A Retrospective Mixed-Methods Analysis of Falls Among Patients in a Social Model Hospice Residential Care Home

While falls among older adults have been studied extensively in various medical settings, less is known about falls occurring during home hospice care when care is provided by informal caregivers. A retrospective mixed methods design was used to examine patients' and caregivers' experiences with falls, including fall frequency and characteristics, contributing factors, and fall consequences and corrective measures. A data registry of 535 hospice patients who received care between 2004-2020 was queried to identify patients that experienced one or more falls during their stay in one of 4 residential care homes (RCHs). A total of 81 patients (15.1%) experienced one or more falls, and there were 119 falls across 13,860 days of care or 8.6 falls per 1000 days of care. The majority of patients who fell (65%) did so just once, and for most of the falls there were either no injuries (50%) or minor injuries (44%). Only two falls (6%) resulted in hospitalization. In the 24-hour period prior to patients' falls, opiates were shown to be the most frequently administered medication followed by benzodiazepines, with higher rates of falls among patients who consumed both of these medications in combination. Most falls occurred in the bedroom or bathroom and were related to toileting needs. Results suggest that informal caregivers may benefit from additional training when supporting hospice patients' toileting needs, especially when they have received opiates and benzodiazepines. Results illustrate caregivers' efforts to balance fall risk with patients' desire for autonomy as a central element of home hospice care.