Characteristics, consequences and prevention of falls in institutionalised older adults in the province of Malaga (Spain): a prospective, cohort, multicentre study

Abstract

ObjectivesFalls are an important adverse event among institutionalised persons. It is in this clinical setting where falls occur more frequently than in any other, despite the measures commonly taken to prevent them. This study aimed to determine the characteristics of a typical institutionalised elderly patient who suffers a fall and to describe the physical harms resulting from this event. We then examined the association between falls and the preventive measures used.MethodsThis was a prospective cohort study in 37 nursing homes in Spain. The participants were all the nursing home residents institutionalised in these centres from May 2014 to July 2016. Participants were followed up for 9 months. During this period, two observations were made to evaluate the preventive measures taken and to record the occurrence of falls.Results896 residents were recruited, of whom 647 completed the study. During this period, 411 falls took place, affecting 213 residents. The injuries caused by the falls were mostly minor or moderate. They took place more frequently among women and provoked 22 fractures (5.35%). The most commonly used fall prevention measure was bed rails (53.53% of cases), followed by physical restraint (16.79%). The latter measure was associated with a higher incidence of injuries not requiring stitches (OR=2.06, 95% CI 1.01 to 4.22, P=0.054) and of injuries that did require stitches (OR=3.51, 95% CI 1.36 to 9.01, P=0.014) as a consequence of falls. Bed rails protected against night-time falls.ConclusionsFalls are a very common adverse event in nursing homes. The prevention of falls is most commonly addressed by methods to restrain movement. The use of physical restraints is associated with a greater occurrence of injuries caused by a fall.

Practices and behaviors of professionals after falls in institutionalized elderly with and without cognitive decline

“…Cognitive impairment, severe mobility problems and a greatly restricted capacity to perform daily living activities are determining factors in the decision to implement restraint systems. 2,7 Each nursing home has specific needs determined by elderly characteristics, number of residents, knowledge and experience, prevention practice, fall recording and reporting, and the location and architectural characteristics of buildings, 4 which can influence post-fall practices and behaviors.…”

“…Falls are considered the main cause of restrictions in activities of daily living for this age group, especially among individuals with cognitive decline, for whom it is a significant contributory factor to their dependence. 1,2 Although this in itself is cause for concern, the problem is compounded by significant post-fall consequences like fear and post-fall anxiety syndrome, which translate into a loss of self-confidence and the self-imposition of limitations both at home and within institutions. 1 The relationship between falls and the institutionalized elderly is complex due to its direction -whether falls are the only cause or just one factor in deciding whether to admit an elderly person to a nursing home.…”

“…1,5 Contributing factors to this increase in prevalence include greater dependence, chronic disease, the environment, cognitive decline and the presence of caregivers. 2,5,6 An unfamiliar environment and the presence of other people hinders risk identification and control, increasing the risk of a fall, particularly in the first few days of institutionalization, when one in five newlyadmitted elderly residents experiences a fall. 3 It should also be noted that in the first few days of admission, the elderly may feel less confident performing daily living activities, which contributes to increased risk.…”

Falls among the elderly

“…Every fifth fall causes serious injuries, including hip fractures or head trauma [6]. Falls in the world rank second, after road accidents, among the causes of death caused by accidental injuries [7]. Other studies among older people living in a home environment have found an even higher percentage of people who fall within a year, reaching 30-40%.…”

Use of physical restraint in nursing homes in Spain and relation with resident characteristics: a retrospective multi-centre cohort study with a self-organised maps approach

“…These events are even more frequent in long-term care facilities for older adults, where approximately half of the institutionalised residents suffer at least one fall per year (Rubenstein and Josephson, 2002; Panel on Prevention of Falls in Older Persons (American Geriatrics Society and British Geriatrics Society), 2011). Along with physical exercise, the main preventive measure in nursing homes is the use of bedrails and the application of physical restraints (Aranda-Gallardo et al ., 2018). However, the prolonged use of such devices may reduce the residents’ functional capacity, since limited mobility has physical consequences.…”