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Incidence and Associated Risk Factors for Falls in Older Adults After Elective Total Knee Replacement Surgery: A
Anne-Marie Hill1, Gail Ross-Adjie, Steven M McPhail
1From the School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia (A-MH, AJ); Institute for Health Research, The University of Notre Dame Australia, Fremantle, Australia (A-MH, MB); School of Nursing and Midwifery, The University of Notre Dame Australia, Fremantle, Australia (GR-A, LM); Australian Centre for Health Services Innovation and Centre of Healthcare Transformation, School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, Brisbane, Australia (SMM); Clinical Informatics Directorate, Metro South Health, Brisbane, Australia (SMM); Centre for Nursing and Midwifery Research, St John of God Hospital, Murdoch, Australia (AC, NRA, S-JP, LM); WA Centre for Health and Ageing, University of Western Australia, Perth, Australia (CE-B); Faculty of Health and Medical Sciences: Surgery, University of Western Australia, Perth, Australia (GH); Western Orthopaedic Clinic, St John of God Hospital Murdoch and Hollywood, Perth, Australia (GH); School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia (LM); and Ngangk Yira Research Centre for Aboriginal Health and Social Equity, Murdoch University, Murdoch, Australia (LM).
Objective:
The aim of the study was to determine the incidence and associated risk factors for falls in older adults in the 12 mos after elective, primary total knee replacement surgery.
Design:
A prospective observational cohort of older adults undergoing total knee replacement were followed. Baseline measurements included risk factors of history of falls, using a gait aid and number of medications. Falls data were recorded after discharge for 12 mos alongside patient reported outcomes (Oxford Knee Score). Analyses used logistic and negative binomial regression modeling.
Results:
There were 267 participants (mean age = 70 [6.7] yrs) enrolled. Participants who fell (n = 102 [40.6%]) reported 200 falls in the 12 mos after surgery. The incidence of falls was 2.4 falls per 1000 patient days in the 12 mos after surgery, with the highest incidence (2.6 falls per 1000 patient days) in month 1. Risk factors for falling were a history of falls (adjusted odds ratio = 2.41, 95% confidence interval = 1.35-4.31) and number of central nervous system acting medications taken before surgery (adjusted odds ratio = 1.66, 95% confidence interval = 1.25-2.21). Using a walking aid at baseline was associated with falls after discharge (adjusted incident rate ratio = 2.38, 95% confidence interval = 1.57-3.60).
Conclusions:
Older adults experience a high incidence of falls after elective total knee replacement. Further research that investigates falls prevention after total knee replacement is required.
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