Fall Risk Factors and Fall Risk Assessment of Inpatients

Yoon Sook Kim; Choi-Kwon Smi

doi:10.7475/KJAN.2013.25.1.74

Journal List > Korean J Adult Nurs > v.25(1) > 1094329

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim and Smi: Fall Risk Factors and Fall Risk Assessment of Inpatients

Original Research

Korean J Adult Nurs 2013;25(1):74-82.

Published online: 18 February 2013

DOI: https://doi.org/10.7475/KJAN.2013.25.1.74

Fall Risk Factors and Fall Risk Assessment of Inpatients

Yoon Sook Kim¹, Choi-Kwon Smi^2,

^¹Registered Nurse, Asan Medical Center, Seoul

^²College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Corresponding author: Choi-Kwon, Smi College of Nursing, Seoul National University, 28 Yeongeon-dong, Jongro-gu, Seoul 110-799, Korea. Tel: +82-2-740-8830, Fax: +82-2-765-4103, E-mail: smi@snu.ac.kr

Received 7 August 201224 October 2012 Accepted 21 February 2013

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of this study was to identify the fall risk factors and to evaluate the effectiveness of the Morse Fall Scale(MFS) as an assessment tool among hospitalized inpatients.

Methods

The medical records of a total of 294 patients who admitted to hospital from January 1 to December 31, 2010 were reviewed. One hundred forth seven patients who had experienced fall were matched with 147 patients who have never experienced fall. The fall information was obtained from electronic medical records and fall reports.

Results

There were significant differences in visual disturbances, pain, emotional disturbances, sleep disorder, urination problems and elimination disorder at admission between fallers and non-fallers. Patients who had higher MFS scores at admission were more likely to fall as compared to the patients with lower MFS scores. When falls did occur, these occurred within five days following admission, in the patient room, among patients with alert mental status, and among patients who were ambulant with some assistance.

Conclusion

The findings of this study support the need of using risk assessment tool for predicting risk for falls. This finding can be used as a useful resource to develop nursing intervention strategies for fall prevention at the hospital.

Keywords: Accidental fall, Risk factor, Risk assessment

REFERENCES

American Nurses Association. 2011. NDNQI indicators and reported rates. Retrieved 2012, from the NDNQI Web site:. https://www.nursingquality.org/data.aspx.

Beack Y. J.2011. Fall risk at the emergency department in patients. Unpublished master's thesis, Pusan National University, Busan.

Browne J. A.., Covington B. G.., Davila Y.2004. Using information technology to assist in redesign of a fall prevention program. Journal of Nursing Care Quality. 19(3):218–225.

Evans D.., Hodgkinson B.., Lambert L.., Wood J.2001. Fall risk factors in the hospital setting: A systematic review. International Journal of Nursing Practice. 72(4):38–45.

Foley S. J.., Lord S. R.., Srikanth V.., Cooley H.., Jones G.2006. Falls risk is associated with pain and dysfunction but not radiographic osteoarthritis in older adults: Tasmanian older adult cohort study. Osteoarthritis Cartilage. 14(6):533–539. http://dx.doi.org/10.1016/j.joca.2005.12.007.

Grey-Miceli D.2008. Preventing falls in acute care. Cape-zuti E., Zwicker D., Merzey M., Fulmer T. T., Gray-Miceli D., Kluger M., editorsEvidence-based geriatric nursing protocols for best practice. p. 161–193. New York: Springer Publishing Company.

Hayes N.2004. Prevention of falls among older patients in the hospital environment. British Journal of Nursing. 13(15):896–901.

Hur J. Y.., Kim H. J.2009. Relationship of risk factors, knowledge and attitude to falls in elderly patients. Journal of Korean Gerontological Nursing. 11(1):38–50.

Jung D. Y.., Lee J. H.., Lee S. M.2009. A meta-analysis of fear of falling treatment programs for the elderly. Western Journal of Nursing Research. 31(1):6–16.

Kim C. G.., Suh M. J.2002. An analysis of fall incidence rate and its related factors of fall in inpatients. Journal of Korean Society of Quality Assurance in Health Care. 9(2):210–228.

Kim E. K.., Lee J. C.., Eom M. R.2008. Fall risk factors of inpatients. Journal of Korean Academic Nursing. 38(5):676–684.

