Huey-Ming Tzeng1, Brian Downer2, Allen Haas3, Kenneth J Ottenbacher4. 1. School of Nursing, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA. 2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA. Electronic address: brdowner@utmb.edu. 3. Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA. 4. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA.
Abstract
OBJECTIVES: To examine the relationship between cognitive status and falls with and without injury among older adults during the first 18 days of a skilled nursing facility (SNF) and determine if this association is mediated by limitations in activities of daily living (ADL) and impaired balance. DESIGN: Cohort study of Medicare fee-for-service beneficiaries admitted to an SNF between October 1, 2016, and September 31, 2017. SETTINGS AND PARTICIPANTS: 815,927 short-stay nursing home residents admitted to an SNF within 3 days of hospital discharge. METHODS: Cognitive status at SNF admission was classified as intact, mild, moderate, or severe impairment. Residents were classified as having no falls, a fall without injury, and a fall with a minor or major injury. We used ordinal logistic regression to model the association between cognitive status and falls adjusting for resident and facility characteristics. A causal mediation analysis was used to test for the mediating effects of ADL limitations and impaired balance on the association between cognitive status and falls with an injury. RESULTS: Mild, moderate, and severe cognitive impairment were associated with 1.72 (95% CI: 1.68-1.75), 2.72 (95% CI: 2.66-2.78), and 2.61 (95% CI: 2.48-2.75) higher odds of being in a higher fall severity category, respectively, compared to being cognitively unimpaired. Greater ADL limitations and impaired balance were significantly associated with falls, but each mediated the association between cognitive status and falls by less than 2%. CONCLUSIONS AND IMPLICATIONS: Older adults with cognitive impairment are more likely to experience a fall during an SNF stay. ADL limitations and impaired balance are risk factors for falls but may not contribute to the increased fall risk for SNF residents with cognitive impairment. Continued research is needed to better understand the risk factors for falls among SNF residents with cognitive impairment.
OBJECTIVES: To examine the relationship between cognitive status and falls with and without injury among older adults during the first 18 days of a skilled nursing facility (SNF) and determine if this association is mediated by limitations in activities of daily living (ADL) and impaired balance. DESIGN: Cohort study of Medicare fee-for-service beneficiaries admitted to an SNF between October 1, 2016, and September 31, 2017. SETTINGS AND PARTICIPANTS: 815,927 short-stay nursing home residents admitted to an SNF within 3 days of hospital discharge. METHODS: Cognitive status at SNF admission was classified as intact, mild, moderate, or severe impairment. Residents were classified as having no falls, a fall without injury, and a fall with a minor or major injury. We used ordinal logistic regression to model the association between cognitive status and falls adjusting for resident and facility characteristics. A causal mediation analysis was used to test for the mediating effects of ADL limitations and impaired balance on the association between cognitive status and falls with an injury. RESULTS: Mild, moderate, and severe cognitive impairment were associated with 1.72 (95% CI: 1.68-1.75), 2.72 (95% CI: 2.66-2.78), and 2.61 (95% CI: 2.48-2.75) higher odds of being in a higher fall severity category, respectively, compared to being cognitively unimpaired. Greater ADL limitations and impaired balance were significantly associated with falls, but each mediated the association between cognitive status and falls by less than 2%. CONCLUSIONS AND IMPLICATIONS: Older adults with cognitive impairment are more likely to experience a fall during an SNF stay. ADL limitations and impaired balance are risk factors for falls but may not contribute to the increased fall risk for SNF residents with cognitive impairment. Continued research is needed to better understand the risk factors for falls among SNF residents with cognitive impairment.
Authors: Joshua Chodosh; Maria Orlando Edelen; Joan L Buchanan; Julia Ann Yosef; Joseph G Ouslander; Dan R Berlowitz; Joel E Streim; Debra Saliba Journal: J Am Geriatr Soc Date: 2008-11 Impact factor: 5.562
Authors: Brian Downer; Kali S Thomas; Vincent Mor; James S Goodwin; Kenneth J Ottenbacher Journal: J Am Med Dir Assoc Date: 2017-06-13 Impact factor: 4.669