Differing risk factors for falls in nursing home and intermediate-care residents who can and cannot stand unaided.
OBJECTIVE
To determine fall risk factors in nursing home and intermediate-care residents who can and cannot stand unaided.


METHODS
Prospective cohort study.


METHODS
Residential elderly care facilities in Sydney, Australia.


METHODS
One thousand people aged 65 to 103 (mean age +/- standard deviation: 85.0 +/- 7.4).


METHODS
Accidental falls.


RESULTS
Fall rates were highest in those with fair standing balance, intermediate in those with the best standing balance, and lowest in those with the worst standing balance. This nonlinear pattern was even more striking when subjects were categorized according to their standing balance and ability to rise from a chair. Using this dual classification, fall rates were highest in those who could rise from a chair but could not stand unaided (81%) and lowest in those who could neither rise from a chair nor stand unaided (48%). In residents who could stand unaided, risk factors included increased age, male sex, higher care classifications, incontinence, psychoactive medication use, previous falls, and slow reaction times. In contrast, quite different risk factors were evident in residents who could not stand unaided, with a number of known fall risk factors (previous stroke, reduced ability to rise from a chair, slow reaction times) being associated with fewer falls. In this group, risk factors were intermediate versus nursing home care, poor health status, psychoactive medication use, Parkinson's disease, previous falls, and being able to get out of a chair.


CONCLUSIONS
The findings indicate that there are different risk factors for falls for people living in residential aged care facilities who can and cannot stand unaided. These findings provide important information for developing fall-prevention strategies and suggest that those who can stand unaided but have multiple falls risk factors constitute the highest priority group for such interventions.
Lord
Stephen R
SR
Prince of Wales Medical Research Institute, University of New South Wales, New South Wales, Australia. S.Lord@unsw.edu.au
March
Lynn M
LM
Cameron
Ian D
ID
Cumming
Robert G
RG
Schwarz
Jennifer
J
Zochling
Jane
J
Chen
Jian Sheng Charles
JS
Makaroff
Jan
J
Sitoh
Yih Yiow
YY
Lau
Tang Ching
TC
Brnabic
Alan
A
Sambrook
Philip N
PN
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D040561:Assisted Living Facilities / Q000706:statistics & numerical data; D001315:Australia / Q000453:epidemiology; D015331:Cohort Studies; D003196:Computer Graphics; D005260:Female; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009735:Nursing Homes / Q000706:statistics & numerical data; D004856:Postural Balance / Q000502:physiology*; D011446:Prospective Studies; D012112:Residential Facilities / Q000706:statistics & numerical data*; D012307:Risk Factors