Incidence and risk factors for falls among nursing home residents in Italy: a retrospective cohort study

Background: Falls are a public health concern among older adults, particularly in nursing home (NH) residents, but in Italy data on fall incidence and risk factors remain limited. Aims: To estimate the incidence of falls, identify associated risk factors, and evaluate the predictive value of the Tinetti Performance-Oriented Mobility Assessment (T-POMA) in a large cohort of NH residents. Methods: We conducted a retrospective cohort study using electronic health records from 32 NHs managed by Kos Care company across Italy. Residents aged ≥ 65 years with at least one functional assessment were included. Fall incidence was calculated per 100 person-years. Cox proportional hazards regression models were used to identify predictors of time to first fall. Results: Overall, 754 residents (19.2%) experienced a fall. A T-POMA score ≤ 18 was a strong predictor of falls (HR 2.13; 95% CI: 1.61–2.81), along with age ≥ 85 years (HR 1.39; 1.02–1.90), male sex (HR 1.47; 1.27–1.71), cognitive impairment (HR 1.30; 1.10–1.53), hearing impairment (HR 1.26; 1.01–1.58), mood and behavioural disorders (HR 1.29; 1.09–1.54), and therapies known to increase fall risk (HR 1.29; 1.09–1.52). Poor general health (HR 0.63; 0.52–0.77) and frequent physical restraint (HR 0.70; 0.58–0.86) use were associated with lower fall risk. Severe fall consequences occurred in 15.9% of fallers and were significantly associated with low T-POMA scores and restraint use. Discussion and conclusion: Falls are highly prevalent among Italian NH residents and influenced by multiple clinical and functional factors. These findings support the implementation of multifactorial fall prevention strategies and real-time risk monitoring in NH settings.