Falls in hospital and new placement in a nursing home among older people hospitalized with acute illness

Figures & data

Table 1 Canadian Study of Health and Aging Clinical Frailty Scale

Category	Category description
1	Very fit (energetic, motivated, exercise regularly)
2	Well (no active disease, less fit than category 1)
3	Well, with treated comorbid disease
4	Apparently vulnerable (not frankly dependent, disease symptoms, slowed up)
5	Mildly frail (limited dependence in IADL)
6	Moderately frail (help needed with ADL and IADL)
7	Severely frail (completely dependent in ADL, or terminally ill)

Abbreviations: IADL, instrumental activities of daily living; ADL, basic activities of daily living.

Table 2 Characteristics of study participants according to fall

Characteristic	Fall
	Yes, N=257	No, N=2,688
Age (mean ± SD)	82.3±7.4	82.8±7.7
Male sex (%)	54.5	36.8
Non-English-speaking COB (%)	52.9	52.3
English-speaking (%)	69.7	70.1
Admission domicile (%)
Community-based home	82.1	85.9
Hostel	17.9	14.1
Referral source (%)
Emergency department	91.8	93.9
Consultation and transfer care	6.2	4.7
Other	2.0	1.4
CSHA-CFS category (%)
1	0.5	0.7
2	0.0	1.6
3	2.7	4.3
4	5.5	9.2
5	22.8	27.9
6	57.1	43.3
7	11.4	13.0
Dementia (%)	59.5	38.1
Delirium (%)	51.0	29.4
BPSD (%)	11.7	5.6
Deconditioning (%)	29.2	20.5
Urine retention (%)	17.5	9.7
Intracranial hemorrhage (%)	2.7	0.7
Knee arthritis (%)	4.3	2.7
Hip arthritis (%)	3.9	2.9
Malnutrition (%)	9.7	7.0
Dysphagia (%)	11.3	7.9
Cardiac failure (%)	16.0	16.6
Myocardial ischemia (%)	12.1	15.7
Renal failure (%)	25.7	26.1
COPD (%)	8.2	13.6
Proximal myopathy (%)	2.0	0.9
Peripheral neuropathy (%)	3.9	3.4
Parkinson’s disease (%)	3.5	3.2
Stroke (%)	7.8	5.2
Pelvic fracture (%)	2.0	3.3
Vertebral fracture (%)	5.1	4.4
Humeral fracture (%)	0.8	1.2
Fracture (%)	17.1	15.8
Infection (%)	61.5	56.3
Malignant neoplasm (%)	14.4	11.6
Major depression (%)	3.9	2.8
Hearing impairment (%)	3.9	3.2
Visual impairment (%)	4.7	6.1
Pressure area (%)	2.0	2.4

Notes: CSHA-CFS data are missing in 38 (14.8%) fallers and 288 (10.7%) nonfallers. All other data are fully complete. Other source of referral to geriatrician refers to other hospitals and outpatient departments. The diagnoses displayed are those commonly seen in older inpatients (shown to further define the study population). Knee arthritis, hip arthritis, malnutrition, proximal myopathy, peripheral neuropathy, hearing impairment, and visual impairment refer to severe disease. Pressure area refers to grade 2 or higher.

Abbreviations: SD, standard deviation; COB, country of birth; CSHA-CFS, Canadian Study of Health and Aging Clinical Frailty Scale; BPSD, behavioral and psychological symptoms of dementia; COPD, chronic obstructive pulmonary disease.

Table 3 New placement in a nursing home according to fall, fall-related injury, and multiple falls

Fall	One or more falls		Falls without injury		Falls with injury		Multiple falls
	Placed		Placed		Placed		Placed
	Yes	No	Yes	No	Yes	No	Yes	No
Yes	58 (22.6)	199 (77.4)	41 (21.5)	150 (78.5)	17 (25.8)	49 (74.2)	13 (24.5)	40 (75.5)
No	253 (9.4)	2,435 (90.6)	253 (9.4)	2,435 (90.6)	253 (9.4)	2,435 (90.6)	253 (9.4)	2,435 (90.6)

Note: Cross-tabulation data show the frequency and the row percent for each subset of falls.

Table 4 Predictors of new placement in a nursing home according to fall, fall-related injury, and multiple falls

Predictor	Primary analysis	Secondary analyses
	One or more falls	Falls without injury	Falls with injury	Multiple falls
Fall	2.03 (1.37–3.00)	1.83 (1.17–2.85)	2.35 (1.15–4.77)	1.51 (0.69–3.30)
Dementia	1.97 (1.46–2.67)	1.93 (1.42–2.62)	1.97 (1.43–2.72)	1.95 (1.41–2.69)
Delirium	0.73 (0.55–0.98)	0.76 (0.56–1.02)	0.73 (0.53–1.00)	0.76 (0.56–1.04)
Age	1.02 (1.00–1.04)	1.02 (1.00–1.04)	1.02 (1.00–1.04)	1.02 (1.00–1.04)
Male sex	1.67 (1.27–2.21)	1.66 (1.25–2.20)	1.75 (1.31–2.35)	1.70 (1.27–2.29)
CSHA-CFS	3.39 (2.74–4.18)	3.37 (2.72–4.18)	3.20 (2.57–3.98)	3.24 (2.60–4.05)
BPSD	2.53 (1.69–3.81)	2.61 (1.73–3.96)	2.53 (1.63–3.93)	2.62 (1.69–4.07)
Urine retention	2.10 (1.47–3.01)	2.13 (1.48–3.07)	2.08 (1.41–3.06)	1.97 (1.34–2.90)
Knee arthritis (severe)	2.36 (1.20–4.62)	2.42 (1.21–4.86)	2.39 (1.20–4.79)	2.37 (1.19–4.74)
Deconditioning	1.43 (1.04–1.96)	1.52 (1.10–2.10)	1.54 (1.10–2.15)	1.73 (1.24–2.41)
Intracranial hemorrhage		2.93 (1.08–7.90)	3.68 (1.33–10.14)	3.89 (1.41–10.75)

Notes: Dementia, delirium, age, and sex were forced into all models. Age was not significant in falls with injury (P=0.09) and multiple falls (P=0.06) models. Spearman correlation coefficients between dementia and BPSD =0.26, between delirium and dementia =0.25, and between delirium and CSHA-CFS =0.24. Data shown as OR (95% CI).

Abbreviations: OR, odds ratio; CI, confidence interval; CSHA-CFS, Canadian Study of Health and Aging Clinical Frailty Scale; BPSD, behavioral and psychological symptoms of dementia.