Background Falls are the leading cause of injury-related death in older adults, while little is known about the frequency and severity of falls on mortality in nursing homes. We examined how rates of falls and head impact were associated with death in two nursing homes.

Methods Between 2007 and 2016, we followed 194 residents (mean age: 82±9) whose falls were documented in incident reports. We captured videos of falls in common areas. We determined the occurrence of head impact through video analysis and nursing reports. We used survival analysis to examine associations between mortality, falls and head impact.

Results Among all participants, the median rate of falls was 2.5 falls/year. 60% of participants were observed on video to have at least one head impact, and the median rate of head impacts was 0.4 times/year. 117 residents died during the study, after an average follow-up period of 3.6±1.7 years. In the multivariate survival analysis, an increase of one head impact per year was associated with a hazard ratio (HR) of 1.32 (95% CI 1.14–1.53). However, rate of falls was not associated with mortality (1.003, 0.97–1.04). Men had higher mortality than women (1.89, 1.29–2.76). Age was not associated with death.

Conclusion Mortality among older adults in nursing homes is associated more strongly with the occurrence of head impact during falls, than with the frequency of falls.

Learning Outcomes Our results highlight the need to focus on strategies for preventing and reducing the consequences of falls that lead to head impact.