risk factors for injurious falls among residents in ltc facilities scott, v., votova, k., gallagher,...
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Risk Factors for Injurious Falls among Residents in LTC FacilitiesScott, V., Votova, K., Gallagher, E., Kozak, J., Johnson, S., & Pearce, M.
Funded by: Health Canada, Population Health Fund; B.C. Ministry of Health; and Regional Partners
Profile of LTC Residents
• Proportion of seniors in LTC is decreasing
• Residents now have more complex health challenges, e.g., advanced dementia, multiple chronic health problems and limited mobility
• Hip fractures occur 4X more in LTC compared to seniors in community
Risk Factor Evidence
• Medication side effects
• Gait and mobility impairments
• Use of assistive devices
• Dementia or cognitive impairment
• Environment
Sources: Fleming 1993; Graafmans 2003; Kallin 2002; Kiely 1998; Krueger 2001; Myers 1991; Ray 2000; Rubenstein 1994; van Doorn 2003
Falls Prevention Evidence
• Multifactorial interventions– Staff education– Environmental modifications– Hip protector use– Medication reviews– Exercise
• Exercise
• Vitamin D and calciumSources: Becker 2003; Bischoff 2003; Gillespie 2004; Jensen 2003;
Mulrow 1994; Ray 1997; Scott (draft manuscript)
Study Objective• To report on the resident and incident
characteristics that predicted injurious falls among residents of long-term care facilities using a standardized Falls Surveillance Report©
Sample and Setting
• Residents occupying 463 beds in 5 facilities
• Average age 84.5• Age range 52-104• 77% female• 75% dementia• Part of “Stepping In”
Study in B.C., ON & N.S.
Wolfville Nursing Home, Wolfville Nova Scotia
Data Collection
• All reported fall incidents for all residents
• Over 480 consecutive days in five facilities
• Data collected on Falls Surveillance Report© by trained on-site staff
• Data entered on “Access” program and analyzed using SPSS
Microsoft Word Document
Analysis
• Descriptive statistics• Logistic regression for:
– Dependent variable: fall with injury vs. fall without injury
• Injury includes: Bruises/abrasions, skin tear, sprain/strain, concussion, cuts/scrapes, dislocation, fractured bone(s), or other injury
– Independent variables:• Resident characteristics• Incident characteristics
Descriptive Results• 1691 falls among 326 fallers (with <20 falls)• 538 (31.8%) resulted in injury• 68% occurred among female residents
– Females more likely to injury head/neck and to sustain skin tears
• Location– Bedroom 53%– Dining room/cafeteria 11.7%– Resident bathroom 8.9%
Significant X2
differences• More likely to sustain injury from fall if:
– Ambulatory status independent 69% (p<.001)– Transfer status independent 63% (p<.001)
• Less likely to sustain injury from fall if health condition at time of fall include:
• Agitation/aggression 38% (p<.05)• Urinary incontinence 24% (p<.05)• Bowel incontinence 17% (p<.01)• Using a walker 35% (p<.05)• Using wheelchair 23% (p<.001)
Significant LR Model Variables
Variable Coefficient t-stat OR (95%CI) Uses prosthetic/ brace 1.12 4.17 3.06 (1.05-8.94) Uses wheelchair -0.63 30.00 0.53 (0.43-0.67) Age at time of fall 0.02 18.04 1.02 (1.01-1.03) Uneven surface 0.61 8.25 1.85 (1.22-2.81) Clothing too long/obstructive
0.61 9.21 1.85 (1.20-2.74)
No or low lighting -0.40 6.95 0.67 (0.50-0.90) Pushed by another 0.70 4.61 2.02 (1.03-3.96) Anti-anxiety meds 0.48 15.48 1.62 (1.27-2.06) Narcotic analgesics 0.43 8.74 1.53 (1.15-2.03) New arrangement of objects
-0.42 5.47 0.66 (0.46-0.93)
Note: The t-stat (Wald) statistics are distributed chi-square with 1 degree of freedom. *p< 0.05.
Discussion• Implications for policy:
– Standardized reporting / post fall assessment– Risk assessment and tailored prevention– Facility-wide prevention training, protocols and audits
• Implications targeted strategies:– Balance, gait and strengthening exercises and bone
enhancement for females– Attention to uneven surfaces / long clothing– Injury protection for independent ambulatory– Calming techniques to reduce aggression– Medication reviews / attention to using pain
medication
For more information on falls prevention:
www.injuryresearch.bc.ca
Questions?Questions?