Associations with rates of falls among home care clients in Ontario, Canada: a population-based, cross-sectional study

Abstract

Background: Accidental falls among older adults are a leading cause of injury-related hospitalizations. Reducing falls is an ongoing quality improvement priority for home care, given that many home care clients experience falls. In this study, we identify factors associated with the rate of falls among home care clients. Methods: We conducted a population-based, cross-sectional study using secondary data from the Hamilton, Niagara, Haldimand, and Brant health region of Ontario, Canada from January 1-March 31, 2018. We captured person-level characteristics with falls from the Resident Assessment Instrument-Home Care (RAI-HC). Negative binomial regression was used to model the rate of falls. Results: Functional characteristics of home care clients had strong, statistically significant associations with the rate of falls. Declines in activities of daily living, assistive device use for locomotion indoors, polypharmacy, and health conditions, such as dizziness or lightheadedness, and parkinsonism, were associated with a higher rate of falls. Males who used assistive devices had a higher rate of falls compared to females; however, males with neurological and cardiovascular health conditions had a decrease in the rate of falls compared to females. Home care clients with parkinsonism who used a cane and took eight or more drugs had stronger associations with an increased rate of falls compared to those who do not have parkinsonism. Conclusions: Functional characteristics, polypharmacy, and health conditions are associated with increased rates of falls among home care clients. Home care clients who are at a greater risk of falls may require environmental adjustments in their home to reduce or eliminate the possibility of falling.

Profiling chronic diseases and hospitalizations in older home care recipients: a nationwide cohort study in Sweden

“…These methodological differences likely explain some notable differences in disease prevalence but also prevalence of hospitalization between our and previous studies. For instance, we observe a lower prevalence of dementia in our study (9%) compared to two studies from Finland (29%) [ 15 ] and Canada (22%) [ 8 ]. Both studies used resident assessments of dementia conducted during HC visits [ 22 ] while we used data from administrative registers which have limited sensitivity in capturing dementia.…”

“…In order to allow older adults with functional impairment to live at home, Sweden offers publicly funded home care (HC) to older adults in need (Box 1 ) [ 4 ]. Since HC access is needs-based [ 5 ], recipients presumably present with even more complex health care needs than the average older person [ 6 ] with higher risks for hospitalizations and death [ 7 , 8 ].…”

Association between falls in elderly and the number of chronic diseases and health-related behaviors based on CHARLS 2018: health status as a mediating variable

“…For example, arthritis, diabetes, visual impairment, especially hypertension and chronic obstructive pulmonary disease, will lead to an increase in the number of falls in the elderly [ 16 ]. Canadian scholars have studied the rate and risk factors of falls in people with neurological diseases (such as dementia and Parkinson’s disease) [ 17 , 18 ]. Chronic renal failure also increases the risk of falls [ 19 ].…”

Comprehensive Geriatric Assessment in the era of telemedicine

“…The Mini‐Nutritional Assessment is commonly used to identify dietary patterns, nutritional deficiencies, and issues related to obesity or malnutrition 17 The likelihood of falls among older individuals is linked to increased rates of morbidity, mortality, and the necessity for prolonged care 20 . Fall risk is frequently complex and not solely attributable to declines in functioning among older adults; environmental factors should also be taken into consideration. Caregiver burden assessment is vital for evaluating the challenges faced by individuals providing care to family members or loved ones with chronic illnesses or disabilities.…”