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Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors

Authors Mazur K, Wilczyński K, Szewieczek J

Received 25 June 2016

Accepted for publication 26 July 2016

Published 14 September 2016 Volume 2016:11 Pages 1253—1261

DOI https://doi.org/10.2147/CIA.S115755

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Amy Norman

Peer reviewer comments 4

Editor who approved publication: Dr Richard Walker

Katarzyna Mazur, Krzysztof Wilczyński, Jan Szewieczek

Department of Geriatrics, School of Health Sciences in Katowice, Medical University of Silesia, Katowice, Poland

Background: Inpatient geriatric falls are a frequent complication of hospital care that results in significant morbidity and mortality.
Objective: Evaluate factors associated with falls in geriatric inpatients after implementation of the fall prevention program.
Methods: Prospective observational study comprised of 788 consecutive patients aged 79.5±7.6 years (x̅ ± standard deviation) (66% women and 34% men) admitted to the subacute geriatric ward. Comprehensive geriatric assessment (including Mini-Mental State Examination, Barthel Index of Activities of Daily Living, and modified Get-up and Go Test) was performed. Confusion Assessment Method was used for diagnosis of delirium. Patients were categorized into low, moderate, or high fall risk groups after clinical and functional assessment.
Results: About 15.9%, 21.1%, and 63.1% of participants were classified into low, moderate, and high fall risk groups, respectively. Twenty-seven falls were recorded in 26 patients. Increased fall probability was associated with age ≥76 years (P<0.001), body mass index (BMI) <23.5 (P=0.007), Mini-Mental State Examination <20 (P=0.004), Barthel Index <65 (P=0.002), hemoglobin <7.69 mmol/L (P=0.017), serum protein <70 g/L (P=0.008), albumin <32 g/L (P=0.001), and calcium level <2.27 mmol/L. Four independent factors associated with fall risk were included in the multivariate logistic regression model: delirium (odds ratio [OR] =7.33; 95% confidence interval [95% CI] =2.76–19.49; P<0.001), history of falls (OR =2.55; 95% CI =1.05–6.19; P=0.039), age (OR =1.14; 95% CI =1.05–1.23; P=0.001), and BMI (OR =0.91; 95% CI =0.83–0.99; P=0.034).
Conclusion: Delirium, history of falls, and advanced age seem to be the primary risk factors for geriatric falls in the context of a hospital fall prevention program. Higher BMI appears to be associated with protection against inpatient geriatric falls.

Keywords:
falls, geriatric inpatients, comprehensive geriatric assessment, delirium, body mass index

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