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

Abstract

Aims and objectives. The objectives of this study were to determine the prevalence of falls with minor and major injuries and identify their risk factors. Background. Falls among residents of long-term care facilities (LTCF) constitute a significant health issue. Design. This is a secondary analysis of a cross-sectional study carried out among older people (n = 2332). Methods. This is a descriptive study focusing on the secondary analysis of a cross-sectional study carried out with a group of older people (n = 2332) in 28 LTCF in Quebec City, Canada. Research assistants collected original data for each resident from two sources: structured simultaneous interviews with two nurses per unit from each of the homes and a review of the residents' medical files. Results. 7.2% of subjects had a fall leading to minor injuries and 10.1% a fall leading to major injuries. Risk factors associated with fall-related minor injury are young age, male gender and cognitive impairment. Factors associated with fall-related major injury were functional autonomy and length of stay. In further statistical analysis, controlling for functional autonomy, disruptive behaviours and neuroleptic use were found associated with fall-related major injury. Conclusions. This study demonstrates that the factors associated with fall-related minor injury are different from those associated with fall-related major injury. Relevance to clinical practice. This study suggests that nurses working with LTCF residents who are concerned about the prevention of fall-related major injury, may contribute to a reduction in such falls through optimal management of behavioural problems and neuroleptic use.

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

“…The first relevant finding of this study is that the use of psychotropic medications, depression, neuropsychiatric disturbances, functional mobility, and participants' level of independence in daily life activity performance were identified as risk factors for all four models. Other authors have identified these same factors as predictors of falls in institutionalized older adult populations with and without cognitive impairment, even though analysis were not as detailed with regard to the severity of cognitive impairment attested in the sample (Voyer et al, 2007;Sylliias et al, 2012). a,b,c Groups that attest significant differences within themselves for the same variable.…”

“…Several risk factors predisposing to falls in older adults have already been identified. These include depression, medications, comorbid functional disabilities, and behavioral abnormalities (Hartikainen et al, 2007;Voyer et al, 2007;Sylliias et al, 2012). Two potential risk factors deserve further study given their prevalence in the elderly: the individualś place of residence and their level of cognitive impairment.…”

Pharmacotherapy as a fall risk factor

“…Meanwhile, medications influencing cognitive, neurosensory, cardiovascular, and musculoskeletal functions may potentially increase fall risk independently of the number of diagnoses (Voyer et al, 2007;World Health Organization, 2007 Kim, 2014). Due to the mean age of our respondents, the incidence of polymorbidity was high in both groups.…”

The risk of falling among older adults in long-term care: screening by the Morse Fall Scale

“…Among the population taking these medications, side effects can also result in falls. The combination of balance instability, taking 4 or more medications, and hip joint weakness is 100% predictive of falls risk [3,6,12]. The risk of falling grows due to mental health problems, such as impaired mental status due to cognitive impairment, dementia, depression, mania and anxiety [31].…”

“…The identification of individual factors that can be influenced enables the choosing of targeted interventions and incorporating them into the patient care plan. Some of the most important and easily identifiable risk factors in older adults are older age (over 80 years), female gender, physical frailty, a history of falls, chronic diseases (cardiovascular, neurological, musculoskeletal system), polymorbidity, risk medication and/or its side effects, decreased physical and cognitive capacity, muscle weakness, unsteady gait and balance, use of ambulatory aids, impaired vision, hearing, urinary incontinence and environmental risks [2,3,[5][6][7][8][9][10][11][12]. Falls are multicausal and risk factors combine in different ways in older adults.…”