Analysis of risk factors for falls among institutionalized elderly persons

to identify the demographic and clinical profile, context of risk and the occurrence of falls among institutionalized elderly persons; analyze the association between the classification of risk of falling using the Brazilian version of the Morse Fall Scale and the occurrence of falls in such individuals.

Method:

A cohort study was performed in two long-stay institutions in the city of Porto Alegre, Brazil. The sample consisted of 193 elderly persons. Descriptive and inferential statistics (Chi-squared and Fisher tests) were used for analysis.

Results:

The occurrence of falls was associated with hearing impairment, hand grip strength, Katz Index score, degree of dependence according to Collegial Board Resolution 283/2005 and risk of falls according to the MFS-B.

Conclusion:

Falls have multifactorial causes, which makes it important to identify the agents that contribute to their occurrence, as it is known that institutionalization significantly increases the risk of falling. Multidisciplinary actions are important for reducing the risk of falls, together with the use of instruments that can predict such risk among institutionalized elderly people.

Keywords:
Patient Safety; Accidental Falls; Risk Factors; Elderly; Homes for the Aged

Authorship

Vitor Pena Prazido Rosa

Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Programa de Pós-graduação em Gerontologia Biomédica. Porto Alegre, Rio Grande do Sul, Brasil.Pontifícia Universidade Católica do Rio Grande do SulBrazilPorto Alegre, Rio Grande do Sul, BrazilPontifícia Universidade Católica do Rio Grande do Sul, Escola de Medicina, Programa de Pós-graduação em Gerontologia Biomédica. Porto Alegre, Rio Grande do Sul, Brasil.

https://orcid.org/0000-0001-5420-9772

Fátima Cristina Bordin Dutra Cappellari

Pontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde. Porto Alegre, Rio Grande do Sul, Brasil.Pontifícia Universidade Católica do Rio Grande do SulBrazilPorto Alegre, Rio Grande do Sul, BrazilPontifícia Universidade Católica do Rio Grande do Sul, Escola de Ciências da Saúde. Porto Alegre, Rio Grande do Sul, Brasil.

https://orcid.org/0000-0002-2044-1271

Janete de Souza Urbanetto

https://orcid.org/0000-0002-4697-1641

Correspondence
Janete de Souza Urbanetto jurbanetto@pucrs.br

SCIMAGO INSTITUTIONS RANKINGS

Tables

Tables (5)

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Table 1
Clinical characteristics of institutionalized elderly persons (N = 193) in two long-term institutions for the elderly. Porto Alegre, Rio Grande do Sul, 2016.

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Table 2
Context of falls of institutionalized elderly persons who fell after the first evaluation in two LTCFs. Porto Alegre, Rio Grande do Sul, 2016.

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Table 3
Characterization of the occurrence of harm and contributory factors for the risk of falls among institutionalized elderly persons who had suffered falls, from two long term care facilities for the elderly. Porto Alegre, Rio Grande do Sul, 2016.

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Table 4
Association between falls and sociodemographic and clinical variables of elderly persons institutionalized in two long term care facilities for the elderly (N=193). Porto Alegre, Rio Grande do Sul, 2016.

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Table 5
Association of falls with clinical variables of institutionalized elderly persons (N = 193) from two long-term care facilities for the elderly. Porto Alegre, RS, 2016.

Table 1 Clinical characteristics of institutionalized elderly persons (N = 193) in two long-term institutions for the elderly. Porto Alegre, Rio Grande do Sul, 2016.

Variables	n (%)
Visually impaired
Not impaired	33 (17.1)
Impaired	160 (82.9)
Hearing impaired
Not impaired	87 (45.1)
Impaired	106 (54.9)
Diagnosis of illnesses
No diagnosis	15 (7.8)
Up to three diagnoses	95 (49.2)
Four or more diagnoses	83 (43.0)
Katz Index Score
Independent	84 (43.5)
Partially Dependent	51 (26.4)
Totally Dependent	58 (30.1)
Degree of dependency
Degree of dependency 1	99 (51.3)
Degree of dependency 2	27 (14.0)
Degree of dependency 3	67 (34.7)
Suitability of footwear
Suitable	108 (56.0)
Not suitable	85 (44.0)
Number of drugs
Does not use medicines	5 (2.6)
Up to four medications	50 (25.9)
Five or more medications	138 (71.5)
Handgrip Strength Test (n = 149)
Reduced female	75 (50.3)
Normal female	19 (12.8)
Reduced male	27 (18.1)
Normal male	28 (18.8)
Risk of falls according to Brazilian version of Morse Fall Scale (MFS-B)
Low	35 (18.1)
Moderate	85 (44.0)
High	73 (37.8)

