Specific Aims: To identify trends in NH resident fall events; and to describe situation-specific factors (e.g. person and environmental characteristics) and high fall risk activities.

Research Design: Retrospective analyses of six months of incident report data for a group of fallers.

Population: All fall events experienced by NH residents of a nine-facility Maryland NH corporation from March-August 2004.

Analyses: From close-ended questions on incident reports, event-level descriptive analyses illustrate circumstances surrounding fall events. From open-ended narrative statements, an open coding procedure generated categories of situational characteristics of the person, environment and activity at the time of the fall.

Results: 1,564 fall events occurred in 686 residents over six months, with an overall fall rate of 2.21 falls/bed/year for the nine-facilities. 40.5% of falls occurred during each day and evening shifts, with 19.0% on nights. In the majority of falls (65.3%) residents were found on the floor, 23.6% were witnessed, 5.2% were assisted or intercepted, 4.2% were reported falls, and 1.7% were when residents were found on other horizontal surfaces. 18.7% of falls resulted in minor injuries and 3.0% major injuries. Falls occurred in resident bedrooms (67.5%), bathrooms (8.4%), public rooms (8.7%), transit spaces (13.4%), and outdoors (2.0%). Narrative analyses revealed situation-specific person factors (lost balance, leg weakness, gait unsteadiness, incontinence, and confusion) and environmental factors (obstacles, wet/slippery floor surfaces, inadequate footwear, brakes on beds and wheelchairs). High fall risk activities included: reaching, bending, leaning, transferring, standing, walking, sitting, repositioning, and dressing.

Conclusion: Findings suggest areas for fall-specific preventive interventions. Additional analyses of narrative data will lead to targeted interventions for the person and the environment.