Falls in hospital and new placement in a nursing home among older people hospitalized with acute illness
Authors Basic D, Hartwell T
Received 10 June 2015
Accepted for publication 22 August 2015
Published 14 October 2015 Volume 2015:10 Pages 1637—1643
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Chang-Yong Ko
Peer reviewer comments 5
Editor who approved publication: Dr Richard Walker
David Basic,1 Tabitha J Hartwell2
1Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia; 2Department of Geriatric Medicine and Rehabilitation, Shoalhaven District Memorial Hospital, Nowra, NSW, Australia
Purpose: To examine the association between falls in hospital and new placement in a nursing home among older people hospitalized with acute illness.
Materials and methods: This prospective cohort study of 2,945 consecutive patients discharged alive from an acute geriatric medicine service used multivariate logistic regression to model the association between one or more falls and nursing home placement (primary analysis). Secondary analyses stratified falls by injury and occurrence of multiple falls. Demographic, medical, and frailty measures were considered in adjusted models.
Results: The mean age of all patients was 82.8±7.6 years and 94% were admitted through the emergency department. During a median length of stay (LOS) of 11 days, 257 (8.7%) patients had a fall. Of these, 66 (25.7%) sustained an injury and 53 (20.6%) had two or more falls. Compared with nonfallers, fallers were more likely to be placed in a nursing home (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.37–3.00), after adjustment for age, sex, frailty, and selected medical variables (including dementia and delirium). Patients without injury (OR: 1.83, 95% CI: 1.17–2.85) and those with injury (OR: 2.35, 95% CI: 1.15–4.77) were also more likely to be placed. Patients who fell had a longer LOS (median 19 days vs 10 days; P<0.001).
Conclusion: This study of older people in acute care shows that falls in the hospital are significantly associated with new placement in a nursing home. Given the predominantly negative experiences and the financial costs associated with placement in a nursing home, fall prevention should be a high priority in older people hospitalized with acute illness.
Keywords: aged, inpatients, falls, nursing homes
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