Association Between Cognitive Status and Falls With and Without Injury During a Skilled Nursing Facility Short Stay |
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| Institution: | 1. School of Nursing, University of Texas Medical Branch, Galveston, TX, USA;2. Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA;3. Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, TX, USA;4. Office of Biostatistics, University of Texas Medical Branch, Galveston, TX, USA;1. Cardiology Department, Cardiovascular Institute (ICCV), Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain;2. Cardiology Department, Complejo Asistencial Universitario de León, León, Spain;3. Cardiology Department, Hospital del Mar, Barcelona, Spain;4. Cardiology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain;1. Departments of Family Medicine and Internal Medicine, School of Medicine, and the Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;2. Departments of Internal Medicine and Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;1. Harvard T.H. Chan School of Public Health, Boston, MA, USA;2. Department of Family Medicine, Uijeongbu Eulji Medical Center, University School of Medicine, Gyeonggi-do, Republic of Korea;3. Department of Family Medicine, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea;4. Harvard T.H Chan School of Public Health, Boston, MA, USA;5. Division of Infectious Diseases, Department of Internal Medicine, CHA Bundang Medical Center, Seongnam, Republic of Korea;6. Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, USA;7. Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA |
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| Abstract: | ObjectivesTo 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.DesignCohort study of Medicare fee-for-service beneficiaries admitted to an SNF between October 1, 2016, and September 31, 2017.Settings and Participants815,927 short-stay nursing home residents admitted to an SNF within 3 days of hospital discharge.MethodsCognitive 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.ResultsMild, 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 ImplicationsOlder 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. |
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| Keywords: | Falls skilled nursing facilities cognitive impairment |
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