Falls: an examination of three reporting methods in nursing homes.
OBJECTIVE
To examine the concordance of various fall reporting methods and to use the results to recommend a preferred method of ascertaining fall frequency for residents of nursing homes, both for research and in the collection of federally mandated nursing home data.


METHODS
A cohort study followed for 858 patient months, with a mean individual follow-up of 6.6 months.


METHODS
Falls were independently ascertained monthly by three methods: review of administrative incident reports, nursing home chart abstraction, and structured interview of subjects. Concordance of events was assessed using measures of simple agreement and Kendall's Tau-b. Simple correlation and multiple regression were used to evaluate the relation of age, sex, gender, depression, mental status, and functional status with degree of concordance between self-reported falls and chart-recorded falls.


METHODS
One academic and six community nursing homes in San Antonio, Texas.


METHODS
131 long-stay nursing home residents, greater than 60 years of age, dependent in at least two activities of daily living, and mildly cognitively impaired.


RESULTS
Falls were ascertained in 74 of the 131 individuals; 53 subjects fell 124 times by incident report, 58 had 140 falls according to chart review, and 66 subjects self-reported 232 falls. Greatest agreement between reporting methods was shown for incident report and chart review, with a Kendall's Tau-b of 0.88; self-report and chart-review agreement was 0.56; and self-report and incident agreement was 0.53. Estimated total fall events were more often (P = 0.001) identified by chart review (92%) than incident report (82%). Although concordance was higher for non-fallers, no significant relationships were observed between concordance and age, sex, race, depression, mental status, and functional status. Also, there was no systematic relationship between length of follow-up and degree of concordance.


CONCLUSIONS
Fall frequency varies by ascertainment method, with chart review reflecting a greater number of fall events than the traditionally counted incident reports.
Kanten
D N
DN
Geriatric Research, Education and Clinical Center (GRECC), Audie L. Murphy Memorial Veterans Hospital, San Antonio, Texas.
Mulrow
C D
CD
Gerety
M B
MB
Lichtenstein
M J
MJ
Aguilar
C
C
Cornell
J E
JE
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D015982:Bias; D015331:Cohort Studies; D003625:Data Collection / Q000379:methods* / Q000592:standards; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D008485:Medical Audit / Q000592:standards; D009735:Nursing Homes; D012308:Risk Management / Q000592:standards; D011795:Surveys and Questionnaires / Q000592:standards