Incidence Morbidity and Mortality From Falls in Skilled Nursing Facilities: A Systematic Review and Meta-Analysis

Maren Kimura; Sydney Ruller; Cairina Frank; Alison Bell; Micaela Jacobson; Jordi Pardo Pardo; Tim Ramsey; Monica Sobala; Celeste Fung; Daniel Kobewka

doi:10.1016/j.jamda.2023.07.012

Incidence Morbidity and Mortality From Falls in Skilled Nursing Facilities: A Systematic Review and Meta-Analysis

J Am Med Dir Assoc. 2023 Nov;24(11):1690-1699.e6. doi: 10.1016/j.jamda.2023.07.012. Epub 2023 Aug 22.

Authors

Affiliations

¹ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
² Department of Medicine, University of Ottawa, Ottawa, ON, Canada.
³ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.
⁴ St. Patrick's Home of Ottawa, Ottawa, ON, Canada.
⁵ St. Patrick's Home of Ottawa, Ottawa, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada.
⁶ Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Medicine, University of Ottawa, Ottawa, ON, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada; St. Patrick's Home of Ottawa, Ottawa, ON, Canada; Division of General Internal Medicine, Department of Medicine, The Ottawa Hospital, Ottawa, ON, Canada. Electronic address: dkobewka@toh.ca.

PMID: 37625452
DOI: 10.1016/j.jamda.2023.07.012

Abstract

Objectives: The primary objective of this study was to systematically review and meta-analyze the incidence and consequential morbidity and mortality from falls in skilled nursing facilities. Our secondary objective is to synthesize current evidence on risk factors for injurious falls.

Design: Systematic review and meta-analysis.

Setting and participants: Older adults residing in skilled nursing facilities or similar settings.

Methods: We completed study screening, data extraction, and quality assessment in duplicate. Random effects models were used for meta-analysis of fall incidence rates and proportions of outcomes per fall. Sensitivity analysis and meta-regression were completed to assess differences based on study design, quality, and population characteristics. The Newcastle Ottawa Scale and Cochrane Risk of Bias tools were used to assess quality of observational and intervention-based studies, respectively. The GRADE tool was used to evaluate strength of evidence for fall risk factors.

Results: We identified 3103 unique references, of which 38 were included in systematic review and 37 in meta-analysis. Pooled incidence of falls was 121 per 100 person-years (95% CI 86-170). Outcomes of transfer to hospital, admission to hospital, overall injury, head injury, fracture, 30-day mortality, death in hospital, and disability were reported by included studies. Sensitivity analysis indicated no significant difference in fall rates between study designs. Meta-regression indicated no significant relationship between fall rate and age or sex; however, a weak positive correlation was identified with increasing prevalence of dementia. No fall risk factors were supported by high-quality evidence.

Conclusion/implications: Our study confirms that falls in skilled nursing facilities are common and cause significant morbidity, mortality and health system use. As populations in high-income countries age, falls will become increasingly prevalent. Future research should be directed at preventing injurious falls and determining when hospital care will benefit a faller.

Keywords: Aged; SNF; falls; morbidity; mortality; systematic review.

Publication types

Meta-Analysis
Systematic Review
Review
Research Support, Non-U.S. Gov't

MeSH terms

Accidental Falls* / prevention & control
Aged
Fractures, Bone*
Hospitals
Humans
Incidence
Skilled Nursing Facilities