We hereby state that there is no conflict of interest involved in the work described in this manuscript.
A Case-control Study of Patient, Medication, and Care-related Risk Factors for Inpatient Falls
Article first published online: 9 FEB 2005
Journal of General Internal Medicine
Volume 20, Issue 2, pages 116–122, February 2005
How to Cite
Krauss, M. J., Evanoff, B., Hitcho, E., Ngugi, K. E., Dunagan, W. C., Fischer, I., Birge, S., Johnson, S., Costantinou, E. and Fraser, V. J. (2005), A Case-control Study of Patient, Medication, and Care-related Risk Factors for Inpatient Falls. Journal of General Internal Medicine, 20: 116–122. doi: 10.1111/j.1525-1497.2005.40171.x
Address requests for reprints to Dr. Fraser: Washington University School of Medicine, Department of Internal Medicine, Division of Infectious Diseases, Campus Box 8051, 660 South Euclid Avenue, St. Louis, MO 63110 (e-mail: firstname.lastname@example.org).
- Issue published online: 1 APR 2005
- Article first published online: 9 FEB 2005
- Accepted for publication July 1, 2004
- accidental falls;
- risk factors;
Objective: To comprehensively analyze potential risk factors for falling in the hospital and describe the circumstances surrounding falls.
Design: Case-control study. Data on potential risk factors and circumstances of the falls were collected via interviews with patients and/or nurses and review of adverse event reports, medical records, and nurse staffing records.
Setting: Large urban academic hospital.
Patients: Ninety-eight inpatients who fell and 318 controls matched on approximate length of stay until the index fall.
Measurements And Main Results: In a multivariate model of patient-related, medication, and care-related variables, factors that were significantly associated with an increased risk of falling included: gait/balance deficit or lower extremity problem (adjusted odds ratio [aOR], 9.0; 95% confidence interval [CI], 2.0 to 41.0), confusion (aOR, 3.6; 95% CI, 1.6 to 8.4), use of sedatives/hypnotics (aOR, 4.3; 95% CI, 1.6 to 11.5), use of diabetes medications (aOR, 3.2; 95% CI, 1.3 to 7.9), increasing patient-to-nurse ratio (aOR, 1.6; 95% CI, 1.2 to 2.0), and activity level of “up with assistance” compared with “bathroom privileges” (aOR, 8.7; 95% CI, 2.3 to 32.7). Urinary or stool frequency or incontinence was of borderline significance (aOR, 2.3; 95% CI, 0.99 to 5.6). Having one or more side rails raised was associated with a decreased risk of falling (aOR, 0.006; 95% CI, 0.001 to 0.024).
Conclusions: Patient health status, especially abnormal gait or lower extremity problems, medications, as well as care-related factors, increase the risk of falling. Fall prevention programs should target patients with these risk factors and consider using frequently scheduled mobilization and toileting, and minimizing use of medications related to falling.