Profiling the risk factors associated with falls in older people with diabetes receiving at‐home nursing care: Retrospective analysis of an Australian aged care provider database

Abstract

Falls among older people with diabetes mellitus (DM) are a major health concern.Preventive measures can be implemented to reduce the likelihood of falls. The aim of this study was to determine the factors most strongly associated with falls in older people living with DM who receive at-home care support services. This will inform home-visiting nurses to prioritise falls prevention strategies in the care of clients who are at high risk of falls. A retrospective analysis of routinely collected data from a large not-for-profit community aged care service provider was undertaken. The sample comprised adults aged ≥65 years residing in Victoria, Australia, with a recorded diagnosis of DM, and who received at least one episode of care by the aged care provider during July 1, 2014 and June 30, 2015. Self-reported data on falls in previous 6 months was obtained via the Comprehensive Health Assessment Tool (CHAT). Selection of factors associated with falls was guided by the Falls Risk for Older People in the Community (FROP-Com) assessment tool. For the study population, data for these factors were obtained from clients' self-reported CHAT data, and from International Classification of Disease codes obtained from medical records. Descriptive statistics were used to identify the demographic and clinical profile; logistic regression was used to assess the strength of association between various factors and the occurrence of a fall. Data were obtained for 1,574 older adults; overall prevalence of falls was 30.6% (n = 482). Significant factors displaying the highest odds of falling were gait issues (OR: 2.11, p = 0.002); needing help to walk (OR: 1.91, p = <0.001); and cognitive dysfunction (OR: 1.55, p = 0.001). Interpreted with caution, several factors contribute to an increased odds of falling in older people with DM. Home-visiting nurses are uniquely placed to introduce preventive interventions to reduce the likelihood of debilitating falls in this population.

Prevalence of falls, incontinence, malnutrition, pain, pressure injury and restraints in home care: A narrative review

“…From 27 included studies, the majority ( n = 16; 59.3%) was conducted in Europe (Adıgüzel & Acar‐Tek, 2019 ; Geurden et al, 2015 ; Johansen et al, 2015 ; Kiesswetter et al, 2020 , 2014 ; Lahmann et al, 2016 ; Leiske et al, 2015 ; Meijers et al, 2012 ; Mengelers et al, 2020 ; Neziraj et al, 2021 ; Scheepmans et al, 2017 ; Schildmeijer et al, 2018 ; Schilp et al, 2012 ; Suhr & Lahmann, 2018 ; van der Pols‐Vijlbrief et al, 2016 ; Vikman et al, 2011 ). The others were conducted in Australia (Brett et al, 2020 ; Burton et al, 2018 ; Meyer et al, 2020 ; Rist et al, 2012 ), Canada (Doran et al, 2013 ; Northwood et al, 2021 ), Brazil (da Silva Gabriel Capeletto et al, 2021 ; Rocha do Carmo et al, 2020 ) and China (Xu et al, 2018 ). Two studies were systematic reviews which included samples from Europe, Asia, America, Australia and Africa (Cereda et al, 2016 ) and Europe, Asia and America (Scheepmans et al, 2018 ).…”

“…In total, the six nursing‐sensitive indicators of falls, incontinence, malnutrition, pain, pressure injury and restraints were reported 34 times in the 27 included studies. The most frequently measured indicator in HC was malnutrition ( n = 11; Adıgüzel & Acar‐Tek, 2019 ; Cereda et al, 2016 ; Geurden et al, 2015 ; Kiesswetter et al, 2014 , 2020 ; Lahmann et al, 2016 ; Meijers et al, 2012 ; Neziraj et al, 2021 ; Rist et al, 2012 ; Schilp et al, 2012 ; van der Pols‐Vijlbrief et al, 2016 ), followed by falls ( n = 9) (Brett et al, 2020 ; Burton et al, 2018 ; Doran et al, 2013 ; Meijers et al, 2012 ; Meyer et al, 2020 ; Neziraj et al, 2021 ; Rocha do Carmo et al, 2020 ; Schildmeijer et al, 2018 ; Vikman et al, 2011 ). Prevalence and incidences regarding restraints (da Silva Gabriel Capeletto et al, 2021 ; Mengelers et al, 2020 ; Scheepmans et al, 2017 , 2018 ) and pressure injury (Doran et al, 2013 ; Johansen et al, 2015 ; Neziraj et al, 2021 ; Schildmeijer et al, 2018 ) were reported in four studies.…”

“…The participants assessed in the included studies were not homogeneous, and some studies examined HC clients with a specific diagnosis due to their higher risk for a specific nursing‐sensitive indicator. Mengelers et al ( 2020 ) examined restraints in HC clients with dementia; Meyer et al ( 2020 ), falls in HC clients with diabetes mellitus; and Northwood et al ( 2021 ), incontinence in HC clients with diabetes mellitus, which may have influenced the wide range of prevalence rates. People with dementia, for example, have a higher risk of falls (Allan et al, 2009 ) as do people with diabetes mellitus (Yang et al, 2016 ).…”

“…The participants assessed in the included studies were not homogeneous, and some studies examined HC clients with a specific diagnosis due to their higher risk for a specific nursing-sensitive indicator Mengelers et al (2020). examined restraints in HC clients with dementia;Meyer et al (2020), falls in HC clients with diabetes mellitus; andNorthwood et al (2021), inconti-…”

Identification of Contributing Factors of Falls and Non-Fall Accidents Among Home Care Clients: A Retrospective Study Using Incident Reports

“…Our findings align with previous studies reporting intrinsic fall risk factors, such as dizziness, diseases, alcohol, medications, and nutrition deficiencies. 9,10,13,43 In addition, behavioral factors have been reported. 9 The fact that the person was living alone also appeared to be a risk factor for accidents in some cases.…”