Journal List > J Korean Acad Nurs > v.47(3) > 1003248

Choi, Lee, Yang, Kim, Kim, and Park: Characteristics and Risk Factors for Falls in Tertiary Hospital Inpatients

Abstract

Purpose

The aim of this study was to explore characteristics of and risk factors for accidental inpatient falls.

Methods

Participants were classified as fallers or non-fallers based on the fall history of inpatients in a tertiary hospital in Seoul between June 2014 and May 2015. Data on falls were obtained from the fall report forms and data on risk factors were obtained from the electronic nursing records. Characteristics of fallers and non-fallers were analyzed using descriptive statistics. Risk factors for falls were identified using univariate analyses and logistic regression analysis.

Results

Average length of stay prior to the fall was 21.52 days and average age of fallers was 61.37 years. Most falls occurred during the night shifts and in the bedroom and were due to sudden leg weakness during ambulation. It was found that gender, BMI, physical problems such elimination, gait, vision and hearing and medications such as sleeping pills, antiarrhythmics, vasodilators, and muscle relaxant were statistically significant factors affecting falls.

Conclusion

The findings show that there are significant risk factors such as BMI and history of surgery which are not part of fall assessment tools. There are also items on fall assessment tools which are not found to be significant such as mental status, emotional unstability, dizziness, and impairment of urination. Therefore, these various risk factors should be examined in the fall risk assessments and these risk factors should be considered in the development of fall assessment tools.

