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

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Abstract

OBJECTIVE: To comprehensively analyze potential risk factors for falling in the hospital and describe the circumstances surrounding falls.

DESIGN: Case-control study. Data on potential risk factors and circumstances of the falls were collected via interviews with patients and/or nurses and review of adverse event reports, medical records, and nurse staffing records.

SETTING: Large urban academic hospital.

PATIENTS: Ninety-eight inpatients who fell and 318 controls matched on approximate length of stay until the index fall.

MEASUREMENTS AND MAIN RESULTS: In a multivariate model of patient-related, medication, and care-related variables, factors that were significantly associated with an increased risk of falling included: gait/balance deficit or lower extremity problem (adjusted odds ratio [aOR], 9.0; 95% confidence interval [CI], 2.0 to 41.0), confusion (aOR, 3.6; 95% CI, 1.6 to 8.4), use of sedatives/hypnotics (aOR, 4.3; 95% CI, 1.6 to 11.5), use of diabetes medications (aOR, 3.2; 95% CI, 1.3 to 7.9), increasing patient-to-nurse ratio (aOR, 1.6; 95% CI, 1.2 to 2.0), and activity level of “up with assistance” compared with “bathroom privileges” (aOR, 8.7; 95% CI, 2.3 to 32.7). Urinary or stool frequency or incontinence was of borderline significance (aOR, 2.3; 95% CI, 0.99 to 5.6). Having one or more side rails raised was associated with a decreased risk of falling (aOR, 0.006; 95% CI, 0.001 to 0.024).

CONCLUSIONS: Patient health status, especially abnormal gait or lower extremity problems, medications, as well as care-related factors, increase the risk of falling. Fall prevention programs should target patients with these risk factors and consider using frequently scheduled mobilization and toileting, and minimizing use of medications related to falling.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Infectious Diseases, Washington University School of Medicine, 660 South Euclid Avenue, Campus Box 8051, 63110, St. Louis, MO

    Melissa J. Krauss MPH, Bradley Evanoff MD, MPH, Eileen Hitcho MS, Kinyungu E. Ngugi BS, William Claiborne Dunagan MD, Irene Fischer MPH, Stanley Birge MD &  Victoria J. Fraser MD

  2. BJC HealthCare, St. Louis, MO, USA

    William Claiborne Dunagan MD

  3. Barnes-Jewish Hospital, St. Louis, MO, USA

    Shirley Johnson RN, MS, MBA & Eileen Costantinou MSN, RN

Authors
  1. Melissa J. Krauss MPH
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  2. Bradley Evanoff MD, MPH
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  3. Eileen Hitcho MS
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  4. Kinyungu E. Ngugi BS
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  5. William Claiborne Dunagan MD
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  6. Irene Fischer MPH
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  7. Stanley Birge MD
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  8. Shirley Johnson RN, MS, MBA
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  9. Eileen Costantinou MSN, RN
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  10. Victoria J. Fraser MD
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Corresponding authors

Correspondence to Melissa J. Krauss MPH or Victoria J. Fraser MD.

Additional information

We hereby state that there is no conflict of interest involved in the work described in this manuscript.

See Editorial by Auerbach, P. 208-9.

This work was funded by grant U 18HS 1189801, Agency for Healthcare Research and Quality.

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Krauss, M.J., Evanoff, B., Hitcho, E. et al. A case-control study of patient, medication, and care-related risk factors for inpatient falls. J GEN INTERN MED 20, 116–122 (2005). https://doi.org/10.1111/j.1525-1497.2005.40171.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2005.40171.x

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