Do Falls Predict Institutionalization in Older Persons?

Abstract

Data from the Longitudinal Study of Aging (LSOA) were analyzed to estimate the subsequent risk of institutionalization associated with a report of one or more falls, and to determine if the association is affected by controlling for demographic traits, chronic conditions, and disabilities present at baseline. Risk was estimated at two time points, 2 years and 4years after baseline interview. A report of multiple falls at baseline was associated with an increased risk of institutionalization at both 2 years (odds ratio [OR] 3.1; 1.9-5.3) and 4 years (OR 2.6; 1.64.4) of follow-up. The risk was decreased but remained significant in a model controlling for age, sex, marital status, and selected chronic conditions associated with both report of falls and institutionalization. However, multiple falls were not significantly associated with institutionalization when measures of disability (number of difficulties with activities of daily living) were added to the model. These analyses suggest that multiple falls should be regarded as an important sentinel event to alert caregivers to the presence of underlying disease and disability that may require intervention.

Get full access to this article

View all access options for this article.

References

Branch, L. G. , & Jette, A. M. (1982). A prospective study of long-term care institutionalization among the aged. American Journal of Public Health, 72(12), 1373-1379.

Buchner, D. M. , & Larson, E. B. (1988). Transfer bias and the association of cognitive impairment with falls. Journal of General Internal Medicine, 3, 254-259.

Coughlin, T. A. , McBride, T. D. , & Liu, K. (1990). Determinants of transitory and permanent nursing home admissions. Medical Care, 28, 616-631.

Dunn, J. E. , Rudberg, M. A. , Furner, S. E. , & Cassel, C. K. (1992). Mortality, disability and falls in older persons: The role of underlying disease and disability. American Journal of Public Health, 82(3), 395-400.

Fitti, J. E. , & Kovar, M. G. (1987). The supplement on aging to the 1984 National Health Interview Survey. Vital and Health Statistics (Series 1, No. 21, DHHS Pub. No. PHS 87-1323). Washington, DC: U.S. Government Printing Office.

Ford, A. B. , Haug, M. R. , Jones, P. K. , Roy, A. W. , & Folmar, S. J. (1990). Race-related differences among elderly urban residents: A cohort study, 1975-1984. Journal of Gerontology, 45(4), S163-S171.

Gryfe, C. I. , Amies, A. , & Ashley, M. J. (1977). A longitudinal study of falls in an elderly population: L. Incidence and morbidity. Age and Aging, 6, 201-210.

Harrell, F. E., Jr. (1986). The LOGIST procedure. In SAS Institute, Inc., SUGI supplemental library user's guide (pp. 269-294). Cary, NC: SAS Institute.

Kelman, H. R. , & Thomas, C. (1990). Transitions between community and nursing home residence in an urban elderly population. Journal of Community Health, 15(2), 105-122.

10.

Kiel, D. P. , O'Sullivan, P. , Teno, J. M. , and Mor, V. (1991). Healthcare utilization and functional status in the aged following a fall. Medical Care, 29(3), 221-228.

11.

Kovar, M. G. (1987). The Longitudinal Study of Aging: The 1986 reinterview public use file. Proceedings of the 1987 Public Health Conference on Records and Statistics (DHHS Pub. No. PHS 88-1214). Hyattsville, MD: U.S. Government Printing Office.

12.

Lewis, M. A. , Cretin, S. , & Kane, R. L. (1985). The natural history of nursing home patients. The Gerontologist, 25(4), 382-387.

13.

Liu, K. , Coughlin, T. , & McBride, T. (1991). Predicting nursing-home admission and length of stay. Medical Care, 29(2), 125-141.

14.

Murtaugh, C. M. , Kemper, P. , & Spillman, B. C. (1990). The risk of nursing home use in later life. Medical Care, 28(10), 952-962.

15.

Perry, B. C. (1982). Falls among the elderly: A review of the methods and conclusions of epidemiologic studies. Journal of the American Geriatrics Society, 30, 367-371.

16.

SAS Institute, Inc. (1985). SMS User's Guide, Version 5 Edition. Cary, NC: Author. Sattin, R. W., Lambert Huber, D. A., DeVito, C. A., Rodriguez, J. G., Ros, A., Bacchelli, S., Stevens, J. A., & Waxweiler, R. J. (1990). The incidence of fall injury events among the elderly in a defined population. American Journal of Epidemiology, 131(6), 1028-1037.

17.

Shah, B. V. , Folsom, R. E. , Harrell, F. E. , & Dillard, C. N. (1987). RTILOGIT: Procedure for logistic regression on survey data. Research Triangle Park, NC: Research Triangle Institute.

18.

Tinetti, M. E. , Speechley, M. , & Ginter, S. F. (1988). Risk factors for falls among elderly persons living in the community. New England Journal of Medicine, 319(26), 1701-1707.

19.

Tinetti, M. E. , Williams, T. F. , & Mayewski, R. (1986). Fall risk index for elderly patients based on number of chronic disabilities. American Journal of Medicine, 80, 429-434.

20.

Weissert, W. G. , & Cready, C. M. (1989). Toward a model for improved targeting of aged at risk of institutionalization. Health Services Research, 24(4), 485-510.

21.

Wiener, J. M. , & Hanley, R. J. (1989). Measuring the activities of daily living among the elderly: A guide to national surveys (Federal Forum Final Report). Interagency Forum on Aging-Related Statistics, Committee on Estimates of Activities of Daily Living in National Surveys. Washington, DC: Brookings Institution.