Environmental factors in the movement space of aged-care residents and their impact on falls and fall-related injuries in participants from Staying Upright study.

Posted by on 7 April 2023

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2022-23 Summer Research Impact Report

by Sonja Neef, University of Auckland

Supervisors: Dr Catherine Bacon, Professor Ngaire Kerse and Dr Lynne Taylor

23 Neef Photo sI would like to thank the HOPE Foundation for funding my summer research scholarship and for giving me the opportunity to become part of an incredible research team in the field of ageing. This scholarship has been an invaluable experience and has allowed me to take a first step into research relating to the elderly, in which I hope to pursue my postgraduate studies. This experience has given me a chance to further enhance my skills regarding data analysis and presentation and to have a more critical and flexible way of thinking. This project introduced me to the aging field, which I had not had the chance to experience in my undergraduate courses. This opportunity has enhanced my motivation and drive to continue research in this field in the future and inspired me to focus on nursing homes as a study population. This summer research scholarship has been incredibly valuable and has given me a solid foundation on which I hope to build my future academic career in the field of ageing.

Aims and Methods 

This research project aimed to examine the relationships between environmental, life-space, physical, and cognitive variables and how they interact to impact falls and fall injuries in elderly living in residential care facilities. The primary research question I examined was, “Are environmental indices associated with falls and fall-injury risk?

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During the initial stages of the project, I was invited to join one of the research assistants in visiting one of the residential care facilities to collect Part A data from interviews with residents’ caregivers.

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I also attended a couple of meetings with my supervisory team, Catherine Bacon, Lynne Taylor, and Ngaire Kerse, where we discussed steps and possible variables I could examine using the Staying Upright main study data. Throughout the summer, I met with my main supervisor, Catherine, every week to give updates on my progress and plan the next steps for the project. In the first week of the summer project, I mainly carried out reviews of the current literature around falls and fall risk in elderly populations and the key studies on which our sub-study was based. I was then tasked to clean the large data set by correcting all the units, comments, and values. After this, I was tasked to create variable names and a large variable dictionary with explanations and identification for each variable and the scaling of the units. During this process, I had to contact research assistants to confirm queries regarding anomalies and missing data, as well as clarify their comments for different participants.

After this initial data cleaning process, I then moved on to calculating scores for different variables, for example, the weekly distance a participant is predicted to have walked when going to the toilet. While carrying out these calculations, I had meetings with the Staying Upright statistician and my supervisor to review the variables we would need to examine with comorbidities and other confounding variables for our analysis. After finishing the calculations, I carried out preliminary data analysis, including analysis of the descriptive statistics for each variable and a correlation matrix of all variables in SPSS, focusing on the relationship between variables and the participants' fall rate.

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23 Neef Final report 05I was invited to present my initial findings to the supervisory team and statistician and subsequently at the Research Café at the School of Nursing. My presentation was around 15-20 minutes long and covered all the stages and processes I had gone through by that time, as well as the next steps for the data analysis. The images throughout this report are taken from my PowerPoint presentation. Following the presentation and with all the comments, suggestions, and feedback I received, my supervisor and I met with a statistician to discuss the main analyses for the project. In preparation for this, and after the meetings, I researched how to conduct the specific statistical analysis using SPSS. 

The two main statistical tests were the negative binomial regression analysis and Cox’s proportional hazard regression analysis, where I carried out initial tests for each using different variable groups. Throughout the summer, I also had the chance to assist in drafting the manuscript for publication in an academic journal.

Research Outputs and Outcomes 

The primary research output of this project was the data analysis, which revealed interesting findings to my supervisory team and other academics in the School of Nursing. My secondary research outputs are my presentations to the supervisory team and the School of Nursing Research Café. The initial findings from this sub-study project will help inform and support the aims and findings of the Staying Upright parent study. I have also been invited to present the project findings to the Staying Upright team at their next research meeting in March. My initial data cleaning, exploration, and statistical analysis provided a solid foundation for the project to progress into more comprehensive and complex data analysis.

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The main outcomes of this summer research project were to fill in gaps in the literature and understanding around falls and fall risk in elderly living in nursing homes, and how these risks may be modified by their surrounding environment, including the presence of hazards, the distances to the bathroom, and elevations across the facility. In New Zealand, there is scant research on falls in elderly populations, especially those over the age of 80. The project findings suggest that there are different factors that may increase or decrease the likelihood of falling and that there may be specific measures that may help to predict these risks. As falls are one of the major causes of injury, rapid deterioration of health, and death, examining the impact that environmental factors on falls and fall risk are essential so that facilities, such as nursing homes, are designed to protect and support our elderly members of society.

Conclusions and Implications 

There is sparse literature regarding the topic of falls and their relationships with environmental, life-space, and distance indices in residential care facilities. Hence, this project may contribute to understanding how modifiable environmental risk factors can be adjusted to prevent falls and fall injuries in nursing homes. While the study focused on elderly residents in nursing homes, the findings of the study have implications for all populations of elderly living in different settings, including those in the community, in different levels of care, and those living in retirement homes. Conducting further research regarding falls in elderly populations is crucial in understanding the complex interaction between a person, their environment, and other contributing factors such as physical and cognitive ability, to improve the care given to the elderly to prevent them from experiencing falls and experiencing rapid declines in health. The quote below encapsulates the overall implications of this study to develop facilities and practices that allow the elderly to take care of themselves and when they are unable to, support them by providing care tailored to their individual needs. As the global population of elderly is predicted to increase dramatically, with the New Zealand population of people aged over 65 predicted to increase to one million people by 2028, it is crucial that we seek to understand and develop methods to improve the overall outcomes of all elderly people.

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