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?