Gait speed and adverse events in nursing home residents: a prospective cohort study

Background: Falls, wounds and hospitalisation are serious adverse events that may result in reduced independence and quality of life, and contribute to higher risks of disability and death in nursing homes. Objectives: To quantify the incidence of events (falls, hospital admissions and wounds) in nursing home residents and to determine if gait speed thresholds can predict falls. Design: A prospective cohort design was used to estimate the incidence and types of adverse events. Setting: Three nursing homes on the Gold Coast/Northern New South Wales, Australia. Participants: 100 nursing home adults consented to participate in this project. Measurements: The primary outcome included the number of adverse events (falls, wounds and hospital admissions) accessed through the nursing homes records. We used negative binomial regression models adjusted for potential confounders to examine associations between gait speed group and falls suffered by residents in nursing home settings, and we reported incidence rate ratios (IRRs) with 95% CIs and the actual P-value. Results: During the six months, there were a total of 226 falls, 243 wounds, 65 hospital admissions and 29 deaths with 12% of the residents having a fall(s), wound, admitted to hospital and dying in the 6-month period. Gait speed was not a statistically significant factor that impacted adverse events. However, for every additional hospital admission there was a 28% increased rate of falling, for every additional wound there was a 7.8% increased rate of falling and for every kilogram increase in handgrip strength there was a 4.4% increase rate of falling. Residents were also found to have an increased rate of falling if they were female (65.5%) and a decreased rate of falling with a positive impairment Mini-Cog score residents were likely to have a 52% decrease in their rate of falling when compared with negative cognitive impairment. Conclusion: The incidence of adverse events in Australian nursing homes is high, suggesting that continual refinement of assessment, education, awareness and management processes are required to improve resident outcomes. In particular, falls reduction interventions appear important, as they would likely reduce the number of hospital admissions and wounds in the nursing home setting