Association Between Cognitive Status and Falls With and Without Injury During a Skilled Nursing Facility Short Stay.
Huey-Ming Tzeng, Brian Downer, Allen Haas and 1 others
PMID 34237256WHAT IT FOUND
In the first 18 days of a skilled nursing facility stay, greater cognitive impairment was linked to more severe falls.
Residents with mild impairment had higher fall severity, and those with moderate or severe impairment had still higher fall severity.
Key findings
01Greater cognitive impairment was associated with higher odds of a more severe fall category: mild impairment 1.72, moderate impairment 2.72, severe impairment 2.61.
02Impaired balance was associated with 1.33 higher odds of a more severe fall category, and ADL scores of 16 to 18 or 19 to 21 were associated with higher odds, while ADL scores of 22 to 28 were not.
03Severe ADL limitations mediated 1.21% of the association between cognitive status and falls, and totally impaired balance mediated 1.57%.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Falls were taken from MDS reports, and the authors say nursing homes under-report falls. Residents who died during the SNF stay were excluded, removing some people at highest risk. The analysis covered only the first 18 days, so it does not describe falls later in a longer stay. Staffing data came from Nursing Home Compare reports made by facilities, and the authors note accuracy concerns. 80,341 residents were excluded for missing variables, though the authors say fall rates were similar to those included. The study is observational, so it cannot show that any treatment prevented a fall.
Declared interests
No conflicts declaration is supplied in the article text. The publication types note NIH extramural research support.
The easy way to misread this
Do not treat this as evidence that improving cognition, balance, or ADL independence prevents falls. It is an observational analysis of documented falls, and the authors note falls are under-reported, residents who died were excluded, and minority residents may have fewer documented major injury falls.