Table 2 Context of falls of institutionalized elderly persons who fell after the first evaluation in two LTCFs. Porto Alegre, Rio Grande do Sul, 2016.

Variables	n (%)
Falls after 1st evaluation (n = 193)
Did not fall	140 (72.5)
Fell	53 (27.5)
Total falls
None	140 (72.5)
One	34 (17.6)
Two	12 (6.2)
Three	3 (1.6)
Four	1 (0.5)
Five	1 (0.5)
Seven	2 (1.0)
Time of fall (n = 53)
Morning	20 (37.7)
Evening	9 (17.0)
Night	15 (28.3)
Not reported	9 (17.0)
Fall Type 1 (n = 53)
From own height	28 (52.8)
From chair/sofa/wheelchair	15 (28.3)
Not reported	10 (18.9)
Fall type 2 (n = 53)
Fell to ground	47 (88.7)
Did not reach ground - was supported or supported self	5 (9.4)
Not reported	1 (1.9)
Fall site (n = 53)
Recreation Room	4 (7.5)
Refectory	3 (5.7)
Courtyard	5 (9.4)
Bathroom	6 (11.3)
Consulting room	1 (1.9)
Nursing area	1 (1.9)
Bedroom	24 (45.3)
Hall	8 (15.1)
Not reported	1 (1.9)

Table 3 Characterization of the occurrence of harm and contributory factors for the risk of falls among institutionalized elderly persons who had suffered falls, from two long term care facilities for the elderly. Porto Alegre, Rio Grande do Sul, 2016.

Variables	n (%)
Occurrence of harm (n = 53)
No harm	26 (49.0)
Suffered harm	27 (51.0)
Physical harm (n = 53)
No	29 (54.7)
Yes	24 (45.3)
Psychological harm (n = 53)
No	43 (22.3)
Yes	10 (5.2)
Social harm (n = 53)
No	48 (90.6)
Yes	5 (9.4)
Total specific physical harm (n = 24)
Edema	2 (8.3)
Bruise	3 (12.5)
Fracture	2 (8.3)
Skin Lesion	7 (29.4)
Local pain	2 (8.3)
Edema/hematoma	2 (8.3)
Hematoma/skin lesion	2 (8.3)
Edema/hematoma/skin lesion	2 (8.3)
Not reported	2 (8.3)
Specific psychological harm (n = 10)
Fear of falling	6 (60.0)
Shame	2 (20.0)
Crying	1 (10.0)
Not reported	1 (10.0)
Specific Social harm (n = 5)
Removal from activities	4 (80.0)
Not reported	1 (20.0)
Environmental factors (n = 53)
Unsuitable gurneys	10 (18.7)
Slippery floor	8 (15.1)
Open wing division gate	1 (1.9)
Defect with wheelchair	1 (1.9)
Not reported	33 (62.4)
Personal factors (n = 53)
Unsuitable shoes	15 (28.3)
Shaking	6 (11.3)
Not adhering to instructions	14 (26.4)
Unaccompanied	1 (1.9)
Visual impairment	1 (1.9)
Not reported	16 (30.2)
Fall context report (n = 53)
Imbalance	12 (22.6)
Not reported	13 (24.5)
Slipped	12 (22.6)
Tripped	7 (13.2)
No restraints	2 (3.8)
Shaking	6 (11.4)
Unsuitable bed	1 (1.9)

Table 4 Association between falls and sociodemographic and clinical variables of elderly persons institutionalized in two long term care facilities for the elderly (N=193). Porto Alegre, Rio Grande do Sul, 2016.

