%; 64.0% falls resulted in injuries, with 32.0% involving fractures. Women had a significantly higher incidence of injurious falls than men (χ2 = 4.066, p = 0.044). Residents aged 80-89 years or in level 1 care had the highest incidence of falls with severe consequences. The incidence of falls was significantly higher at small- or medium-sized LTCFs, public LTCFs, and LTCFs with higher environmental risk levels compared to their counterparts. Most falls occurred when walking on a flat floor (28.9%) and rising up or sitting down (24.0%); 40.9% occurred during the night. Of those injured, 54.8% were treated in hospitals, and only 53.7% completely recovered.

CONCLUSIONS

Though the average incidence of falls in LTCFs in Shanghai was relatively low, great variation was observed between LTCFs, and severe consequences occurred frequently. Fall prevention programmes should be evidence-based with applicable devices and individualized care services and supports. The roles of personal and institutional factors on falls warrant further study.

Risk factors associated with accidental falls among Italian nursing home residents: A longitudinal study (FRAILS)

Older adults living in nursing homes (NHs) are at greater risk of injury resulting from a fall due to multiple factors, such as functional/cognitive impairment, postural instability, polytherapy, and psychotropic drugs. We aimed to assess characteristics of fallers, and investigate risk factors associated with falls among older NHs residents, through one-year longitudinal study. Demographic and clinical characteristics, number/typology of drugs, and fall occurrence were collected for each resident. We recruited 409 residents (82% women; 83 ± 9.4 years) in geriatric units (331, 81%) and in specialized dementia units (SDUs, 78%). 111 residents fell (27%), and 54 (48.6%) of them had an injury related to a fall. We detected an average of 1.3 falls (±0.48, range 1-10) per resident. Higher autonomy in activities of daily living, living in SDUs, and previous falls were significantly associated with falls. Thus, these findings should be considered as an alert to subsequent falls.

Influence of cognitive impairment on fall risk among elderly nursing home residents

BACKGROUND

Information relating the severity of cognitive decline to the fall risk in institutionalized older adults is still scarce. This study aims to identify potential fall risk factors (medications, behavior, motor function, and neuropsychological disturbances) depending on the severity of cognitive impairment in nursing home residents.

METHODS

A total of 1,167 nursing home residents (mean age 81.44 ± 8.26 years; 66.4% women) participated in the study. According to the MEC, (the Spanish version of the Mini-Mental State Examination) three levels of cognitive impairment were established: mild (20-24) "MCI", moderate (14-19) "MOCI", and severe (≤14) "SCI". Scores above 24 points indicated the absence cognitive impairment (NCI). Information regarding fall history and fall risk during the previous year was collected using standardized questionnaires and tests.

RESULTS

Sixty falls (34%) were registered among NCI participants and 417 (43%) among people with cognitive impairment (MCI: 35%; MOCI: 40%; SCI: 50%). A different fall risk model was observed for MCI, MOCI, SCI, and NCI patients. The results imply that the higher the level of cognitive impairment, the greater the number of falls (F1,481 = 113.852; Sig = 0.015), although the level of significance was not maintained when MOCI and SCI participants were compared. Depression, neuropsychiatric disturbances, autonomy constraints in daily life activity performance, and low functional mobility were factors closely associated with fall risk.

CONCLUSION

This study provides evidence indicating that fall risk factors do not hold a direct correlation with the level of cognitive impairment among elderly nursing home care residents.