Nursing home residents (in)dependence: the role of falls, intrinsic and extrinsic factors

Abstract

Ageing Safety in Alentejo– Understand for Action (ESACA) Refª: ALT20-03-0145-FEDER-000007 arises in response to the international recommendations advocating an active and successful ageing for worldwide population. It is important to develop and implement strategies for successful ageing for community residents and also for institutionalized ones. Present study objective was to determine the main factors explaining (in)dependence on basic daily life activities (BDLA) of nursing home residents. This crossectional study enrolled 132 Portuguese nursing home residents (≥ 65 years old, 84.2± 6.9 years, 70.5% women. Measurements comprised BDLA (Barthel Index), falls occurrence (y/n), fear of falling (FES-I), sleeping quality (Epworth scale), cognitive impairment (MMSE), physical fitness: balance (Tinetti Balance Assessment Tool); strength, flexibility, agility and double task (Senior Fitness Test + TUG in DT), body composition: BMI, body lean and fat mass (stadiometre and bioimpedance scale); Environment hazards (questionnaire). Univariate linear regression showed that the variables explaining BADL were balance, agility, DT, strength and fear of falling (R2range: 7.4- 22%) in which a poor result was associated to a higher dependence level, p<0.05. However, multivariate linear regression selected upper limb strength and fear of falling as the main factors explaining (in)dependence (R2 44,0% p <0.05). These results suggest that older adults’ intrinsic factors (physical fitness rather than cognitive impairment), and fear of falling explains more their (in)dependence than environmental factors or falls occurrence. Interventions designed for the maintenance of nursing home residents independence should consider these results, and include in clinical assessment at least upper limbs strength and fear of falling.