Risk Factors for Injurious Falls among Residents in LTC Facilities Scott, 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 calcium Sources: 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 % female 75% dementia Part of “Stepping In” Study in B.C., ON & N.S.

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

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 X 2 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

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: Questions?