Kim K. S.., Kim J. A.., Choi Y. K.., Kim Y. J.., Park M. H.., Kim H. Y., et al. 2011. A comparative study on the validity of fall risk assessment scales in Korean hospitals. Asian Nursing Research. 5:28–37.

Lane A. J.1999. Evaluation of the fall prevention program in an acute care setting. Orthopedic Nursing. 18(6):37–46.

Leveille S. G.., Jones R. N.., Kiely D. K.., Hausdorff J. M.., Shmerling R. H.., Guralnik J. M., et al. 2009. Chronic musculoskeletal pain and the occurrence of falls in an older population. Journal of the American Medical Association. 302(30):2214–21. http://dx.doi.org/10.1001/jama.2009.1738.

Mayo N. E.., Korner-Bitensky N.., Kaizer F.1990. Relationship between response time and falls among stroke patients undergoing physical rehabilitation. International Journal of Rehabilitation Research. 13(1):47–55.

Morse J. M.1997. Preventing patient falls. Thousand Oaks, CA: Sage.

Morse J. M.., Morse R. M.., Tylko S. J.1989. Development of a scale to identify the fall-prone patient. Canadian Journal on Aging. 8:366–377.

National Patient Safety Agency. 2007. Slips, trips and falls in hospital. London: NPSA;, 2007, Retrieved from. http://www.npsa.nhs.uk.

Oliver D.., Britton M.., Seed P.., Martin F.C.., Hopper A. H.1997. Development and evaluation of evidence based assessment tool (STRATIFY) to predict which elderly inpatients will fall: Case-control and cohort studies. British Medical Journal. 315:1049–1053. http://dx.doi.org/10.1136/bmj.315.7115.1049.

Oliver D.., Daly F.., Martin F. C.., McMurdo E. T.2004. Risk factors and risk assessment tools for falls in hospital in-patients: A systematic review. Age Ageing. 33(2):122–130. http://dx.doi.org/10.1093/ageing/afh017.

Park I. S.., Cho I. S.., Kim E. M.., Kim M. K.2011. Evaluation of a fall risk assessment tool to establish continuous quality improvement process for inpatients falls. Journal of Korean Academy of Nursing Administration. 17(4):484–492.

Poe S. S.., Cvach M. M.., Gartrell D. G.., Radizik B. R.., Joy T. L.2005. An evidence-based approach to fall risk assessment, prevention and management lessons learned. Journal of Nursing Care Quality. 20(2):107–116.

Sasakia E. D.., Niek S. K.., Patrick S. R.., Daniel J. T.., Maria A. G.., Moria C. H.2009. Application of patient safety indicators internationally: A pilot study among seven countries. International Journal for Quality in Health Care. 21(4):272–278. http://dx.doi.org/10.1093/intqhc/mzp018.

Schwendimann R.., DeGeest S.., Milsen K.2006. Evaluation of the morse fall scale in hospitalized patients. Age Ageing. 35(5):311–313. http://dx.doi.org/10.1093/ageing/afj066.

Scott D.., Blizzard L.., Fell J.., Jones G.2010. A prospective study of self-reported pain, radiographic osteoarthritis, sar-copenia progression and falls risk in community-dwelling older adults. Arthritis Care Res. 64(1):30–37. http://dx.doi.org/10.1002/acr.20545.

Shin J. G.2011. Prevalence and management of falls among elderly in a hospital. Unpublished master's thesis, Hanyang University, Seoul.

Staab A. S.., Hodges L. C.1996. Essentials of gerontological nursing. Philadelphia, PA: Lippincott Company.

Tinetti M. E.., Speechley M.., Ginter S. F.1988. Risk factors for falls among elderly persons living in the community. New England Journal of Medicine. 310:1701–1707.

Wong C. A.., Recktenwald A. J.., Jones M. L.., Waterman B. M.., Bollini M. K.., Dunagan W. C.2011. The cost of serious fall-related Injuries at three midwestern hospitals. Joint Commission Journal on Quality and Patient Safety. 37(2):81–87.

Yoon J. L.2000. Fall. Journal of the Korean Geriatrics Society. 4(1):53–63.

Table 1.

General Characteristics of the Subjects (N=294)

Characteristics	Categories	Fallers (n=147)	Nonfallers (n=147)
Characteristics	Categories	n (%)	n (%)
Age (year)	15~64	85 (57.8)	85 (57.8)
Age (year)	≥65	62 (42.2)	62 (42.2)
Gender	Male	84 (57.1)	84 (57.1)
Gender	Female	63 (42.9)	63 (42.9)
Department	Medical department	70 (47.6)	70 (47.6)
	Surgical department	34 (23.1)	34 (23.1)
	Others	43 (29.3)	43 (29.3)

Table 2.

