Multiple illness increases falling risk for nursing home residents

By Sally Robertson, B.Sc.Jan 22 2013

Older adults living in institutions are at a greater risk for accidentally falling over if they have more than one disease, researchers report.

Other main factors associated with falling include urinary incontinence, antidepressant use, number of medications, and arrhythmia, report Javier Damian (Carlos III Institute of Health, Madrid, Spain) and colleagues.

The team's analysis of data collected from a survey of 744 residents from nursing homes across Spain showed that the proportion of individuals reporting at least one fall in the 30 days preceding the day of survey was 12%.

The residents were aged a mean of 83.4 years, had an average of 3.2 diseases, and were taking a mean of 4.2 medications.

As reported in BMC Geriatrics, the total number of falls was 146, corresponding to a rate of 2.4 falls per person-year.

The factor most strongly associated with the likelihood of falling was the number of diseases the individuals had, with the likelihood of falling increasing by 32% with each additional comorbidity.

The number of medications was also associated with risk for falling, in conjunction with the number of diseases. With one additional medication, the risk was raised by 31% among those with one or no diseases, and by 14% in those with two or more diseases.

"The effectiveness of interventions for the prevention of falls in care homes is debatable…" say Damian et al. "Number of diseases, a prevalent and difficult-to-mitigate factor in these very aged populations, might go some way to explain this resistance to preventive programs."

Among specific medical conditions, arrhythmias and urinary incontinence were the most strongly associated with risk for falling, at relative risks (RRs) of 2.56 and 2.00, respectively. And antidepressant use was also significantly associated with falling risk, at a RR of 2.32.

"Antidepressants, albeit useful are consistently associated with risk for falling, something that should therefore be borne in mind and the necessity of their use be periodically questioned in each particular situation," say the researchers.

However, the other risk factors identified in the study, urinary incontinence, antidepressant use, number of medications, and arrhythmias, may be more amenable to control than number of diseases, they point out.

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