Comparison of Risk Factors of Falling for Psychiatric Inpatients and General Ward Inpatients Who Had Fallen

BACKGROUND: For psychiatric patients, the issue of falling is complex. OBJECTIVE: The objective of this study was to compare the risk factors for falling in psychiatric inpatients and general ward inpatients who had fallen. METHODS: The researchers first derived official fall records for 122 psychiatric inpatients and then selected 122 psychiatric inpatients who had not fallen as well as 122 general ward patients who had fallen, matched for gender, age, and length of hospital stay at the time of the fall incident. RESULTS: After controlling other variables, multinomial logistic regression analysis revealed that psychiatric inpatients who had fallen and had dizziness (odds ratio [OR] = 7.11, p < .001), had an unsteady gait (OR = 1.97, p = .030), or were not using aids (OR = 0.42, p = .042) were at greater risk of falling than those who had not fallen. The researchers also found that general ward inpatients who had fallen and had higher Charlson Comorbidity Index scores (OR = 1.77, p < .001), were clear-headed (OR = 27.15, p = .001), had dizziness (OR = 11.55, p < .001), were unable to walk (OR = 64.28, p < .001), or were using aids (OR = 3.86, p = .001) were at greater risk of falling than those who had not fallen before. CONCLUSIONS: The causes of falling among psychiatric inpatients and general ward inpatients are different. Medical personnel should understand the medications and attributes of patients for an accurate assessment of their risk factors for falling and thus implement fall prevention measures and health education to reduce falls.

Risk factors for falling for people with Multiple Sclerosis identified in a prospective cohort study

Objective: To identify risk factors for falling for people with Multiple Sclerosis. Design: Prospective cohort study. Setting: Neurology service in a tertiary hospital. Subjects: Participants were 101 people with Multiple Sclerosis and Expanded Disability Status Score of 3-6.5. One participant withdrew after the baseline assessment; data were analysed for 100 participants. Interventions: No intervention. Main measures: Outcome was rate of falls, and predictors were Timed Up and Go, Symbol Digit Modalities test, demographics and 15 self-report questions about various symptoms including fatigue, concentration, dual tasking, bladder and bowel control. Three-month prospective diaries recorded falls. Results: There were 791 falls reported over the 3-month period from a total of 56 fallers. Falls rate per person-year was 32.08 falls. Following multivariable regression analysis, the model with the greatest levels of clinical utility and discriminative ability (sensitivity 88% and area under the receiving operating curve statistic = 0.72, 95% CI 0.62–0.82), included the variables of history of a fall, not having visual problems, problems with bladder control and a slower speed on the Timed Up and Go. Conclusion: This study confirms the high incidence of falls for people with Multiple Sclerosis and provides a risk prediction model including fall history, problems with bladder control, not having visual problems and a slower Timed Up and Go speed that may be used to identify those at greater risk and in need of tailored falls prevention intervention.

Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study

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.

Fall prevention knowledge and practice patterns among home healthcare professionals in southern Saudi Arabia: an observational study

Objectives To determine the knowledge of falls risk factors among home healthcare (HHC) professionals and the practice patterns of HHC professionals regarding falls prevention. Methods A modified version of a survey designed and validated for use in home healthcare settings was distributed to HHC professionals for self-completion. Responses were collected and analysed using descriptive methods. Results Out of 80 surveys distributed to 23 HHC centres, 52 returned surveys were included for analyses (completed by physicians, physical therapists [PTs] and nurses). In terms of practice patterns, 82.7% of participants always asked older adults if they have a history of falls, 81% always identified falls risk factors, 73% documented risk factors for falling and 71% always provided interventions to address falls risk factors. Environmental hazards were the most common risk factor identified by HHC professionals. Approximately one quarter of nurses felt they had little knowledge of falls risk factors. Conclusion Over 70% of HHC professionals acknowledged the importance of falls, and over 80% of participants displayed knowledge of falls prevention factors. As HHC professionals most likely to encounter patients requiring intervention for falls prevention, physical therapists may benefit from training programmes to help identify important falls risk factors.