Falls in hospitalized geriatric psychiatry patients: high incidence, but only a few fractures

Abstract

Fall rates from 3.2 to 17.1 falls per 1,000 hospital days in geriatric psychiatry facilities have been reported to date. Up to 5% of the falls result in severe injuries, but data concerning medical consequences are scare. This brief report presents a retrospective analysis of one year fall protocols from a geriatric psychiatry department focusing on consequences of falls. Fall-induced injuries were rated in four categories: no injuries, mild injuries (contusions, hematomas, abrasions), moderate injuries (lacerations, dislocations), and severe injuries (fractures, cerebral hemorrhages). In total, 510 falls were registered during the study period, indicating a fall rate of 17.7 falls per 1,000 hospital days. Overall, 375 falls (73.5%) resulted in no injuries, 67 (13.1%) resulted in mild injuries, 59 (11.6%) resulted in moderate injuries, and only 9 (1.8%) falls led to severe injuries (fractures and cerebral hemorrhages). These results indicate a quite high fall rate in our sample of hospitalized geriatric psychiatry patients with only a relatively small number of severe injuries resulting from the falls. These results raise the question about the use of physical restraints and the use of bedrails in geriatric patients to prevent falls as the medical implications of falls may be less problematic than previously thought.

Falls Among Psychiatric Inpatients: A Systematic Review of Literature

“…Only 3 studies reported on the consequences of falling. Oepen et al 24 reported on the outcome after a fall, finding that 73.5% of fallers sustained no injury, 13.1% had mild injury, 11.6% had moderate injury, and 1.8% suffered severe injury. Turner et al 4 reported an injurious fall rate of 1.9 injurious falls per 1000 hospital days.…”

“…Among the 18 included studies, there were 4 prospective cohort studies, [11][12][13][14] 8 retrospective cohort studies, 10,15-20 3 case-control studies, [21][22][23] and 3 case series. 4,24,25 The oldest study dates back to 1975 while the most recent was published in 2020.…”

“…As for the consequence of falls, Kwan et al 26 found in 2011 that 10% of fall-related injuries among the general population are considered to be severely injured, with 6-8% being fractures. Only Oepen et al 24 reported on the severity of injury and found that only 1.8% sustained severe injuries, such as fractures and cerebral hemorrhages. Unique to the psychiatric inpatient, Heslop et al reported the negative impact of falls on mental health outcome, stating that older adults generally experience improvement with routine mental health care except for the patients who fell.…”

Análise das ocorrências de quedas associadas ao dano em unidade de internação psiquiátrica

“…1 Por ser um evento com características não intencionais, ocorrem em grande parte em populações mais vulneráveis, em especial crianças, idosos e pacientes psiquiátricos. 2 Entre os principais incidentes de segurança no ambiente hospitalar, as quedas se destacam, sendo responsáveis por dois em cada cinco eventos relacionados à assistência do paciente. 3 As instituições públicas e privadas têm aumentado sua preocupação em relação a determinados grupos de pacientes que seriam mais propensos a cair, como os psiquiátricos, em razão da alta taxa de comorbidades e do uso recorrente de medicamentos psicotrópicos.…”

<b> Quedas em pacientes psiquiátricos: uma revisão integrativa/ Psychiatric patients’ falls: an integrative review

“…Observa-se que iniciativas nacionais e internacionais vêm sendo desenvolvidas para estimular a análise de indicadores e a implantação de políticas e práticas para garantir uma assistência mais segura (5) , bem como auxiliar no planejamento e promoção de ações preventivas ao paciente (6) . Portanto, as quedas representam um indicador de qualidade da assistência prestada nas instituições de saúde, tornando-se uma preocupação para as instituições hospitalares (7) .…”