Retrospective Analysis of Fall Incidents in Elderly Patients within a Long-Term Care Facility

Abstract

Falls represent a widespread and serious health threat for residents of long-term care (LTC) facilities. Among older persons, falls cause injury, loss of independence, and increased mortality. In the USA, falls are the leading cause of injury-related morbidity and mortality among the elderly, leading to 734,000 hospitalizations and 22,000 deaths (D. Cox et al., 2022) ; they carry an estimated economic burden exceeding $50 billion. Constructing a detailed understanding of the incidence and risk factors for falls in LTC is vital for informing evidence-based prevention strategies and improving quality of care (Lee et al., 2024).

Unfortunately, even extensive literature on falls in LTC is chiefly limited to single-site studies or other designs that preclude comparison of different kinds of data. Many fall-prevention programs are based on the assumption that LTC residents fall primarily due to poor physiologic status, but this has never been assessed on a population scale. In addition to information on fall counts and associated risk factors, the present analysis therefore characterizes patterns and determinants of fall injuries, examines links between prior falls and current risk, and considers the relationship with prognosis. Long-term monitoring of falls has likewise been inadequate, despite the benefit of ongoing program evaluation. Prior research has typically fitted insufficiently specified models or collected only nominal demographic data. Great variation in the design, content, population, analysis methods, and objectives of existing studies means that even broadly similar investigations are often difficult to interpret. Meta-analysis is hindered by failure to report incidence, time-to-event statistics, and demographic factors in similar formats.

The LTC facility under study is a 203-bed nursing home located in a county seat of a major Midwestern state. On the day of data collection, it housed 154 residents; among them, 86% were female and the average length of stay was 409 days. Although 84% of residents were frail enough to qualify for Medicaid, the overall census reflects a relatively more independent and higher-income population than the statewide average. All residents receive a similar level of assistance with activities of daily living and at least 70% receive occupational or physical therapy services. Residents are free to spend time alone, participate in group activities, or attend off-site outings in a facility vehicle; restraints are seldom applied. The data required to conduct an adequate risk assessment and develop sound prevention strategies have not been previously available.