Environmental hazards increase the fall risk among residents of long-term care facilities: a prospective study in Shanghai, China.

BACKGROUND Falls are one of the most common safety concerns in long-term care facilities (LTCFs). OBJECTIVE To evaluate the associations between the environmental hazards and the fall risk in LTCF residents. DESIGN Prospective study with 12-month follow-up. SETTING Twenty-five LTCFs in a central district of Shanghai. SUBJECTS A total of 739 older people participated and 605 were followed up for 1 year. METHODS Environmental hazards were measured using a 75-item Environment Assessment Checklist, and the associations between environmental hazards and falls were analysed using univariate and multilevel logistic regressions. RESULTS The incidence of falls was 0.291 per person with 11 items/LTCF of hazards on average. The most common hazard items were inadequate/inappropriate handrails (96% LTCFs; odds ratio (OR) for falls: 1.88 [95% confidence interval: 1.13-3.13]), unsafe floors (92% LTCFs; 2.50 [1.11-5.61]) and poor lighting (84% LTCFs; 2.01 [1.10-3.66]). Environmental hazards were most frequently distributed in bedrooms (96% LTCFs), shared toilets/showers (80% LTCFs) and individual toilets/showers (68%LTCFs) and accounted for 20% of the differences in falls occurrence among the LTCFs. After adjusting for individual intrinsic and fall-related behavioural factors, it is found that having more than eight environmental hazard items increased the fall risk among older residents (adjusted OR = 4.01 [1.37-11.73]). Environmental hazards and toilet visits at night showed significant associations with falls (adjusted OR = 5.97 [1.10-32.29]). CONCLUSIONS The high prevalence of environmental hazards associated with falls highlights the urgency of improving environmental safety in LTCFs and the need of environmental safety policies, resource allocation and interventions in falls prevention.