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.
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