Characteristics and Risk Factors for Falls in Tertiary Hospital Inpatients

Eun-Ju Choi; Young-Shin Lee; Eun-Jung Yang; Ji-Hui Kim; Yeon-Hee Kim; Hyeoun-Ae Park

doi:10.4040/jkan.2017.47.3.420

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

Original Article

J Korean Acad Nurs 2017;47(3):420-430.

Published online: 15 January 2017

DOI: https://doi.org/10.4040/jkan.2017.47.3.420

Characteristics and Risk Factors for Falls in Tertiary Hospital Inpatients

Eun-Ju Choi¹, Young-Shin Lee¹, Eun-Jung Yang¹, Ji-Hui Kim¹, Yeon-Hee Kim¹, Hyeoun-Ae Park^2,

¹Department of Nursing, Asan Medical Center, Seoul

²College of Nursing, Seoul National University, Seoul, Korea

Address reprint requests to : Park, Hyeoun-Ae College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8827 Fax: +82-2-765-4103 E-mail: hapark@snu.ac.kr

Received 6 January 2017 Revised 21 May 2017 Accepted 22 May 2017

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License. (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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.

Keywords: Accidental falls, Risk factors, Inpatients, Patient safety

References

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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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