Risk factors for falls in older people in nursing homes and hospitals. A systematic review and meta-analysis

Abstract

This is a systematic review and meta-analysis aimed at providing a comprehensive and quantitative review of risk factors for falls in older people in nursing homes and hospitals. Using MEDLINE, we searched for prospective studies investigating risk factors for falls in nursing home residents (NHR) and older hospital inpatients (HI). When there were at least 3 studies investigating a factor in a comparable way in a specific setting, we computed the pooled odds ratio (OR) using random effect models. Twenty-four studies met the inclusion criteria. Eighteen risk factors for NHR and six for HI were considered, including socio-demographic, mobility, sensory, medical factors, and medication use. For NHR, the strongest associations were with history of falls (OR = 3.06), walking aid use (OR = 2.08) and moderate disability (OR = 2.08). For HI, the strongest association was found for history of falls (OR = 2.85). No association emerged with age in NHR (OR = 1.00), while the OR for a 5 years increase in age of HI was 1.04. Female sex was, if anything, associated with a decreased risk. A few other medical conditions and medications were also associated with a moderately increased risk. For some important factors (e.g. balance and muscle weakness), a summary estimate was not computed because the measures used in various studies were not comparable. Falls in older people in nursing homes and hospitals have multifactorial etiology. History of falls, use of walking aids and disability are strong predictors of future falls.

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.