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Observational Study
. 2018 May 24;19(1):73.
doi: 10.1186/s12875-018-0741-6.

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

Emily J Cameron  1 , Susan K Bowles  2   3 , Emily Gard Marshall  4 , Melissa K Andrew  5
Affiliations
Observational Study

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

Emily J Cameron et al. BMC Fam Pract. .

Abstract

Background: 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).

Methods: 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).

Results: 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).

Conclusions: 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.

Keywords: Falls; Frail elderly; Long-term care; Nursing homes; Polypharmacy; Potentially inappropriate medication; Primary health care.

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Conflict of interest statement

Ethics approval and consent to participate

The study was approved by the Capital District Health Authority Research Ethics Committee and individual Research Ethics boards of participating LTCF, where these existed.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Total number of Falls Reported per Resident
Fig. 2
Fig. 2
Individual variables in relation to falls risk. Shown are linear regression coefficients with 95% Confidence Interval from the fully adjusted multivariable regression model
See this image and copyright information in PMC

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