Examining Falls Rates Across Health Care Settings for Older Adults in Canada: Implications for Population-Level Estimates of Risk

OBJECTIVES: Falls remain a significant public health concern given both the person-level and system-level effects of experiencing a fall, namely decreased function, decreased intrinsic capacity, social isolation, and increased health care utilization. The World Health Organization has prioritized falls as a health outcome indicator in evaluating the impact of policy, strategy, and programming. The objective was to establish cross-sectoral fall rates across health care sectors in Canada and identify key risk factors as candidate risk adjustment variables for a falls quality indicator. DESIGN: A retrospective, cross-sectional study. SETTING AND PARTICIPANTS: Seven hundred thousand two hundred four Canadian health care recipients, across multiple health care sectors, aged 60 years and older, were included. METHODS: analyses were used in descriptive analysis. Multivariable logistic regression analyses were used to establish key fall risk adjustors for a quality indicator. The independent variables considered in development included measures, such as function, cognition, health instability, balance impairment, and demographic variables. This model was then applied to a cohort with no serious mobility impairment. Mobility impairment included being completely dependent with ambulation, using a wheelchair or a scooter, or being bedbound. RESULTS: A higher prevalence of falls was observed in community settings. Regression analysis showed a protective effect of those receiving care in a designated care facility (odds ratio range across facilities with mandated assessments, 0.36-0.55). Those with balance impairment, bladder incontinence, health instability, cognitive impairment, and activities of daily living impairment were more likely to fall. Similar trends were observed in the subgroup with no mobility impairment. CONCLUSIONS AND IMPLICATIONS: These findings provide a national cross-sectoral landscape of falls in settings not generally considered in population surveys. The rates of falls are highly variable across settings, and key fall risk factors identified in this study provide a foundation for risk adjustment in global comparisons of falls in older adults.