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Document Type

Thesis - University Access Only

Award Date

1999

Degree Name

Master of Science (MS)

Department

Graduate Nursing

First Advisor

Barbara Heater

Keywords

falls in older age, nursing home patient wounds and injuries, health risk assessment of older women

Abstract

Elderly women residing in nursing homes experience falls more often than their male counterparts and experience greater morbidity and mortality after a fall. Nevertheless, very few studies have examined risk factors that are unique to this at risk population. Risk factors that contribute to falls are either intrinsic or extrinsic, this study examined intrinsic risk factors. The purpose of this study was to describe intrinsic risk factors that may contribute to increased incidence and severity of falls. Muscular strength, balance, and flexibility, three intrinsic risk factors, exclusive to females fallers, were tested in this study. Comparisons were then made with fall incidence and fall severity. Age, length of stay, bodyweight, fall related medication use, and fall related medical diagnosis were also examined for relationships with fall incidence and fall severity.
The design of this study was correlational predictive. The medical records of female nursing home residents who had given informed consent and had fallen within the past year were reviewed for inclusion and exclusion criteria. Inclusion criteria included being capable of informed consent and having ambulatory status. Thirty five ambulatory, female nursing home residents were tested for strength, balance, and gait; scores were then compared with fall incidence and severity. Records of those who were tested were examined again for other intrinsic risk factors that may have contributed to falls. These other risk factors were then compared to fall incidence and fall severity.
Pearson Product-Moment was used to examine relationships. Logistical regression was used to identify the predictors for number and severity of falls. Gait scores had the strongest relationship with fall incidence. Balance had a moderate negative inverse relationship with fall incidence. Muscular strength scores had a strong inverse relationship with fall severity. Subjects with weaker muscular strength fell more often and did worse after a fall. Subjects with very severe falls also had decreased balance scores. Gait appeared to have a moderate relationship with fall severity.
Age and length of stay had no correlation with increased fall incidence or increased fall severity. Bodyweight shared a moderate negative inverse relationship with fall severity. Antihypertensive medication use was predictive of increased fall severity and antidepressant medication use was predictive of decreased fall severity. A medical diagnosis of coronary artery disease and insulin dependent diabetes mellitus was shown to be predictive of fall severity.
Limitations of the study included a small sample size (N=35). Three nursing homes from one geographical area limited the generalizability of the findings. Interrater reliability was impaired due to differences in RN perception at the time of fall. Recommendations for further study include the use of a longitudinal study, this would allow patients to serve as their own control over a period of time. In addition, a quasi-experimental study with supervised strengthening exercises for the independent variable and fall severity or incidence as a dependent variable would prove to be beneficial.

Library of Congress Subject Headings

Falls (Accidents) in old age
Nursing home patients -- Wounds and injuries
Older women -- Health risk assessment
Older women -- Wounds and injuries

Format

application/pdf

Number of Pages

105

Publisher

South Dakota State University

Rights

Copyright © 1999 Brian Miller. All rights reserved

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