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Table 1.
Differences in Fall Risk Factors between Fallers and Non-fallers (N=4114)
Variables Categories Fallers (n=447) Non-fallers (n=3667) c2/t p
n (%) or M±SD n (%) or M±SD
Gender Male 248 (55.5) 2255 (61.5) 6.05 .014
Female 199 (44.5) 1412 (38.5)
Age (yr) 19~29 13 (2.9) 173 (4.7) 19.13 .004
30~39 28 (6.3) 269 (7.3)
40~49 36 (8.1) 434 (11.8)
50~59 101 (22.6) 945 (25.8)
60~69 137 (30.6) 980 (26.7)
70~79 100 (22.4) 687 (18.7)
80~94 32 (7.2) 179 (4.9)
61.37±14.23 58.23±14.65
Median (IQR) 63.00 (18) 60.00 (19)
HOD (day) 37.01±53.58 38.53±26.10 0.58 .563
Median (IQR) 20.50 (30) 31.00 (15)
Fall day 21.52±40.11
Median (IQR) 9.00 (19)
Education No formal education 11 (2.5) 94 (2.6) 17.99 .003
Elementary school 91 (20.6) 603 (16.5)
Middle school 82 (18.6) 521 (14.2)
High school 157 (35.6) 1310 (35.8)
College 85 (19.3) 971 (26.5)
Graduate school 15 (3.4) 159 (4.3)
BMI Under weight (<18.5) 70 (15.7) 431 (12.0) 10.76 .013
Normal (18.5≤BMI<25) 280 (62.8) 2190 (60.8)
Overweight (25≤BMI<30) 87 (19.5) 843 (23.4)
Obesity (≥30) 9 (2.0) 136 (3.8)
Surgery Yes 143 (32.0) 1781 (48.6) 43.98 <.001
No 304 (68.0) 1886 (51.4)
Department Internal medicine 264 (59.1) 2271 (61.9) 1.39 .239
Surgery 183 (40.9) 1396 (38.1)
Diagnosis Neoplasm 258 (57.7) 2183 (59.5) 13.26 .010
Infectious disease 23 (5.1) 142 (3.9)
Liver, Digestive disease 49 (11.0) 555 (15.1)
Vascular, Pulmonary 44 (9.8) 241 (6.6)
Others 73 (16.3) 546 (14.9)
Table 2.
The Characteristics of Fall Events (N=447)
Characteristics Categories n (%)
Place Patient’s room 258 (57.7)
Restroom 77 (17.2)
Corridors 63 (14.1)
Treatment room 11 (2.5)
Bathrooms 9 (2.0)
Others 28 (6.5)
Activities Walking
One’s legs giving out while 107 (23.9)
walking
Tripping over equipment 39 (8.7)
Dizziness while walking 31 (6.9)
Slipping while walking 24 (5.4)
Using Bed
Getting out of bed 93 (20.8)
Getting into bed 19 (4.3)
Out of bed 17 (3.8)
Rest/Bathroom
Dizziness and loss of consciousness 19 (4.3)
Slipping in the restroom 15 (3.4)
Standing up on the toilet seat 11 (2.5)
Sitting down on the toilet seat 6 (1.3)
Sitting on the toilet seat 4 (0.9)
In the shower 4 (0.9)
Sitting
Sitting on/up/down in a 19 (4.3)
wheelchair
Sitting on/up/down on a chair 10 (2.2)
Related Facilities No related facilities 175 (39.1)
Bed /Stretcher car 95 (21.3)
IV pole 65 (14.5)
Wheelchair/ Walking stick 27 (6.0)
Caregiver’s bed 24 (5.4)
Toilet 13 (2.9)
Chair 12 (2.7)
Walker/crutches 9 (2.0)
Line/Tube 7 (1.6)
Shoes/Patient’s clothes 6 (1.3)
Companion None 262 (58.6)
Caregiver 174 (38.9)
Hospital employee 8 (1.8)
Others 3 (0.7)
Duty shift Day duty 136 (30.4)
Evening duty 119 (26.6)
Night duty 189 (42.3)
IV catheter Peripheral line 283 (63.3)
Central line 100 (22.4)
Peripheral & central line 15 (3.4)
No 49 (10.9)
Catheter or drain Yes 133 (29.8)
No 314 (70.2)
Medical equipment Yes 89 (19.9)
No 358 (80.1)
Table 3.
Comparisons of Fall Related Factors at Admission between Fallers and Non-fallers (N=4114)
Characteristics Variables Categories Fallers (N=447) Non-fallers (N=3667) c2 p
n (%) n (%)
Physical factors Paralysis or Weakness Yes 70 (15.7) 550 (15.0) 0.14 .712
Deformity Yes 5 (1.1) 31 (0.8) 0.34 .559
Visual defects Yes 126 (28.2) 1140 (31.1) 1.59 .207
Hearing defects Yes 24 (5.4) 176 (4.8) 0.28 .597
Urinary problems Yes 79 (17.7) 708 (19.3) 0.69 .407
Defecation problems Yes 95 (21.3) 984 (26.8) 6.41 .011
Fever Yes 27 (6.0) 277 (7.6) 1.38 .240
Insomnia Yes 68 (15.2) 572 (15.6) 0.05 .832
Nutritional imbalance Yes 62 (14.0) 527 (14.4) 0.05 .823
Pain Yes 208 (46.5) 1629 (45.2) 0.29 .590
Mental status Alert 428 (95.7) 3533 (96.3) 0.40 .529
Emotional factors Stable 439 (98.2) 3543 (98.0) 0.06 .801
Medication factors
   Narcotics Yes 170 (38.0) 740 (20.2) 73.70 <.001
   Antihypertensive Yes 150 (33.6) 1180 (32.2) 0.35 .556
   Bowel softener Yes 95 (21.3) 806 (22.0) 0.12 .726
   Diuretics Yes 88 (19.7) 714 (19.5) 0.01 .913
   Hypnotics Yes 68 (15.2) 250 (6.8) 39.37 <.001
   Antiepileptic Yes 52 (11.6) 508 (13.9) 1.67 .196
   Antidepressants Yes 50 (11.2) 293 (8.0) 5.32 .021
   Antihistamines Yes 43 (9.6) 451 (12.3) 2.71 .100
   Benzodiazepines Yes 40 (8.9) 290 (7.9) 0.58 .445
   Antipsychotics Yes 37 (8.3) 209 (5.7) 4.71 .030
   Chemo drugs Yes 27 (6.0) 133 (3.6) 6.21 .013
   Antiarrhythmic Yes 25 (5.6) 105 (2.9) 9.70 .002
   Vasodilators Yes 17 (3.8) 49 (1.3) 15.36 <.001
   Neuromuscular drugs Yes 13 (2.9) 36 (1.0) 12.57 <.001
Table 4.
Comparisons of the Morse Fall Scale Factors at Admission between Fallers and Non-fallers (N=4114)
Variables Categories Fallers (N=447) Non-fallers (N=3667) ) c2 p
n (%) n (%)
Morse Fall Scale
Risk Group Low risk 232 (51.9) 2382 (65.0) 29.32 <.001
High risk 215 (48.1) 1285 (35.0)
History of falling (within 3 months) Yes 35 (7.8) 172 (2.7) 8.22 .004
Secondary diagnosis Yes 306 (68.5) 2202 (60.0) 11.83 <.001
IV therapy/Heparin lock Yes 240 (53.7) 1907 (52.0) 0.45 .500
Ambulatory aid Bed rest 388 (86.8) 3424 (93.4) 25.47 <.001
Crutches/cane 45 (10.1) 190 (5.2)
Furniture 14 (3.1) 53 (1.4)
Gait Nor mal/bedrest 268 (60.0) 2723 (74.3) 42.21 <.001
Weak 139 (31.1) 761 (20.8)
Impaired 40 (8.9) 183 (5.0)
Mental status Orientation abilit y 407 (91.1) 3413 (93.1) 2.46 .117
Forgets limit 40 (8.9) 254 (6.9)
Altered mentality Yes 5 (1.1) 54 (1.5) 0.35 .552
Emotional unstability Yes 1 (0.2) 9 (0.2) 0.01 .930
Vision impaired Yes 15 (3.4) 46 (1.3) 12.04 .001
Hearing impaired Yes 10 (2.2) 24 (0.7) 12.18 <.001
Dizziness Yes 6 (1.3) 43 (1.2) 0.10 .755
General weakness Yes 99 (22.1) 638 (17.4) 6.11 .013
Gait disturbance Yes 44 (9.8) 346 (9.4) 0.08 .781
Urination impaired Yes 2 (0.4) 12 (0.3) 0.17 .680
Table 5.
Logistic Regression Analysis of Fall Events
Variables Reference OR Lowest limit Upper limit
95% CI 95% CI
Gender Male 1.26 1.01 1.57
BMI (>30) 18.5≤BMI 0.48 0.24 0.98
<25
Operation No 0.49 0.39 0.61
Defecation problem No 0.67 0.52 0.87
Gait (weak) Normal 1.37 1.04 1.81
Gait (impaired) Normal 1.62 1.04 2.51
Visual problem No 2.28 1.16 4.49
Hearing problem No 2.38 1.02 5.53
Drug-narcotics No 2.30 1.83 2.89
Drug- hypnotics No 2.26 1.65 3.11
Drug- antiarrhythmic No 1.80 1.11 2.93
Drug- vasodilator No 2.35 1.28 4.33
Drug- neuromuscular No 2.45 1.21 4.98
Correctly classified=89.2%
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