Variables	n (%)	Falls		p
Variables	n (%)	No - n (%)	Yes - n (%)
Gender
Women	121 (62.7)	82 (67.8)	39 (32.2)	0.054*
Men	62 (37.3)	58 (80.6)	14 (19.4)	0.054*
Age
Up to 79 years old	96 (49.7)	73 (76.0)	23 (24.0)	0.278*
80 years and over	97 (50.2)	67 (69.1)	30 (30.9)	0.278*
Schooling
Illiterate	50 (25.6)	36 (72.0)	14 (28.0)	0.277**
Literate	20 (10.4)	12 (60.0)	8 (40.0)
Incomplete elementary education	65 (33.7)	51 (78.5)	14 (21.5)
Complete primary education	27 (14.0)	17 (63.0)	10 (37.0)
Incomplete high school education	7 (3.6)	5 (71.4)	2 (28.6)
Complete high school education	16 (8.3)	11 (68.8)	5 (31.3)
University graduate	8 (4.1)	8 (100.0)	0 (0.00)
Time in LTCF
0 to 2 years in LTCF	64 (33.2)	49 (76.6)	15 (23.4)	0.685*
From 2.01 to 5.9 years in LTCF	62 (32.1)	44 (71.0)	18 (29.0)
Over 5.91 years in LTCF	67 (34.7)	47 (70.1)	20 (29.9)
Diagnoses of illness
None	15 (7.8)	12 (80.0)	3 (20.0)	0.261**
Up to three diagnoses of illness	95 (49.2)	73 (76.8)	22 (23.2)
Four or more diagnoses of illness	83 (43.0)	55 (66.3)	28 (33.7)
Total medications
Does not use medications	5 (2.6)	5 (100.0)	-	0.132**
Up to four medications	50 (25.9)	40 (80.0)	10 (20.0)
≥ Five medications (polypharmacy)	138 (71.5)	95 (68.8)	43 (31.2)

* Pearson’s Chi-Squared; ** Fisher’s Exact.

Table 5 Association of falls with clinical variables of institutionalized elderly persons (N = 193) from two long-term care facilities for the elderly. Porto Alegre, RS, 2016.

Variables	n (%)	Falls		p
Variables	n (%)	No - n (%)	Yes - n (%)
Visual impairment
No	33 (17.1)	23 (69.9)	10 (30.3)	0.688*
Yes	160 (82.9)	117 (73.1)	43 (26.9)	0.688*
Hearing impairment
No	87 (45.1)	72 (82.8)	15 (17.2)	0.004*
Yes	106 (54.9)	68 (64.2)	38 (35.8)	0.004*
Hand Grip Strength (n = 149)
Reduced female	75 (50.3)	47 (62.7)	28 (37.3)	0.004*
Normal female	19 (12.8)	16 (84.2)	3 (15.8)
Reduced male	27 (18.1)	19 (70.4)	8 (29.6)
Normal male	28 (18.8)	27 (96.4)	1 (3.6)
Katz Index Score
Independent	84 (43.5)	76 (90.5)	8 (9.5)	<0.001*
Partial dependency	51 (26.4)	30 (58.8)	21 (41.2)
Total dependency	58 (30.1)	34 (58.6)	24 (41.4)
Degree of dependency
Degree of dependency 1	99 (51.3)	87 (87.9)	12 (12.1)	<0.001*
Degree of dependency 2	27 (14.0)	17 (63.0)	10 (37.0)
Degree of dependency 3	67 (34.7)	36 (53.7)	31 (46.3)
Suitability of footwear
Suitable	108 (56.0)	85 (78.7)	23 (21.3)	0.031*
Unsuitable	85 (44.0)	55 (64.7)	30 (35.3)	0.031*
Risk of falls
Low risk	35 (18.1)	29 (82.9)	6 (17.1)	0.012*
Moderate risk	85 (44.0)	67 (78.8)	18 (21.2)
High risk	73 (37.8)	44 (60.3)	29 (39.7)

* Pearson’s Chi-squared.

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Analysis of risk factors for falls among institutionalized elderly persons

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[1] Correspondence
Janete de Souza Urbanetto jurbanetto@pucrs.br