Behavioral and non-behavioral factors related to fall in hospitalized elders in the Shohada Hospital, Tabriz

Abstract

Introduction: Falling is a major health problem and one of the leading causes of accidents in old age that can increase health expenses and mortality rates among older adults. Objective: The goal of the present study was to examine behavioral and non-behavioral factors involved in fall accidents among older adults admitted to the Shohada Hospital in Tabriz, Iran. Methods and materials: This case-control study was conducted in 2017. The statistical population included all older adults admitted to the Shohada Hospital. The study participants were selected from this population using a convenience sampling method, and divided into two groups: “admitted for fall-related injuries” (n=152) and “admitted for other reasons” (n=152). The inclusion criteria were as follows: Aged 60 years or older and consent to participate in the study. The exclusion criteria included: Inability to answer the questions and suffering from underlying disorders, such as dementia, Alzheimer disease, language disorders etc. that prevented data collection using face-to-face interviews. The study data were gathered using the following instruments: The demographic questionnaire, the Fall Reduction, Missouri Alliance for Home Care (MAHC-10) with a Cronbach’s alpha of 0.66, a researcher-made questionnaire assessing behavioral determinants of falls (ELFABI) with a Cronbach’s alpha of 0.61, and the Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS) with a Cronbach’s alpha of 0.85. The logistic regression (Backward: LR) was used to extract the factors predicting falls, and the student's t-test was used to compare means and standard deviations for the factors. Results: The mean and standard deviation of age for the case and control groups were 73.90 ± 9.45 and 67.40 ± 8.06, respectively. According to the data analysis, non-behavioral factors, including age (CI 95%=1.02-1.07, OR=1.5), being female (CI 95%=2.8-8.83, OR=5.13), marital status (CI 95%=1.30-2.15, OR=1.67), education (CI 95%=0.19-0.57, OR=0.33), living alone (CI 95%=1.54-5.12, OR=2.81), financial dependence (CI 95%=1.55-4.83, OR=2.74), health status relative to others (CI 95%=1.85-3.53, OR=2.56), suffering from chronic disorders (CI 95%=3.06-167.62, OR=22.64), falls during the past 3 months (CI 95%=1.23-7.65, OR=3.06), urinary incontinence (CI 95%=1.27-4.69, OR=2.44), taking multiple medications (CI 95%=1.29-4.34, OR=2.37), experiencing pains affecting functioning (CI 95%=0.18-0.64, OR=0.34), and psychological wellbeing (CI 95%=0.88-0.93, OR=0.90); and behavioral factors, including lack of a specific place to sleep (CI 95%=0.45-1.07, OR=0.69), furniture rearrangement (CI 95%=0.22-0.90, OR=0.44), climbing up ladders or chairs to do routine tasks (CI 95%=0.40-1.08, OR=0.66), obtaining information on the side-effects of the medications used (CI 95%=0.94-0.30, OR=1.76), participation in group exercises (CI 95%=0.28-0.97, OR=0.53), taking preventive measures in bathroom (CI 95%=0.98-3.14, OR=1.83), wearing eyeglasses (CI 95%=1.02-2.16, OR=1.48), and use of walking aids (CI 95%=1.00-1.89, OR=1.37) were predictors of falls among the older adults admitted for fall-related injuries. Conclusion: Through providing preventive interventions based on the behavioral and non-behavioral factors involved in falls, such as balance and strength exercises, pharmacological interventions, calcium and vitamin D supplements, home assessments and reducing environmental risk factors, cataract surgery, use of a cardiac pacemaker, fluid and electrolyte therapy, psychological interventions, providing support for vulnerable organs, and awareness training, the incidence of falls among community-residing older adults and the subsequent costs for the families, the health care system, and the society as a whole can be reduced. exercises, pharmacological interventions, calcium and vitamin D supplements, home assessments and reducing environmental risk factors, cataract surgery, use of a cardiac pacemaker, fluid and electrolyte therapy, psychological interventions, providing support for vulnerable organs, and awareness training, the incidence of falls among community-residing older adults and the subsequent costs for the families, the health care system, and the society as a whole can be reduced.