Fall determinants in hospitalised older patients: a nested case control design - incidence, extrinsic and intrinsic risk in Malaysia

Abstract

Background The older person is at greater risk of falls due to multiple intrinsic and extrinsic factors. This is compounded when the elderly is admitted to hospitals, as they are acutely ill and placed in an unfamiliar environment. Delirium and polypharmacy further complicate these problems. As falls reflect quality of care with potential for grave outcomes, this study aimed to identify the extent and risk of falls in public hospitals. Methods We conducted a nested case control study in 12 public hospitals in Malaysia. In the cohort section, we screened all inpatients 60 years of age and above daily until discharge, or the end of the study period. Daily, we identified those who fell, inclusive of near falls, in the preceding 24 h. Our enumerators interviewed patients on experience of fall, and supplemented data from the nurses and caregivers. For each case, ten controls were chosen. Results The incidence of falls/near falls was 1.0 per 1000 patient days (95% CI: 0.9, 1.1). Intrinsic risk factors found to be significant included patients who were not from a nursing home or not cared for by a domestic helper prior to admission, had prior history of indoor fall either in home or hospital, had four or more clinical diagnoses or exited from the bed on the weak side. Significant extrinsic factors were the absence of transfer bar in toilet, call bells, light switches or walking aids that were not within reach, as well as not having a walking aid. Non-sturdy chair was associated with lesser falls than when sturdy chairs with armrests were present. Conclusion Querying patients for falls produced better results than incident reporting. Several intrinsic factors such as history of indoor or in-hospital fall, having four or more clinical diagnoses or exiting from weaker side and residence history may help to identify those at higher risk. Addressing significant extrinsic factors such as transfer bars and the identification of switches may help in reducing falls risk in hospitals. Trial registration This study was registered in National Medical Research Register of Malaysia (NMRR-07-772-1044; date 26/05/2008) with Ethics Approval from Medical Research and Ethics Committee (MREC: MRG-07-LOI-HSR-1).

Falls as the result of interplay between nurses, patient and the environment: Using text-mining to uncover how and why falls happen

“…Apart from the patient biological factors, nurses also identified that a slippery floor, the use of unsafe footwear, and unsupportive chairs and commodes increased the risk of falling. A slippery floor and unsafe footwear are environmental factors that have constantly been identified as increasing the risk of falling [ 22 , 23 ]. Thus, the results of this study are consistent with the previous findings as regards patient and environmental factors.…”

“…The intrinsic factors include the characteristics of a patient, such as sex [ 15 ], the types of disease [ 16 , 17 ], decline in physical function [ 6 , 18 ], elimination and sleeping problems [ 18 , 19 ], confusion and impaired understanding [ 20 ], the types of medication used [ 6 , 17 , 21 ], and patients’ predisposition such as “doing everything on one’s own” [ 20 ]. The extrinsic factors involve the use of unsafe footwear including slippers [ 22 ], tubes and drains attached to patients [ 21 ], and wet and slippery floors [ 23 ]. These intrinsic and extrinsic factors have been incorporated into several fall-screening tools to identify those at risk of falling so that precautions can be taken to prevent falls.…”

Analysis of Hospital Safety in Fall Prevention in the Elderly

“…These findings are in line with a study carried out in Australia [43], which identified slippery floors in bathrooms and the presence of water or body substances on these surfaces as the main causes of falls among the elderly. Corroborating these findings, another study [41] identified irregularities also related to bathrooms, with the absence of a support bar in the toilet.…”

“…These measures demonstrate a commitment to patient safety, providing ideal conditions for multidisciplinary care and the comfort of hospitalized individuals [40]. A study carried out in 12 public hospitals in Malaysia [41] disclosed significant extrinsic factors that led to falls in elderly people, including the absence of a transfer bar by the toilet and a bell.…”

Characterisation of institutionalised Portuguese older adult fallers: is there a place for pharmacist intervention? A preliminary study

“…Data from recent studies associate intrinsic and extrinsic factors with falls. 14 , 15 The intrinsic factors are those that result from physiological changes inherent to ageing, diseases, and as a consequence of drug intake. On the other hand, the extrinsic factors include social and environmental hazards.…”