Physical, Cognitive, an d Emotional Status s of Subjects (N=294)

Variables	Categories	Fallers (n=147)	Nonfallers (n=147)	x²	p
Variables	Categories	n (%)	n (%)	x²	p
Respiratory problems	No	121 (82.3)	124 (84.4)	0.22	.643
Respiratory problems	Yes	26 (17.7)	23 (15.6)	0.22	.643
Paralysis, general weakness	No	126 (85.7)	133 (90.5)	1.59	.280
Paralysis, general weakness	Yes	21 (14.3)	14 (9.5)	1.59	.280
Visual problems	No	106 (72.1)	90 (61.2)	3.92	.048
Visual problems	Yes	41 (27.9)	57 (38.8)	3.92	.048
Hearing defects	No	140 (95.2)	139 (94.6)	0.15	.929
Hearing defects	Yes	7 (2.0)	8 (2.7)	0.15	.929
Consciousness disorder	No	133 (90.5)	140 (95.2)	5.85	.211
Consciousness disorder	Yes	14 (9.5)	7 (4.8)	5.85	.211
Pain	No	89 (60.5)	106 (72.1)	4.40	.036
Pain	Yes	58 (39.5)	41 (27.9)	4.40	.036
Emotional disturbances	No	134 (91.2)	144 (98.0)	6.61	.010
Emotional disturbances	Yes	13 (8.8)	3 (2.0)	6.61	.010
Sleep disorder	No	120 (81.6)	132 (89.8)	4.00	.046
Sleep disorder	Yes	27 (18.4)	15 (10.2)	4.00	.046
Urination problems	No	126 (85.7)	137 (93.2)	4.36	.037
Urination problems	Yes	21 (14.3)	10 (6.8)	4.36	.037
Elimination disorder	No	104 (70.7)	122 (83.0)	6.20	.013
Elimination disorder	Yes	43 (29.3)	25 (17.0)	6.20	.013

Table 3.

Logistic Regression Analysis on the Predicting Factors of Fall

Risk factors	p	OR	95% CI
Age	.592	0.87	0.53~1.43
Gender	.929	0.98	0.60~1.59
Pain	.047	1.68	1.01~2.81
Visual problems	.050	0.60	0.36~1.00
Emotional disturbances	.070	3.38	0.91~12.64
Urination problems	.082	2.11	0.91~4.90
Sleeping disorder	.166	1.66	0.81~3.38
Elimination disorder	.155	1.54	0.85~2.79
x²=19.353 (df=4, p=.001)

OR=odds ratio; CI=confidence interval.

Table 4.

Patient Characteristics and Types of Fall among Fallers (N=147)

Characteristics	Categories	n (%)
Mental status	Alert	134 (91.2)
	Drowsy	7 (4.8)
	Stupor	6 (4.1)
Emotional disturbance	No	135 (91.8)
Emotional disturbance	Yes	12 (8.2)
Cognitive impairment	No	131 (89.1)
Cognitive impairment	Yes	16 (10.9)
Dizziness/vertigo	No	124 (84.4)
Dizziness/vertigo	Yes	23 (15.6)
General weakness	No	86 (58.5)
General weakness	Yes	61 (41.5)
Gait disability	No	119 (81.0)
Gait disability	Yes	28 (19.0)
Sleep disorder	No	134 (91.2)
Sleep disorder	Yes	13 (8.8)
Activity status	Independent	59 (40.1)
	Need support	86 (58.5)
	Dependent	1 (0.7)
	Etc.	2 (1.4)
Ambulatory device	Wheelchair	40 (27.2)
	Walker	6 (4.1)
	Cane	3 (2.0)
	Etc.	11 (7.5)
	No	87 (59.2)
Places of fall	Patient room	92 (62.6)
	Corridor	18 (12.2)
	Bathroom	16 (10.9)
	Others^†	21 (14.3)
Contexts of fall	Using Bed (getting out bed)	32 (21.8)
	Using Bed (others)	19 (13.0)
	Sliding or falling on standing/walking	48 (32.7)
	Others	48 (32.7)

^† Using wheelchair, chair, equipment, etc.

TOOLS

Similar articles