Factors Related to Falls among Home-Based Long-term Care Recipients

Abstract

Preventing falls in home care is essential for aging in place without harm. A quality indicator for home-based long-term care, the occurrence of falls is a widespread safety problem that often leads to limitation in physical activity and acts as a disabling factor to older adults ability to maintain independence. In particular, recipients of long-term care in the home are vulnerable to the occurrence and sequelae of falls in the community due to their elevated level of dependency, comorbidity and the nature of home care. The occurrence of falls in this setting often results in nursing home admission and hospitalization, which imposes a substantial burden at both the individual and system level. Targeting an intervention to fortify weaknesses in factors related to the occurrence of falls may prevent them from aligning themselves in a way that hazards result in harm. Yet in Korea, few empirical studies have examined the effect of such factors on the risk of falls in the home-based long-term care setting. Therefore, the purpose of the study is to determine sociodemographic, health, and environmental factors related to the occurrence of falls among Koreas home-based long-term care recipients at baseline, and at 6-month follow-up.

This study is a secondary analysis of data collected from 357 home-based long-term care recipients randomly selected from 19 home care service agencies serving Seoul and Gyeonggi province, of which 184 participants were reassessed at 6-month follow-up. Data was collected through home visits using the Korean translation of interRAI Home Care Assessment System. interRAI-HC assessments provide a comprehensive profile of home care clients including their function, health, social support, environment and services. Falls were defined as the unintentional change in position coming to rest on the ground, floor or onto the next lower surface during the past 90 days. As for analyses, the distribution of fall status and related characteristics were analyzed using descriptive statistics, bivariate, and multivariate regressions. Logistic regression was carried out to examine factors associated with the risk of falling at baseline assessment in model one, and sought to determine predictive factors of the occurrence of falls at 6-month follow-up in model two.

Of the 357 participants at baseline, nearly 14% fell one or more times. Social and health characteristics such as the experience of decline in social activities, conflict with family or friends, unsteady gait, cognitive impairment and pain were significantly associated with falling. In model 1, not living with an informal caregiver, decline in social activities with distress, conflict with family or friends, unsteady gait, less cognitive impairment, and low depression were identified as falls risk factors. Overall, results of the first model showed a heavy influence of social support and isolation on the risk of falling.

Among 154 participants reassessed at six months, thirty individuals(16.3%) had experienced at least one fall, of which 20 were recurrent fallers. Model 2 prospectively examined factors predictive of falls occurrence at 6-month follow-up, and demonstrated the presence of significant relationships of both social and health-related factors with the occurrence of falls at 6-month follow-up. Decline in social activities with distress(OR=6.7) and unsteady gait(OR=5.7) remained significant in model 2. Results confirm the multi-faceted nature of contributing factors of falls occurrence.

Home care agencies should make routine assessments of the social and health conditions of older adults receiving home-based long-term care, especially for those who live without an informal caregiver. Social factors such as reduced social participation and relational conflict could be accompanied by social isolation that could signal neglect, and when accompanied by gait problems, could point to a increase in the risk of falls. These signs should be formally tracked by a comprehensive assessment of care recipients with follow-up, as changes in social and health conditions that are systematically captured may be utilized to identify at-risk older adults for preventive interventions to reduce the occurrence of falls in the home-based long-term care setting.