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Falls in older hospital inpatients and the effect of cognitive impairment: a secondary analysis of prevalence studies

Authors

  • Jürgen Härlein,

    1. Authors:Jürgen Härlein, RN, MA, Lecturer, School of Nursing, General Hospital Fürth, Fürth and Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin, Berlin, Germany; Ruud JG Halfens, PhD, Professor, Department of Health and Nursing Science, CAPHRI, Maastricht University, Maastricht, The Netherlands; Theo Dassen, PhD, RN, Professor and Head of Department, Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin; Nils A Lahmann, PhD, RN, Assistant Professor, Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin, Berlin, Germany
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  • Ruud JG Halfens,

    1. Authors:Jürgen Härlein, RN, MA, Lecturer, School of Nursing, General Hospital Fürth, Fürth and Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin, Berlin, Germany; Ruud JG Halfens, PhD, Professor, Department of Health and Nursing Science, CAPHRI, Maastricht University, Maastricht, The Netherlands; Theo Dassen, PhD, RN, Professor and Head of Department, Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin; Nils A Lahmann, PhD, RN, Assistant Professor, Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin, Berlin, Germany
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  • Theo Dassen,

    1. Authors:Jürgen Härlein, RN, MA, Lecturer, School of Nursing, General Hospital Fürth, Fürth and Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin, Berlin, Germany; Ruud JG Halfens, PhD, Professor, Department of Health and Nursing Science, CAPHRI, Maastricht University, Maastricht, The Netherlands; Theo Dassen, PhD, RN, Professor and Head of Department, Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin; Nils A Lahmann, PhD, RN, Assistant Professor, Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin, Berlin, Germany
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  • Nils A Lahmann

    1. Authors:Jürgen Härlein, RN, MA, Lecturer, School of Nursing, General Hospital Fürth, Fürth and Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin, Berlin, Germany; Ruud JG Halfens, PhD, Professor, Department of Health and Nursing Science, CAPHRI, Maastricht University, Maastricht, The Netherlands; Theo Dassen, PhD, RN, Professor and Head of Department, Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin; Nils A Lahmann, PhD, RN, Assistant Professor, Department of Nursing Science, Centre for the Humanities and Health Sciences CC1, Charité Universitätsmedizin Berlin, Berlin, Germany
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Jürgen Härlein, Lecturer, School of Nursing, General Hospital Fürth, Jakob-Henle-Str. 1, 90766 Fürth, Germany. Telephone: 0049 911/7580 996200.
E-mail:juergen.haerlein@gmx.de

Abstract

Aims and objectives.  The objective of this study was to compare fall rates in older hospital inpatients with and without cognitive impairment. Relationships between age, gender, mobility, cognitive impairment, care dependency, urinary incontinence and medical disciplines were investigated.

Background.  Falls are common in older people with cognitive impairment, but studies in the hospital setting are rare.

Design.  A secondary analysis of three nationwide prevalence studies in German hospitals from the years 2005, 2006 and 2007 was conducted.

Method.  Trained staff nurses used a standardised instrument to collect data about accidental falls within the last two weeks in their institutions and about other patient characteristics. Data from 9246 patients aged 65 years or older from 37 hospitals were analysed.

Results.  The fall rate for cognitively impaired patients was 12·9%, while only 4·2% of older persons without cognitive impairment experienced a fall. Comparison between medical disciplines showed great differences concerning fall risk for confused and non-confused inpatients. In multivariate logistic regression analysis, the odds-ratio association of cognitive impairment and falls was 2·1 (CI 1·7–2·7). Higher age (OR 1·5, CI 1·2–1·9), greater care dependency (OR 1·6, CI 1·1–2·1), reduced mobility (OR 2·6, CI 1·9–3·7) and being a patient on a geriatric ward (OR 1·8, CI 1·1–2·9) were also statistically significant predictors in this model.

Conclusions.  Cognitively impaired older people constitute a high-risk group for accidental falls in hospitals.

Relevance to clinical practice.  Fall prevention strategies in the hospital setting should address cognitively impaired inpatients as an important high-risk group.

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