Falls in focus: an analysis of the rate of falls in 25 Australian residential aged care facilities from 2019 to 2021, pre- and during COVID-19 lockdowns.

Introduction: During 2020-2021 Australia maintained comparatively low rates of COVID-19 in the community and residential aged care facilities (RAC) due to stringent public health measures such as lockdowns. However, the public health measures implemented may have had unintended impacts on critical RAC resident health outcomes, such as falls, due to routine care disruptions and aged care resident isolation. We utilised a longitudinal data to assess the association between COVID-19 lockdowns and the rate of falls in RAC settings.

Methods: A longitudinal cohort study was conduct using routinely collected data from 25 RAC facilities from one non-profit aged care provider in Sydney, Australia. The study included 2,996 long term residents between March 2019 and March 2021. The outcome measures were all falls, injurious falls, and falls assessed as requiring hospitalisation. Generalised estimating equations (GEE) were applied to determine the association between COVID-19 lockdown periods and fall-related outcomes while adjusting for confounders and seasonality.

Results: During the study period 11,658 falls were recorded. Residents frequently experienced at least one fall during the study period (median: 1, interquartile range: 0-4). During Lockdown 1 (March-June 2020) the rate of all falls increased 32% (IRR 1.32, 95% CI 1.19-1.46, p < 0.01) and the rate of injurious falls increased by 28% (IRR 1.28, 95% CI 1.12-1.46, p < 0.01) compared to pre-pandemic rates. The rate of falls assessed as requiring hospitalisation remained unchanged during Lockdown 1 (IRR 1.07, 95% CI 0.86-1.32, p = 0.519). During Lockdown 2 (Dec 2020-Jan 2021) the rate of all falls, injurious falls, and falls assessed as requiring hospitalisation did not change significantly compared to pre-pandemic rates.

Conclusion: These findings suggest that the consequences of stringent COVID-19 restrictions, as seen in Lockdown 1, produced changes in residents' care which contributed to more falls and associated harm. The subsequent lockdown, which were less restrictive and occurred after staff had gained experience, was associated with no significant increase in falls rate. The nature and extent of lockdowns implemented for infection control in RAC need to balance multiple potential adverse effects. Factors which facilitated resilience during this period require exploration in future research.