Dissertation/Thesis Abstract

Falls and fall-related injury risk among homebound older adults: The effect of supportive assistance and living arrangements
by Anderson, Rachel Elena, Ph.D., TUI University, 2011, 354; 3496019
Abstract (Summary)

The research reported in this dissertation centers around the effects that living arrangements and supportive assistance have on the risk of falls and fall-related injuries among homebound older adults. Although many quantitative studies regarding falls among community-dwelling older individuals have been performed, there have been, as noted in the literature analysis, few investigations that examined homebound subjects. Furthermore, the environment plays an important role in a person's ability to safely complete daily activities, but little is known about the specific impact of supportive assistance and living arrangements. This work was performed to better understand these factors, as they relate to falls and fall-related injury risk among a particularly vulnerable population, homebound older adults.

Using a retrospective cohort design, data were examined from 4,450 home health episodes of care, involving 3,531 Medicare or Medicaid beneficiaries age 65 and older. Data were explored with full bivariate and multivariate analyses, including chi-square and logistic regression methods.

In the bivariate logistic regression analyses, a number of novel contextual factors were found to be statistically significant predictors of falls or fall-related injuries. These variables included the frequency of supportive assistance, having a primary caregiver who was either a paid helper or a family member other than a spouse or child, having an assisting person residing in the home, living in a family member's home, living with a paid helper, and living with a spouse or child.

In the initial multivariate logistic regression analysis, the inverted odds ratio indicated that those with no primary caregiver were 4.5 times more likely to fall (95% CI = 1.08 – 19.23) when compared with those who received assistance from a primary caregiver once daily, OR = 0.22, 95% CI = 0.05 - 0.92, p = .038. Similarly, in the initial fall-related injury multivariate logistic regression analysis, the inverted odds ratio of living with a spouse or child suggested a 1.76 times reduction in risk (95% CI = 1.04 – 2.99), OR = 0.57, 95% CI = 0.34 - 0.96, p = .035. Moreover, these two factors retained their associations with their respective dependent variables in the final multivariate logistic regression analyses.

Multiple covariates were also statistically significant predictors of falls and fall-related injuries. Although many past investigations of community-dwelling older adults suggested increased risk for the control variables of age, gender (female), and race (white), this study found no evidence to support those associations among homebound subjects. In fact, males were found 1.31 times more likely to fall (inverted 95% CI = 1.02 - 1.68) in the final falls multivariate logistic regression analysis, OR = .76, 95% CI = .59 - .98, p = .035.

The hypothesis that living arrangements and supportive assistance would be associated with falls and fall-related injuries among homebound older adults is supported by the present study. It is noted in the concluding chapter, however, that the investigation had some shortcomings. The retrospective design established correlation rather than causation. Moreover, the study design limited the number of confounding variables and provided no means to assess other potentially relevant information, such as the ability and willingness of those who provided supportive assistance.

The thesis concludes with a discussion of future research avenues. It is suggested that additional investigations target homebound (rather than more active community-dwelling) older adults to further clarify variables associated with falls and fall-related injuries in this distinct population. It would also be useful to extend this exploratory work through a detailed examination of the interactive effects among the various predictors.

Indexing (document details)
Advisor: Hegamin, Angela
Commitee:
School: TUI University
School Location: United States -- California
Source: DAI-B 73/05, Dissertation Abstracts International
Source Type: DISSERTATION
Subjects: Gerontology, Occupational Therapy, Public health
Keywords: Falls, Homebound, Injury risk, Living arrangements, Older adults, Supportive assistance
Publication Number: 3496019
ISBN: 9781267141699
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