Prevalence and risk factors for falls and fall‐related injuries in the 2018 National Post‐acute and Long‐term Care Study
Year: 2022
Type: article
Abstract: Falls and related injuries are common and cause significant morbidity and mortality in older adults living in long-term care settings.1 However, prior epidemiological estimates of falls in this setting are nearly 30 years old and not nationally representative.2 Contemporary representative data are needed to inform research and policy related to falls. Thus, we evaluated the prevalence and characteristics associated with falls and fall-related injuries using a nationally representative sample of residential care community (RCC) residents in the United States. This study used publicly available data at the resident level from the National Post-acute and Long-term Care Study (NPLTCS), conducted by the National Center for Health Statistics in the US. The NPLTCS draws from a random sample of licensed RCCs in each of the 50 states and the District of Columbia. To be eligible, RCCs had to be state regulated; have four or more beds; provide room, board and meals, 24-hour on-site supervision, and help with personal care or health-related services. RCCs exclusively serving mentally ill, intellectually or developmentally disabled populations were excluded. Two residents were randomly selected from eligible RCCs that agreed to participate. The questionnaire was directed to the administrator at the RCC and conducted via computer-assisted telephone interviews.3 In this cross-sectional analysis, we used the 2018 survey (conducted between July 2018 and February 2019), including 904 residents from 419 RCCs.3 Survey weights were applied to yield national estimates for RCCs in the US population.4 We conducted descriptive statistics and logistic regression analyses using "svyset" in Stata (MP16).3 Odds ratios (ORs) and 95% confidence intervals (CIs) were used to estimate residents' demographic or clinical characteristics associated with (1) falls and (2) fall-related injuries, both of which were defined as an occurrence in the past 90 days at the RCC. After excluding residents with missing values for falls, the final sample included 876 RCC residents, representing a national sample of 895,068 residents. Table 1 describes the sample characteristics overall and by fall status, with mean age of 83.3 years. The prevalence of falls during the past 90 days at the RCC was 26.4%. The occurrence of falls did not differ by sex, race, use of Medicaid, visual impairment, or number of comorbidities. However, a greater proportion of those with falls were prescribed polypharmacy ≥9 medications, dependent per the Katz Index of Independence in Activities of Daily Living (Katz ADL score), requiring a walking aid, or having impaired cognitive function. Additionally, those who fell had a marginally higher proportion of hospital overnight stays or emergency department (ED) visits or had aggressive verbal or behavioral symptoms. Among those who had fallen, 36.4% had fall-related injuries. Multivariable logistic regression results for falls and fall-related injuries are presented in Table S1. Those who were dependent or partially dependent, measured by the Katz ADL score, had approximately 3.5- and 4.0-fold increased odds of falling, respectively, than those who were independent in daily living. For fall-related injuries, those who were Black residents (OR: 2.07; 95% CI: 1.39, 7.89), with cognitive impairment (OR: 3.88; 95% CI: 1.73, 8.84), experienced a hospital overnight stay or ED visit in the past 12 months (OR: 1.23; 95% CI: 1.82, 7.02), or had 2–5 comorbidities (OR: 3.00; 95% CI: 1.11, 8.11) were more likely to have fall-related injuries. Subgroup analysis among those with dementia (n = 280, representing 247,021 residents) showed that taking antipsychotics increased the odds of falls more than twofold than those not taking antipsychotics (OR: 2.33; 95% CI: 1.11, 4.90). In this nationally representative cross-sectional study, we found that over one-quarter of RCC residents sustained a fall in the past 90 days, of which over one-third resulted in injury. Our study contributes to the epidemiology of falls in the long-term care setting in recent years. While it is well-known that approximately one-third of community-dwelling older adults report a fall each year, less is known about fall prevalence in long-term care.5, 6 Falls often have serious consequences, especially in frail older residents. Moreover, fall-related injuries reduce the ability to function normally and our analysis shows over 3-fold increased risk of ED visits or hospitalization. We found that functional and cognitive impairment, multimorbidity, and antipsychotic use increased the likelihood of falls and fall-related injuries. Therefore, appropriate management of these acute and chronic conditions, including reducing inappropriate medication use, is a critical aspect of effective falls prevention.7-9 Study limitations include the cross-sectional nature, limiting causal inference for fall risk factors. However, the survey was obtained through a complex, multistage sample design to capture a national representation of RCC residents. Fall-related injuries were not validated by hospital or ED records. While extrinsic risk factors were not available in the survey, various clinical indicators such as Katz ADL score, vision impairment, walking aid, or cognitive function may negate the confounding concern due to environmental hazards. In conclusion, our analysis suggests a high national prevalence of falls and fall-related injuries in US RCCs, with over one-quarter of residents having a fall in the past 90 days. In addition, dependence in daily activities and cognitive impairment were key risk factors for falls. Zachary Marcum and Edwin Tan conceptualized and designed the study. Edwin Tan and Zhaoli Dai acquired study data. Analysis was performed by Zhaoli Dai. All authors participated in drafting and finalizing the manuscript for submission. Open access publishing facilitated by The University of Sydney, as part of the Wiley - The University of Sydney agreement via the Council of Australian University Librarians. The authors have no conflicts of interest to declare. The study was not sponsored by any agency or organization. Table S1 Odds ratios (95% CI) for the risk factors in association with falls and fall-related injuries Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
DOI: 10.1111/jgs.18014
Authors: Zachary A. Marcum, Zhaoli Dai, Edwin C. K. Tan
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,400
Funder: University of Sydney
OpenAlex ID: W4293575995