Incidence and risk factors for falls among nursing home residents in Italy: a retrospective cohort study.

BACKGROUND

Falls are a public health concern among older adults, particularly in nursing home (NH) residents, but in Italy data on fall incidence and risk factors remain limited.

AIMS

To estimate the incidence of falls, identify associated risk factors, and evaluate the predictive value of the Tinetti Performance-Oriented Mobility Assessment (T-POMA) in a large cohort of NH residents.

METHODS

We conducted a retrospective cohort study using electronic health records from 32 NHs managed by Kos Care company across Italy. Residents aged ≥ 65 years with at least one functional assessment were included. Fall incidence was calculated per 100 person-years. Cox proportional hazards regression models were used to identify predictors of time to first fall.

RESULTS

Overall, 754 residents (19.2%) experienced a fall. A T-POMA score ≤ 18 was a strong predictor of falls (HR 2.13; 95% CI: 1.61-2.81), along with age ≥ 85 years (HR 1.39; 1.02-1.90), male sex (HR 1.47; 1.27-1.71), cognitive impairment (HR 1.30; 1.10-1.53), hearing impairment (HR 1.26; 1.01-1.58), mood and behavioural disorders (HR 1.29; 1.09-1.54), and therapies known to increase fall risk (HR 1.29; 1.09-1.52). Poor general health (HR 0.63; 0.52-0.77) and frequent physical restraint (HR 0.70; 0.58-0.86) use were associated with lower fall risk. Severe fall consequences occurred in 15.9% of fallers and were significantly associated with low T-POMA scores and restraint use.

DISCUSSION AND CONCLUSION

Falls are highly prevalent among Italian NH residents and influenced by multiple clinical and functional factors. These findings support the implementation of multifactorial fall prevention strategies and real-time risk monitoring in NH settings.