A predictive model for fall risk in hospitalized adults: A case–control study

Abstract

Aim:To develop and validate a predictive model for falls in hospitalized adult clinical and surgical patients, assessing intrinsic (i.e. patient-related) and extrinsic factors (i.e. care process-related). Background:To identify factors predictive of falls and enable appropriate management of fall risk it is necessary to understand patient and environmental factors, along with care delivery processes. Design:A matched case-control study. Methods:This study was conducted in the medical and surgical wards of a Brazilian teaching hospital. The sample included 536 patients, with data collected in 2013- Data analysis included descriptive statistics and conditional logistic regression.Cases of patients aged 18 years or older who fell while hospitalized were included.One patient who did not fall during hospitalization, matched by sex, ward and admission date, was selected as a control for each included case. Results: The SAK Fall Scale (Severo-Almeida-Kuchenbecker) was developed and validated. The scale includes seven variables: disorientation/confusion, frequent urination, walking limitations, lack of caregiver, postoperative status, previous falls and number of medications administered within 72 hr prior to the fall. This scale showed acceptable predictive accuracy. Conclusions: The newly developed SAK Fall Scale includes five intrinsic and two extrinsic variables and differs from other predictive scales for falls. The findings of this study are broad and the scale, which is easy to apply, can be used worldwide by nurses in health services. In advanced practice, the testing of a new model for fall risk contributes to preventive interventions and thus has an impact on patient safety. K E Y W O R D S adult, advanced practice, falls, nurses, patient safety, risk management *Member of the Study Group on Adult and Elderly Care -GEPECADI -CNPq.• The study gives data for a new prediction model that should be used to predict fall risk.• The findings should be used to support the care and safety of hospitalized clinical and surgical patients. 564 | SEVERO ET AL.

Impact of Nurses’ Intervention in the Prevention of Falls in Hospitalized Patients

“…The analysis of the intervention by logistic regression revealed that a lower likelihood of falls in the intervention group was associated effectively with the method of care in the units included in this group, with no other studied variables being relevant. Our results are consistent with other studies that advocate for the benefits of using scales to identify the risk of falls [ 3 , 13 , 15 , 16 , 20 , 21 , 22 ]. Likewise, the systematic review by Miake-Lye et al [ 19 ] expresses the benefits of programs that include interventions to identify risk factors associated with falls in acute care environments.…”

“…Almost all studies on the incidence of falls that we reviewed were in agreement with the benefits of applying preventive measures based on the risk identified and/or illness [ 13 , 15 , 16 , 18 , 20 , 22 , 30 , 32 , 39 ]. A systematic review by Avanecean et al [ 35 ] indicated patient-centered interventions, in addition to tailored patient education, may have the potential to be effective in reducing fall rates in acute care hospitals.…”

“…Several research studies have shown that the use of scales to identify patients with a high risk of falls is effective, as it achieves a reduction in falls and a decrease in the injuries that result [ 3 , 13 , 15 , 16 , 20 , 21 , 22 ]. In the study by Kobayashi et al [ 3 ], the risk of falls was evaluated using a Fall Assessment Score Sheet at admission and during hospitalization.…”

The Added Value of Combined Timed Up and Go Test, Walking Speed, and Grip Strength on Predicting Recurrent Falls in Chinese Community-dwelling Elderly

“…5 Combined grip strength (GS), WS, and one-leg standing balance is better in predicting all-cause mortality than single test. 6 Meanwhile, toward the effects of combined models on discriminating potential fallers, those models mostly included factors overriding multiple aspects to increase the reliability of assessment, like medical history, psychological condition, surrounding environment and functional tests, [7][8][9] thus lacking of an easy and convenient fallscreening tool based on functional tests only, making our study more valuable.…”

Risk Factors Associated with Falls among Nursing Home Residents: A Case-Control Study

“…Paresthesia, due to peripheral neuropathy or sensorial loss, produces several sudden sensations, which in turn can decrease motor and spatial perceptions, which ultimately results in falls [20,21]. The overactive bladder is a strong predictor of falls in older adults, which is associated with the urgency of having to get to the restroom [4,[22][23][24]. Insomnia as well as the medication prescribed for sleep disorders are also associated with a risk of falls [24,25].…”