Environmental risk factors associated with falls among older people living in long-term aged care facilities: a prospective study

Abstract Background Falls are the most common safety problem among older people living in long-term aged care facilities in China. Unsupportive environments can increase the risk of falls among this population. We aimed to understand the distribution of environmental risk factors in long-term aged care facilities and their associations with falls among residents. Methods The environmental risk factors in 25 long-term aged care facilities in Changning, Shanghai, were investigated on site using a 75-item questionnaire on potential fall-related risk factors. Residents in participating facilities were interviewed and prospectively followed up for 1 year to ascertain the occurrence of falls. Univariate and multivariate analyses were applied to measure the associations between environmental exposures and falls. Findings Between Nov 1, 2017, and Dec 31, 2018, 739 residents were interviewed at baseline and 605 completed 1-year follow-up. 132 (22%) of 605 participants had at least one fall during follow-up. The number of environmental risk factors in each care facility ranged from two to 22 (mean 11 [SD 5]). The three most common factors, which were significantly associated with the occurrence of falls, were inadequate or inappropriate handrails (24 [96%] facilities; risk ratio [RR] for fall occurrence 1·878 [95% CI 1·128–3·126]), unsafe ground (23 [92%]; 2·496 [1·111–5·606]), and insufficient lighting (21 [84%]; 2·008 [1·103–3·656]). Risk factors were most frequently distributed in bedrooms (in 24 [96%] facilities), shared toilets or showers (20 [80%]), and individual toilets or showers (17 [68%]). On univariate analysis, falls were significantly associated with the presence of environmental risk factors in corridors (RR 1·571 [1·058–2·334]), elevators (1·826 [1·224–2·724]), and living rooms (1·843 [1·249–2·720]). After adjusting for demographics and individual risks of falls by Morse Scale, residents in facilities with eight or more environmental factors had significantly increased risk of falls (adjusted RR 2·207 [1·378–3·534]). Interpretation Environmental risk factors in long-term aged care facilities are associated with increased risk of falls among residents. Improving lighting and ground safety and installing adequate handrails, especially in corridors, elevators, and living rooms, could reduce the incidence of falls. Funding Shanghai Municipal Commission of Health and Family Planning (grant number 201640040 ), Chinese Center for Disease Control and Prevention.