Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit

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Abstract

We aimed to identify fall incidence, predictors and characteristics and to investigate hospitalization outcomes for elderly inpatients. In 340 men and 280 women consecutively admitted to a Acute Geriatric Ward of a University Hospital the following variables were evaluated: demographics, clinical history, main disease responsible for hospitalization, comorbidity (cumulative illness rating scale: CIRS 1 and 2) gait and balance deficit (Tinetti's scales), cognition/function (short portable mental status questionnaire: SPMSQ); activities of daily living: ADL; instrumental activities of daily living: IADL; delirium (confusion assessment method: CAM), drugs administered during hospitalization. Overall 80 falls occurred in 70 patients. The incidence rate of falls was of 6.0 per 1000 patient-days with 2.0 falls per bed/year. Age (relative risk = RR = 1.050; 95% confidence interval = CI = 1.013–1.087), delirium (RR = 3.577; 95% CI 1.096–11.672), diabetes (RR = 5.913; 95% CI 1.693–20.644), balance deficit (RR = 0.914; 95% CI 0.861–0.970) and polypharmacy (RR = 1.226; 95% CI 1.122–1.340) were independently predictive of falling. Fallers had a prolonged length of stay (LOS) (35.5 ± 47.8 days vs. 23.2 ± 27.2; p = 0.01) and more frequent nursing home placements (12.9% vs.5.6%; p < 0.005). The knowledge of falling predictors might help in planning specific preventive strategies to improve the patients’ global health status and to reduce the costs of medical care.

Introduction

Falls are a very common type of inpatient accident (ANARI, 2004, Nakai et al., 2006) and with their physical and psychological consequences might compromise an already impaired functional status or cause severe morbidity and mortality in old people (Rubenstein and Josephson, 2006). The incidence of falls rises steadily from middle-aged people and peaks in those who are over 80 years (Rubenstein and Josephson, 2002). In hospitalized people, fall rates might vary from 3 to 13 per 1000 patient-days, depending on department type and patient population, as reported in a recent review (Oliver et al., 2007).

Most falls result from a complex interplay of predisposing and precipitating factors in people's environment and in individual demographic and clinical characteristics. Hospitalization itself may be an important risk factor in falls, representing a deep change in elderly patients’ life habits. In addition, preventing hospital falls requires knowledge of falls and injury circumstances in different settings (Krauss et al., 2007).

Considering that an early identification of hospitalized patients at risk of falling might help to prevent this issue, the aim of our study was to evaluate fall incidence, predictors and characteristics and to investigate hospitalization outcomes for elderly inpatients admitted to a Geriatric Acute Care Ward of a University Hospital.

Section snippets

Materials and methods

Approval was obtained by the Local Ethic Committee. This longitudinal observational study recruited 620 patients (mean age 79.3 ± 8.9 years) consecutively admitted to the Geriatric Acute Care Unit of San Giovanni Battista Hospital in Turin, between August 1st 2006 and December 31st 2007.

Upon hospital admission, using predefined forms, we gathered the following variables for each patient: demographic data (age, sex), the main disease causing hospital admission, the associated pathologies,

Results

During the study period, 80 falls occurred in 70 hospitalized patients (11.3% of the 620 subjects enrolled). Among these 70 fallers, 9 (12.8%) fell more than once. The total number of patient-days was 13,356 for 28 beds with an incidence rate of falls of 6.0 falls per 1000 patient-days and 2.0 falls per bed/year.

Fallers were older than non-fallers (82.1 ± 7.9 years vs. 78.9 ± 8.9 years, p < 0.001). No difference in fall incidence was found between men (12.9%) and women (10.0%). Mortality rate was

Discussion

In our study 70 elderly inpatients (11.3%) fell during hospitalization in an Acute Geriatric Ward and the incidence rate of fall was 6.0 falls per 1000 patient-days and 2.0 falls per bed/year. In medical literature data on this subject are not homogeneous because of the variety of patients and settings evaluated and the research designs. In previous study conducted in hospitalized patients the incidence of falls was 11.7 fall per 1000 patients-days in Swiss geriatric departments (Schwendimann

Conclusion

Falls in hospitalized elderly patients occur as a result of multiple factors, knowledge of which could help in planning adequate preventive strategies. In our study advancing age, balance deficit, acute cognitive impairment, diabetes and polypharmacy were significantly and independently associated to falls. Programs for preventing hospital falls should target patients with these risk factors using scheduled mobilization and toileting, providing exercise and physical therapy interventions and

Conflict of interest

The authors have no conflicts of interest to declare and certify that no founding has been received for the conduct of this study and/or preparation of this manuscript.

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