Ambulatory assisted living fallers at greatest risk for head injury.

27 OBJECTIVES: To determine the relationship between head injuries sustained during each fall 28 with various known high risk health and demographic factors predictive of falls. 29 DESIGN: Prospective cohort study conducted over 1 year 30 SETTING: Assisted living and skilled nursing units of a Continuing Care Retirement 31 Community located in the northeastern United States. 32 PARTICIPANTS: Sixty nine OAs who fell. 33 MEASUREMENTS: Age, gender, diagnosis, high risk medication, functional, cognitive, 34 ambulation/elimination status, mode of locomotion, fall related symptoms and the position of the 35 fall, were analyzed using General Estimating Equations among elderly fallers with and without 36 head injury. 37 RESULTS: A total of 173 falls (average of 2.9 times) were observed for 62 patients who had 38 complete injury data. Injuries were recorded in 40.5% of falls, with 41.4% being head injuries. 39 Head injuries were more likely to be hematomas than lacerations (66.7% vs. 14.7%) and among 40 assisted living residents (p=0.04). Head injured patients were more likely to be walking at the 41 time of the fall (69% vs. 36.1%) and less likely to have bowel incontinence (3.5% vs. 28.5%; 42 p=0.04). None of the high risk diagnosis or medications associated with falls risk increased risk 43 for head injury. 44 CONCLUSION: Those at greatest risk for head injury were ambulatory assisted living 45 residents. None of the known clinical conditions predictive of risk to fall were predictive of head 46 injury. For head injury prevention to be successful we need a closer examination of resident’s 47 mobility, shoe-wear, health behavior with respect to ability to use assistive devices, and floor 48 Elderly fallers at greatest risk for head injury surface landing area. Future health policy implications include measures to ensure standard of 49 care practices for head injured patients are in place. 50 51