Wearing slippers, falls and injury in residential care

Background. Risk factor studies for falls in residential care have not included factors related to the facilities themselves. Objective: To identify risk factors for falls and injury related to the individual and the facility. Method: Cohort study with 1 to 17 months of followup. Setting: A random sample of 14 residential care homes in Auckland, New Zealand. Subjects: All residents were approached and 606 (97%) participated, mean (SD) age was 83 (11) years. 114 (19%) residents died and 64 (11%) were transferred. Measures: Rate of falls and injurious falls per resident year were measured. Results: The mean rate of falls and injurious falls was 2.75 and 1.75 per resident year respectively. Factors independently associated with increased falls included: increased mobility (IRR 1.25; 95% CI 1.14-1.37), and less problematic behaviours (IRR 1.09, 95% CI 1.02-1.17), while unexpectedly digoxin use (IRR 0.56, 95% CI 0.33-0.97) was associated with decreased falls. Factors associated with increased risk of injury included being born in the UK (IRR 2.89, 95% CI 1.24-7.19) and being more mobile (OR 1.15, 95% CI 1.06-1.25), whereas wearing soft-soled shoes compared with slippers (IRR 0.50, 95% CI 0.28-0.90) and unexpectedly visual impairment (IRR 0.52, 95% CI 0.33-0.80) was associated with decreased injury. No significant factors related to the facility were identified. Conclusion: Falls are frequent in residential care facilities and risk factors related to footwear are potentially reversible. Implications: Residents should be encouraged to wear shoes rather than slippers.