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Factors associated with falls among older adults living in institutions

Javier Damián125*, Roberto Pastor-Barriuso13, Emiliana Valderrama-Gama4 and Jesús de Pedro-Cuesta12

Author Affiliations

1 National Center for Epidemiology, Carlos III Institute of Health, Madrid, Spain

2 Consortium for Biomedical Research in Neurodegenerative Diseases (Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas - CIBERNED), Madrid, Spain

3 Consortium for Biomedical Research in Epidemiology and Public Health (CIBER en Epidemiología y Salud Pública - CIBERESP), Madrid, Spain

4 "Arroyo de la Media Legua" Primary Care Center, Madrid Health Service (Servicio Madrileño de Salud), Madrid, Spain

5 Centro Nacional de Epidemiología. Instituto de Salud Carlos III, Av/ Monforte de Lemos 5, 28029, Madrid, Spain

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BMC Geriatrics 2013, 13:6  doi:10.1186/1471-2318-13-6

Published: 15 January 2013



Falls have enormous impact in older adults. Yet, there is insufficient evidence regarding the effectiveness of preventive interventions in this setting. The objectives were to measure the frequency of falls and associated factors among older people living institutions.


Data were obtained from a survey on a probabilistic sample of residents aged ≥65 years, drawn in 1998-99 from institutions of Madrid (Spain). Residents, their caregivers, and facility physicians were interviewed. Fall rates were computed based on the number of physician-reported falls in the preceding 30 days. Adjusted rate ratios were computed using negative binomial regression models, including age, sex, cognitive status, functional dependence, number of diseases, and polypharmacy.


The final sample comprised 733 residents. The fall rate was 2.4 falls per person-year (95% confidence interval [CI], 2.04-2.82). The strongest risk factor was number of diseases, with an adjusted rate ratio (RR) of 1.32 (95% CI, 1.17-1.50) for each additional diagnosis. Other variables associated with falls were: urinary incontinence (RR = 2.56 [95% CI, 1.32-4.94]); antidepressant use (RR = 2.32 [95% CI, 1.22-4.40]); arrhythmias (RR = 2.00 [95% CI, 1.05-3.81]); and polypharmacy (RR = 1.07 [95% CI, 0.95-1.21], for each additional medication). The attributable fraction for number of diseases (with reference to those with ≤ 1 condition) was 84% (95% CI, 45-95%).


Number of diseases was the main risk factor for falls in this population of institutionalized older adults. Other variables associated with falls, probably more amenable to preventive action, were urinary incontinence, antidepressants, arrhythmias, and polypharmacy.

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Accidental falls; Epidemiology; Residential facilities; Nursing homes; Comorbidity