Dataset Information

Is it possible to identify risks for injurious falls in hospitalized patients?

ABSTRACT:

Background

Patient falls are among the most commonly reported adverse hospital events with more than one million occurring annually in the United States; approximately 10% result in serious injury. A retrospective study was conducted to determine predictors and outcomes of fall injuries among a cohort of adult hospitalized patients.

Methods

Data were obtained regarding patients who sustained an initial fall in hospital during a 26-month period from 16 adult general medical and surgical units in an urban university-affiliated community hospital. Data on intrinsic (individual) factors, extrinsic (environmental) factors, and situational activities were collected via nurse and patient interviews, patient examinations, and audits of incident reports and electronic health records. Fall injuries were classified as none/any for analyses. Unadjusted odds ratios [ORs] and 95% confidence intervals [CIs] for each of the variables of interest with fall injury were generated using logistic regressions.

Results

The 784 patients had a median age of 63.5 years (range, 20 to > 90 years), 390 (50%) were women, and 526 (67%) were black. Some 228 (29%) fallers sustained injury; patients who were white (OR: 2.23; 95% CI: 1.62, 3.08), or were administered a selective serotonin reuptake inhibitor (OR: 1.04; 95% CI: 1.04, 2.67), two antipsychotic agents (OR: 3.26; 95% CI: 1.20, 8.90), an opiate (OR: 1.59; 95%; CI: 1.14, 2.20), or a diuretic non-antihypertensive agent (OR: 1.53; 95% CI: 1.03, 2.26) were more likely to sustain an injury. Home-based wheelchair use was protective of fall injury (OR: 0.20; 95% CI: 0.05, 0.84). Seventy-nine percent of the patients had been designated as "high" fall risk within 24 hours before the fall.

Conclusions

Few variables were able to distinguish patients who sustained injury after a hospital fall, further challenging clinicians' efforts to minimize hospital-related fall injury.

SUBMITTER: Mion LC

PROVIDER: S-EPMC3547233 | biostudies-literature | 2012 Sep

REPOSITORIES: biostudies-literature

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Publications

Is it possible to identify risks for injurious falls in hospitalized patients?

Mion Lorraine C LC Chandler A Michelle AM Waters Teresa M TM Dietrich Mary S MS Kessler Lori A LA Miller Stephen T ST Shorr Ronald I RI

Joint Commission journal on quality and patient safety 20120901 9

<h4>Background</h4>Patient falls are among the most commonly reported adverse hospital events with more than one million occurring annually in the United States; approximately 10% result in serious injury. A retrospective study was conducted to determine predictors and outcomes of fall injuries among a cohort of adult hospitalized patients.<h4>Methods</h4>Data were obtained regarding patients who sustained an initial fall in hospital during a 26-month period from 16 adult general medical and sur ...[more]

PMID: 23002493

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Project description:PURPOSE:To review and update the evidence of the relationship between physical activity, risk of fall-related injury, and physical function in community-dwelling older people that was presented in the 2018 Physical Activity Guidelines Advisory Committee Scientific Report (PAGAC Report). METHODS:Duplicate independent screenings of 1415 systematic reviews and meta-analyses published between 2006 and 2016 identified from PubMed®, Cochrane Library, and CINAHL databases yielded 111 articles used for the PAGAC Report. The PAGAC Aging Subcommittee members graded scientific evidence strength based upon a five-criteria rubric and assigned one of four grades: strong, moderate, limited, or not assignable. An updated search of 368 articles published between January 2017 and March 2018 yielded 35 additional pertinent articles. RESULTS:Strong evidence demonstrated that physical activity reduced the risk of fall-related injuries by 32% to 40%, including severe falls requiring medical care or hospitalization. Strong evidence also supported that physical activity improved physical function and reduced the risk of age-related loss of physical function in an inverse graded manner among the general aging population, and improved physical function in older people with frailty and with Parkinson's disease. Aerobic, muscle-strengthening, and/or multicomponent physical activity programs elicited the largest improvements in physical function in these same populations. Moderate evidence indicated that for older adults who sustained a hip fracture or stroke, extended exercise programs and mobility-oriented physical activity improved physical function. CONCLUSIONS:Regular physical activity effectively helps older adults improve or delay the loss of physical function and mobility while reducing the risk of fall-related injuries. These important public health benefits underscore the importance of physical activity among older adults, especially those living with declining physical function and chronic health conditions.

Project description:BACKGROUND:Unassisted falls are more likely to result in injury than assisted falls. However, little is known about risk factors for falling unassisted. Furthermore, rural hospitals, which care for a high proportion of older adults, are underrepresented in research on hospital falls. This study identified risk factors for unassisted and injurious falls in rural hospitals. METHODS:Seventeen hospitals reported 353 falls over 2?years. We categorized falls by type (assisted vs. unassisted) and outcome (injurious vs. non-injurious). We used multivariate logistic regression to determine factors that predicted fall type and outcome. RESULTS:With all other factors being equal, the odds of falling unassisted were 2.55 times greater for a patient aged ?65 than <?65 (95% confidence interval [CI]?=?1.30-5.03), 3.70 times greater for a patient with cognitive impairment than without (95% CI?=?2.06-6.63), and 6.97 times greater if a gait belt was not identified as an intervention for a patient than if it was identified (95% CI?=?3.75-12.94). With all other factors being equal, the odds of an injurious fall were 2.55 times greater for a patient aged ?65 than <?65 (95% CI?=?1.32-4.94), 2.48 times greater if a fall occurred in the bathroom vs. other locations (95% CI?=?1.41-4.36), and 3.65 times greater if the fall occurred when hands-on assistance was provided without a gait belt, compared to hands-on assistance with a gait belt (95% CI?=?1.34-9.97). CONCLUSIONS:Many factors associated with unassisted or injurious falls in rural hospitals were consistent with research conducted in larger facilities. A novel finding is that identifying a gait belt as an intervention decreased the odds of patients falling unassisted. Additionally, using a gait belt during an assisted fall decreased the odds of injury. We expanded upon other research that found an association between assistance during falls and injury by discovering that the manner in which a fall is assisted is an important consideration for risk mitigation.

Dataset Information

Is it possible to identify risks for injurious falls in hospitalized patients?

Background

Methods

Results

Conclusions

Publications

Is it possible to identify risks for injurious falls in hospitalized patients?

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