Background: Falls in older adults represent a major cause of distress, injury, and mortality. The UK is experiencing concurrent population ageing, increases in the prevalence of multi-morbidity, and a growing care home population. Therefore, an understanding of how multi-morbidity impacts falls risk in care home residents is needed such that effective prediction models can be developed for this population.
Data: Data from the Health Data Research UK learning care homes project specifying care home resident interactions with emergency care and in-hospital wards in the County Durham and Darlington NHS trust were analysed to answer the research question.
Methods: In the sample of 4002 care home residents chronic disease records were grouped using dimensionality reduction and K-means cluster analysis. The resulting clusters were used as an explanatory variable during negative binomial regression analysis with the number of fall presentations per care home resident to the emergency department as the outcome variable. Additional models explored associations between individual chronic conditions, frailty measures, and interactions between the chronic conditions with the fall presentations outcome.
Results: The combined cluster and regression analysis indicated a gradient of effect sizes relating to the type of multi-morbidity present. The Non-Specific-High-Burden (117.8%, 76.1%-169.2%), Cardiovascular-Metabolic (63%, 30.1%-103.7%), Neurological-Psychiatric (41.4%, 17.3%-70.2%), Cardiovascular (23.8%, 3.4%-47.9%) clusters, were all associated with increases in fall presentations when compared to the cluster indicating the absence of chronic disease burden. Of the individual chronic health conditions, hypotension (61.1%, 38.0%-87.9%), dementia (32.3%, 19.3%-46.7%), and peripheral neuropathy (33.7%, 7.7%-65.7%) exhibited the largest impact on falls risk, with smaller effects observed for cerebrovascular disease (18.6%, 2.6%-37.1%), atrial fibrillation (21.8%, 8.4%-36.8%), and osteoarthritis and degenerative joint diseases (15.6%, 1.3%-31.7%). Further models indicated the relationship of frailty with falls is dependent on the index used.
Conclusions: The findings indicate that multi-morbidity impacts falls risk differently depending on the combination of chronic health conditions experienced. However, the role of multi-morbidity in falls risk is complex and in need of further research. Improvements in standardised reporting of fall events at the care home level and linking of this information with electronic health records is the next step for the development of effective falls risk prediction models.
