Identification of high risk fallers among older people living in residential care facilities: A simple screen based on easily collectable measures

Purpose: To develop a simple screen based on easily collectable measures to identify older people living in residential care facilities at high risk of falls. Methods: This prospective study was conducted in seven residential care facilities in the U. K. Residents aged > 60 years who were not bedbound or terminally ill participated. Demographics, medical history, medication use, cognition (mini mental state examination (MMSE)), function (Barthel, balance and sit-to-stand ability) and behavior (neuro-psychiatric inventory (NPI) and impulsivity) were recorded at baseline. Falls and injuries were prospectively recorded over 6 months. Data were analyzed for differences between fallers and non-fallers and significant variables entered into logistic regression analysis. Results: Two hundred and forty residents completed the study. In the follow-up period, 50% fell >= 1 times. Fallers had worse function, cognition, behavior and balance and took more medications. Falling in the past year, walking frame and hypnotic/anxiolytic and anti-depressant medication use were also associated with increased likelihood of falling. Logistic regression identified MMSE < 17, impulsivity score >= 2, standing balance score < 6, requiring a walking frame, falling in the previous year and use of antidepressants and hypnotics/anxiolytics as independent and significant predictors of falls. The area under the receiver operating curve (ROC) for this model was 0.79 (95% CI 0.73-0.84). Conclusions: This tool comprising multi-factorial measures provides a simple way of quantifying the probability with which a care home resident will fall over a 6-month period. The tool may also assist in guiding the development and targeting of interventions to prevent falls in this group. Crown Copyright (c) 2012 Published by Elsevier Ireland Ltd. All rights reserved.