Functional Performances on Admission Predict In-Hospital Falls, Injurious Falls, and Fractures in Older Patients: A Prospective Study

Abstract

Falls are common among older inpatients and remain a great challenge for hospitals. Despite the relevance of physical impairments to falls, the prognostic value of performance-based functional measures for in-hospital falls and injurious falls remains unknown. This study aimed to determine the predictive ability and accuracy of various functional tests administered at or close to admission in a geriatric hospital to identify in-hospital fallers and injurious fallers. In this prospective study, conducted in a geriatric hospital in Geneva, Switzerland, 807 inpatients (mean age 85.0 years) were subjected to a battery of functional tests administered by physiotherapists within 3 days (interquartile range 1 to 6) of admission, including Short Physical Performance Battery (SPPB), simplified Tinetti, and Timed Up and Go tests. Patients were prospectively followed up for falls and injurious falls until discharge using mandatory standardized incident report forms and electronic patients' records. During a median length of hospital stay of 23 days (interquartile range 14 to 36), 329 falls occurred in 189 (23.4%) patients, including 161 injurious falls of which 24 were serious. In-hospital fallers displayed significantly poorer functional performances at admission on all tests compared with non-fallers (p < 0.001 for all). In multivariate analysis controlling for age, sex, previous falls, and fall as cause of admission, poorer functional performances on all functional tests predicted in-hospital falls and injurious falls (p < 0.001 for all). The SPPB only significantly predicted serious injurious falls (adjusted odds ratio [OR] = 0.76; 95% confidence interval [CI] 0.60-0.96) and fractures (adjusted OR = 0.76; 95% CI 0.59-0.98). In conclusion, poor functional performances, as assessed by SPPB, are independent predictors of in-hospital falls, injurious falls, and fractures in patients admitted to a geriatric hospital. These findings should help to design preventive strategies for in-hospital falls and support the adoption of objective performance-based functional measures into routine hospital practice. © 2018 American Society for Bone and Mineral Research.

Nutritional Status Is Associated with Function, Physical Performance and Falls in Older Adults Admitted to Geriatric Rehabilitation: A Retrospective Cohort Study

“…Surprisingly, in deconditioned patients, a higher score on the SPPB test at admission was associated with higher risk of being a faller. Contrary to our findings, lower SPPB has been associated with a higher risk of falls among in-hospital patients and community-dwelling older adults [ 57 , 58 ]. However, the SPPB score among hospital-deconditioned fallers in our study was remarkably lower than that in previous studies.…”

<p>The Role of Hip Abductor Strength in Identifying Older Persons at Risk of Falls: A Diagnostic Accuracy Study</p>

“…3 The AUC of the SPPB to identify persons who fell in the 6 months prior to hospitalization was 0.57, and in the same study, it was between 0.68 and 0.72 for the prospective assessment of in-hospital and in-hospital injurious falls. 34 For our population, we calculated an AUC of 0.8 (95% CI, 0.7-0.9), which is again higher than the previously stated values. One explanation for the higher AUC in our study might be the rather heterogeneous study population because we recruited in-and outpatients; it is likely that the…”

“…This might be surprising as the hip ABD MVIS and ABD RFG evaluate only one specific dimension of the 3 oftennamed fall-influencing parameters (ie strength, balance, and gait characteristics). 34 Nevertheless, the influence of the hip abductors on older persons' decreased mediolateral balance control [7][8][9] and the femoral-neck-stress-reducing hip abductor muscle contraction at the moment of impact after falling 14 gives an indication of the importance of this hip muscle group in relation to falls. Therefore, evaluating and understanding the construct of older persons' fall risks might benefit from the additional assessment of hip abductor strength as a not yet systematically assessed parameter to currently used fall risk assessments evaluating complementary aspects of falls.…”

“…In another study, the AUC of the TUG to differentiate between persons who fell 6 months prior to hospitalization and persons who did not fall was 0.58. 34 The AUC for prospectively assessed inhospital and in-hospital injurious falls ranged between 0.64 and 0.67. 34 The AUC of the TUG in our study was 0.8 (95% CI, 0.7-0.9), which is somewhat higher than the AUC in the aforementioned articles.…”

Validation of the Perform-FES: a new fear of falling scale for hospitalized geriatric patients

“…Univariate and multivariate linear and logistic regression models were used, in particular to determine the odds ratios (OR) and 95% confidence intervals (95% CI). Functional data were treated either as continuous or dichotomous (with a cut-off set to SPPB < 5, patients below this score being at increased risk of inhospital falls and fractures in our setting [44]) variables. In addition, analyses were carried out based on the calculation of the area under the receiver operating characteristic curve (AUC).…”