One in five short-stay nursing home patients sustains a fall after their admission, and certified nursing assistant (CNA) staffing is associated with decreased fall risk, according to a study led by USC researcher Natalie Leland. The study recently was published in the Journal of the American Geriatrics Society.
Though falls are unintentional, they hardly are insignificant: the Centers for Medicare & Medicaid Services reports fall rates as a quality indicator, and falls of nursing home residents have been associated with greater morbidity, mortality and health care costs.
Leland, who holds joint appointments at the USC Division of Occupational Science and Occupational Therapy and the USC Davis School of Gerontology, and colleagues from Brown University analyzed the 2006 Minimum Data Set (MDS) assessments of all first-time Medicare and Medicaid patients admitted to a nursing home.
Among more than 230,000 patients in nearly 10,000 nursing homes across the country, the researchers found that 21 percent of newly admitted nursing home residents sustained at least one fall during their first 30 days in the facility.
To identify potential factors contributing to falls, the study also examined various organizational characteristics of nursing homes. Facilities with higher CNA-to-patient staffing ratios were associated with fewer falls, likely because CNAs provide much of the hands-on patient care during high-risk activities.
While fall rates among long-term nursing home populations are well documented, this nationwide study is believed to be the first of its kind to specifically analyze fall rates among newly admitted nursing home residents. Because new admits are in a novel environment and generally are unfamiliar to staff, identification and management of fall risk poses a particular challenge.
Leland, a research gerontologist and licensed occupational therapist, explained the significance of this research.
“This study highlights the different health care goals of a population striving to get back to the community, who were mostly admitted for rehabilitation after a hospital stay, relative to long-term patients who reside in the nursing home,” Leland said. “A fall can delay or permanently prevent the patient from returning to the community, and identifying risk of falling is essential for implementing fall prevention strategies and facilitating successful discharge back to the community.”
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