Abstract
BackgroundEntering permanent residential aged care (PRAC) is a vulnerable time for individuals. While falls risk assessment tools exist, these have not leveraged routinely collected and integrated information from the Australian aged and health care sectors. Our study examined individual, system, medication, and health care related factors at PRAC entry that are predictors of fall-related hospitalisations and developed a risk assessment tool using integrated aged and health care data.MethodsA retrospective cohort study was conducted on N = 32,316 individuals ≥65 years old who entered a PRAC facility (01/01/2009-31/12/2016). Fall-related hospitalisations within 90 or 365 days were the outcomes of interest. Individual, system, medication, and health care-related factors were examined as predictors. Risk prediction models were developed using elastic nets penalised regression and Fine and Gray models. Area under the receiver operating characteristics curve (AUC) assessed model discrimination.Results64.2% (N = 20,757) of the cohort were women and the median age was 85 years old (interquartile range 80-89). After PRAC entry, 3.7% (N = 1209) had a fall-related hospitalisation within 90 days and 9.8% (N = 3156) within 365 days. Twenty variables contributed to fall-related hospitalisation prediction within 90 days and the strongest predictors included fracture history (sub-distribution hazard ratio (sHR) = 1.87, 95% confidence interval (CI) 1.63-2.15), falls history (sHR = 1.41, 95%CI 1.21-2.15), and dementia (sHR = 1.39, 95%CI 1.22-1.57). Twenty-seven predictors of fall-related hospitalisation within 365 days were identified, the strongest predictors included dementia (sHR = 1.36, 95%CI 1.24-1.50), history of falls (sHR = 1.30, 95%CI 1.20-1.42) and fractures (sHR = 1.28, 95%CI 1.15-1.41). The risk prediction models had an AUC of 0.71 (95%CI 0.68-0.74) for fall-related hospitalisations within 90 days and 0.64 (95%CI 0.62-0.67) for within 365 days.ConclusionRoutinely collected aged and health care data, when integrated at a clear point of action such as entry into PRAC, can identify residents at risk of fall-related hospitalisations, providing an opportunity for better targeting risk mitigation strategies.
Highlights
Entering permanent residential aged care (PRAC) is a vulnerable time for individuals
Individuals living in permanent residential aged care (PRAC) facilities are most vulnerable to falls given their age, high burden of frailty, high prevalence of dementia, and use of psychotropic medications and medications that can cause orthostatic hypotension, among other contributing factors [9, 10]
While several risk assessment tools or prognostic models for falls risk identification have been developed for use in hospitals, community, or PRAC facilities [13,14,15], these tools have not leveraged the comprehensive information routinely collected in assessments and administrative records from the Australian aged care and health care sectors
Summary
Entering permanent residential aged care (PRAC) is a vulnerable time for individuals. While several risk assessment tools or prognostic models for falls risk identification have been developed for use in hospitals, community, or PRAC facilities [13,14,15], these tools have not leveraged the comprehensive information routinely collected in assessments and administrative records from the Australian aged care and health care sectors. These tools have not examined the risk profile of individuals at key periods in their aged care journey, including first entry into PRAC. This may be a vulnerable period in terms of falls risk, with residents unfamiliar with their new surroundings, together with considerable changes to medication regimen and care [16]
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