Risk Factors for Fall in Elderly Patients: Follow-Up Study after Hospital Discharge

A fall consists usually in an involuntary and unexpected event, which may be recurrent in the same individual and often entail consequences for the victim, the caregiver and the society. The falls result from a complex interaction of multiple risk factors: biological, behavioral, environmental and socioeconomic factors. And the frequency of falls is even greater in elderly patients after hospitalization. This study aimed to determine the occurrence of falls in the three months after discharge and risk factors in elderly patients. 

In this prospective study, 100 patients over 65 admitted to an Internal Medicine Ward participated. A questionnaire was conducted during the period of hospitalization where the following information and clinical variables were collected: gender, age, onset diagnosis, personal history and usual medication. Three months after discharge, a telephone interview was conducted and the data reported in the fall diaries were questioned. Follow-up information was unavailable for 31 patients (25 deceased, 6 unreachable). 

Of those analyzed 52% were males with 80 ± 8.1 years old (mean ± SD). Polymedication (p = 0.002), use of psychoactive drugs (p = 0.007), analgesics (p = 0.034) and walking devices (p = 0.006) were associated with a higher incidence of falls 6 months before hospitalization. Post-discharge follow-up was obtained for 69 patients: 18 reported falling during the follow-up. There was a higher risk of fall in patients with a history of falls in the 6 months before admission (p = 0.015 RR = 2.76). Patients who had one or more falls after discharge had a significantly shorter length of hospital stay compared to those who didn’t fall (p = 0.012). In multivariate logistic regression, we found that patients who were hospitalized more than 7 days had a lower risk of falling in the post-discharge period (OR = 0.195, p = 0.017) independently of the history of falls 6 months prior to admission. 

In summary, this study shows that patients with a history of falls during the six months before hospital admission had twice the risk of falling within 3 months after discharge. In addition, patients with an inpatient time of less than seven days also showed an increased risk of falling in that period. A holistic evaluation should be done in elderly patients discharged from an Internal Medicine Ward, especially those admitted for a short length of stay, in order to identify risk factors for falls. Integration into a fall prevention program should be considered for high risk patients.

Article by Pedro Caetano, et al, from Portugal.

Full access: http://t.cn/Eb77tDw

Image by Mike Kaser, from Flickr-cc.