Falls and long-term care: a report from the care by design observational cohort study

Falls and long-term care: a report from the care by design observational cohort study

Falls and the resulting complications are common among frail older adults. We aimed to explore risk factors and potential prevention strategies for falls in elderly residents of Long-Term Care Facilities (LTCF). This was a cross sectional study design using data from the Care by Design (CBD) study,...

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Bibliographic Details
Published in:BMC family practice Vol. 19; no. 1; p. 73
Main Authors: Cameron, Emily J, Bowles, Susan K, Marshall, Emily Gard, Andrew, Melissa K
Format: Journal Article
Language:English
Published: England BioMed Central Ltd 24-05-2018
BioMed Central
BMC
Subjects:
Accidental falls
Activities of daily living
Age
Analysis
Care and treatment
Cognitive ability
Cohort analysis
Continuity of care
Dementia
Elderly
Falls
Frail elderly
Frailty
Gender differences
Geriatrics
Health aspects
Health services
Injuries
Long term care facilities
Long term health care
Long-term care
Neurology
Nursing homes
Observational studies
Older people
Patients
Polypharmacy
Population
Potentially inappropriate medication
Prevention
Primary care
Risk factors
Canada
Nova Scotia Canada
Falls
Nursing homes
Frail elderly
Polypharmacy
Primary health care
Potentially inappropriate medication
Long-term care
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Summary:Falls and the resulting complications are common among frail older adults. We aimed to explore risk factors and potential prevention strategies for falls in elderly residents of Long-Term Care Facilities (LTCF). This was a cross sectional study design using data from the Care by Design (CBD) study, within Nova Scotia's Capital District Health Authority. This observational time series cohort study collected data before, during and after the implementation of CBD, a new model of coordinated primary care in LTCF. Here, we analyzed data collected after the implementation of CBD (September 1, 2011- February 28, 2012). Falls were frequent; 56.2% of our sample of 395 residents fell at least once. In univariate analyses, male gender (p = 0.009), dementia (p = 0.005), and use of Selective Serotonin Reuptake Inhibitors or Selective Serotonin-Norepinepherine Reuptake Inhibitors (SSRI/SNRI) (p = 0.084) showed statistically significant associations with having fallen. Benzodiazepine use appeared to be protective for falls (p = 0.058). In a fully adjusted multivariable linear regression model, dementia (β coefficient 0.96, 95% CI: 0.83,1.84; p = 0.032), visual impairment (β 0.84, 95% CI: 0.13,1.56; p = 0.021), and use of any PIMs (β 0.34, 95% CI: 0.037,0.65; p = 0.028) were associated with increased risk of having fallen. Benzodiazepine use remained associated with reduced numbers of falls (p = 0.009), and SSRI/SNRI use was associated with increased numbers of falls (p = 0.007). Male gender was associated with increased falls in the model which excluded frailty (p = 0.022), though gender lost statistical significance once frailty was added to the model (p = 0.06). In our sample of LTCF residents, falls were common. Cognitive impairment, male gender, visual impairment, PIM use and use of SSRI/SNRI medications were associated with increased risk of falls, while benzodiazepine use appeared to be associated with a decreased risk of having fallen. Falls remain an important problem among LTC residents. Screening for falls during patient encounters is recommended, along with further research to identify risk factors and target interventions.
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ISSN:1471-2296
1471-2296
DOI:10.1186/s12875-018-0741-6