Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road North Ryde, Sydney, 2122, Australia.
BMC Health Serv Res. 2024 Sep 2;24(1):1015. doi: 10.1186/s12913-024-11479-x.
During 2020-2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings.
A longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality.
During the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0-4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19-1.46, p < 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12-1.46, p < 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86-1.32, p = 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates.
These findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents' care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research.
在 2020 年至 2021 年期间，由于澳大利亚实施了严格的公共卫生措施，如封锁，社区和养老院的 COVID-19 发病率相对较低。然而，实施的公共卫生措施可能对关键的养老院居民健康结果产生了意外影响，例如由于常规护理中断和养老院居民隔离导致的跌倒。我们利用纵向数据评估了 COVID-19 封锁与养老院环境中跌倒率之间的关联。
对来自澳大利亚悉尼一家非营利性老年护理机构的 25 家养老院的常规收集数据进行了纵向队列研究。该研究包括 2019 年 3 月至 2021 年 3 月期间的 2996 名长期居民。结局指标是所有跌倒、伤害性跌倒和需要住院治疗的跌倒。应用广义估计方程（GEE）确定 COVID-19 封锁期间与跌倒相关结果之间的关联，同时调整混杂因素和季节性。
在研究期间记录了 11658 次跌倒。居民在研究期间经常经历至少一次跌倒（中位数：1，四分位距：0-4）。在 2020 年 3 月至 6 月的封锁 1 期间，所有跌倒的发生率增加了 32%（IRR 1.32，95%CI 1.19-1.46，p<0.01），伤害性跌倒的发生率增加了 28%（IRR 1.28，95%CI 1.12-1.46，p<0.01）与大流行前的比率相比。在封锁 1 期间，需要住院治疗的跌倒发生率保持不变（IRR 1.07，95%CI 0.86-1.32，p=0.519）。在 2020 年 12 月至 2021 年 1 月的封锁 2 期间，与大流行前的比率相比，所有跌倒、伤害性跌倒和需要住院治疗的跌倒率没有显著变化。
这些发现表明，严格的 COVID-19 限制的后果，如封锁 1 所见，改变了居民的护理方式，导致更多的跌倒和相关伤害。随后的封锁限制较少，且发生在工作人员获得经验之后，与跌倒率没有显著增加有关。为感染控制而实施的养老院封锁的性质和程度需要在未来的研究中平衡多种潜在的不良影响。在这一时期促进复原力的因素需要在未来的研究中进行探讨。
