ReviewRisk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis
Introduction
Injuries are the fifth leading cause of death in adults aged 65 years or older (after cardiovascular diseases, cancer, stroke and respiratory causes), and falls cause two thirds of these deaths. Most falls do not cause death, but 5–10% of falls result in serious injuries such as head injuries or fractures. Falls are very common, with about 30% of community-dwelling older adults falling every year in developed countries. The incidence among institutionalized older people is even higher, with a mean percentage of residents who fall each year of over 40% (Rubenstein & Josephson, 2002).
In a previous article (Deandrea et al., 2010) we investigated risk factors for falls in community-dwelling older people, and we found the strongest associations for history of falls, gait problems, walking aids use, vertigo, Parkinson's disease and antiepileptic drugs use with ORs between 2 and 3.
Nursing homes and hospitals constitute different settings with a different organization and care provided. Older people in nursing homes and hospitals are likely to be on average less independent and more frequently affected by chronic or acute conditions as compared to community-dwelling older people. Repeated falls and their consequences often have led to the initial institutionalization of the NHR and falls continue to affect the residents’ remaining independence, once they are living in a facility (Becker & Rapp, 2010). In addition, the presence of hospital and nursing home staff and differences in the physical environment (Oliver, Healey, & Haines, 2010) constitute further differences with respect to community-dwelling persons. Thus, results on risk factors for falls in community-dwelling older people cannot be automatically translated into these setting, and it is important to investigate risk factors for falls in these specific settings.
The objective of this work is to conduct a review and meta-analysis of prospective studies on risk factors for falls in older NHR and HI.
Section snippets
Search strategy and selection criteria
As in a previous review on community-dwelling older people (Deandrea et al., 2010) the basis for our analysis was the systematic search of the relevant literature conducted the National Institute of Clinical Excellence (NICE) (NICE, 2004) between 1998 and 2002, and previous reviews (AGS, 2001, Connell, 1996, Ganz et al., 2007, Hartikainen et al., 2007, Leipzig et al., 1999a, Leipzig et al., 1999b, Lord et al., 2007, NICE, 2004, Perell et al., 2001, Rawsky, 1998, Rubenstein and Josephson, 2002).
Results
The MEDLINE search produced 4155 citations. Review of the titles and abstracts resulted in the selection of 1447 papers, among which 356 were original studies, and 18 met the inclusion criteria. Six additional studies were identified from the references of previously published reviews (AGS, 2001, Connell, 1996, Ganz et al., 2007, Hartikainen et al., 2007, Leipzig et al., 1999a, Leipzig et al., 1999b, Lord et al., 2007, NICE, 2004, Perell et al., 2001, Rawsky, 1998, Rubenstein and Josephson, 2002
Discussion
This is, to the best of our knowledge, the first systematic review on risk factors for falls in older NHR and HI using appropriate meta-analytic techniques to obtain quantitative summary estimates.
We found ORs around 2–3 for history of falls in both settings, and for use of walking aids and moderate disability in nursing homes. For a few other medical conditions and for use of a few drugs, the ORs were significantly, but moderately, above unity. The association with antidepressants and
Conflict of interests statement
No authors have potential conflicts of interest with reference to this paper.
Funding
This study was partially supported by the Directorate General for Health and Consumers (DGSANCO) of the European Union “Strategies and best practices for the reduction of Injuries” (APOLLO) program [Grant Agreement 2004119].
Acknowledgements
The authors wish to thank Ivana Garimoldi and Nicoletta Gheno for editorial assistance.
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