Abstract
Falls are a complex problem, given their multifactorial nature, the comorbidities involved, and due to the dependency of older persons living in nursing homes. Risk, fear of falling, falls themselves, and their recurrence are the main factors behind fragility fractures, lack of independence, and increases in pain prevalence, and other comorbidities in older populations. The objectives of the present quantitative and longitudinal study were: (a) to characterize the cognitive state and fall frequency of older persons living in nursing homes; (b) to analyze the relationship between cognitive status and some fall risk factors; and (c) to associate cognitive decline, gait ability, and muscle strength of the examined institutionalized older persons with fall occurrence and recurrence over 12 months. The participants were 204 older persons who lived in Portuguese nursing homes, and data were collected from January 2019 to February 2020 by consulting medical records and applying the following instruments: the Mini-Mental State Examination, Timed Up and Go Test, and Medical Research Council Manual Muscle Testing Scale. Fall prevalence, assessed in two periods, 12 months apart, was similar in both samples (with and without cognitive decline) and close to 42%, and the annual recurrence rate was 38.3%. Older persons with no cognitive decline showed an association between gait speed and occurrence of first fall and recurrent fall (p < 0.05). Muscle strength and use of gait aid devices were not related to falls and their recurrence, regardless of mental state.
Highlights
As a public health problem, there is a high prevalence of falls in older persons
Another important aspect is that most institutionalized older persons have cognitive decline [5], and there is a relationship between this decline, gait alterations, fall risk, fall prevalence, and the severity of the injuries resulting from falls [5,6,7]
In the first period of evaluation, fall prevalence was high, because at least one fall was recorded during the previous year for 85 older persons (44 without cognitive decline and 41 with cognitive decline)
Summary
As a public health problem, there is a high prevalence of falls in older persons. In addition to physical injuries, there are psychological consequences, such as fear of falling and social issues related to isolation and/or institutionalization [1,2]. After institutionalization, older persons are subject to higher fall risks, since fall prevalence in nursing homes is higher than that recorded in communities [1,2] This situation is worsened by higher levels of dependency, higher incidence of chronic diseases, polymedication, and gait alterations [3,4]. After the first fall episode, recurrence is more frequent in this context, with a recurrence rate in the subsequent 12 months, ranging from 30% to 40% [5] Another important aspect is that most institutionalized older persons have cognitive decline [5], and there is a relationship between this decline, gait alterations, fall risk, fall prevalence, and the severity of the injuries resulting from falls [5,6,7].
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