An Evaluation of Risk Factors for In-Patient Falls in Acute and Rehabilitation Elderly Care Wards

Abstract

Falls occurring in elderly in-patients during periods of hospitalization are common, and attempts have been made to predict and prevent them based on risk factor analysis. These have not looked extensively at specific elderly care wards. We have investigated in-patient falls in mixed acute and rehabilitation elderly care wards in a case-controlled study. Fifty fallers were paired with fifty non-fallers, and their risk factors for falling evaluated. Only three risk factors were significantly more common in the fallers. These were: a previous history of falls; the presence of confusion/disorientation, and needing help to toilet/incontinence/diarrhoea. Prediction of falls based on the presence of the first two of these risk factors gives a sensitivity of 68% and a specificity of 88%. A risk factor approach to the prediction of falls in an in-patient elderly care setting seems to be less practical than was previously hoped.

Clinical history and biologic age predicted falls better than objective functional tests

“…A perceived tendency to fall was almost as predictive of a future fall as a history of a fall and could be closely related to "fear of falling," which to some extent is predictive for future falls and fractures [7,16,17]. Subjects with diseases affecting balance are more prone to falls than others [16][17][18], and in this study a self-assessed question concerning this was sufficient for falls prediction. Intake of psychoactive drugs is predictive of falls [6,7,13].…”

A case-control study of patient, medication, and care-related risk factors for inpatient falls

“…Previous research has identified risk factors for falling in the hospital, including impaired balance or gait, history of falling, increasing age, impaired cognition, depression, dizziness or vertigo, orthostatic hypotension, visual impairment, urinary frequency, nocturia, incontinence, specific diagnoses, and use of certain medications, such as benzodiazepines, antipsychotics, and sedatives. 10,[12][13][14][15][16][17][18] Yet comparative studies on hospital falls have been limited in several ways, including variations in study design, setting, patient population, and definitions of risk factors. Some studies have continued to focus solely on the elderly or relied only on data included in hospital incident reports or chart review.…”

Etiology of Falls among Cognitively Intact Hospice Patients

“…Others have added that falls are more commonly related to age, gender, functional disability, disease status, physical strength, coordination ability, and level of alertness. [13][14][15][16][17] More recently, the Centers for Disease Control and Prevention (CDC) 18 noted ''a fall is a result of an interaction of intrinsic, extrinsic and environmental factors'' without clear definitions pertaining to the boundaries of these domains. Most of the prior studies describing potential factors that contribute to falls have not been translated into preventive practice.…”