title: Falls and nursing home residents with cognitive impairment: new insights into quality measures and interventions.
abstract: OBJECTIVE
  Prevention and public reporting of falls have suffered due to inadequate attention given to the association of falls and cognitive impairment (CI) among nursing home (NH) residents. This study examines the relationship between CI, residence on dementia special care units (SCUs) and other resident characteristics and likelihood of residents experiencing new falls in NHs.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  A total of 21,587 residents from 381 Minnesota NHs.
  
  
  METHODS
  The NH Minimum Data Set (MDS) for 21,587 residents from 381 Minnesota NHs in the first calendar quarter of 2008 were analyzed. New falls, (fall noted on a current MDS assessment but not on a prior assessment); cognitive status, (as defined by Cognitive Performance Scale); residence on an SCU, and health and functional status covariates were recorded. A random effects logistic regression model was used to examine relationships between new falls and the resident's cognitive status, type of unit, and covariates.
  
  
  RESULTS
  The likelihood of a new fall had a nonlinear association with CI. Compared with residents with normal or mild CI, the likelihood of a new fall was significantly higher among residents with moderate CI (OR= 1.43). The risk decreased slightly (OR= 1.34) for residents with more advanced CI, whereas the presence of severe CI was not significantly associated with new falls. Overall the likelihood of new falls was significantly higher for residents on SCUs compared with those on conventional units (OR= 1.27).
  
  
  CONCLUSIONS
  Severity of CI and residence on SCU impact fall incidence and should be accounted for in future fall- prevention interventions and quality-reporting indicators and measures.
authors.affiliation: Indiana University, School of Medicine, Indianapolis, IN 46202-3012, USA. anazir@iupui.edu
authors.forename: Arif
authors.initials: A
authors.lastname: Nazir
authors.forename: Christine
authors.initials: C
authors.lastname: Mueller
authors.forename: Anthony
authors.initials: A
authors.lastname: Perkins
authors.forename: Greg
authors.initials: G
authors.lastname: Arling
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control* / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003072:Cognition Disorders; D006801:Humans; D016013:Likelihood Functions; D016015:Logistic Models; D008485:Medical Audit; D008910:Minnesota; D009735:Nursing Homes; D019984:Quality Indicators, Health Care; D012189:Retrospective Studies; D012307:Risk Factors