Falls in an Inpatient Geriatric Psychiatric Population

Abstract

BACKGROUND: Falls are a major health care concern for older adults in hospital settings. The incidence of falls on psychiatric units tends to be higher than that on general acute care hospital units, with estimated rates of 13.1 to 25 per 1,000 inpatient days compared to 3 to 5 per 1,000 inpatient days, respectively. OBJECTIVE: The purposes of this study were to quantify the number and types of falls and identify the associated risk factors relevant to a psychiatric inpatient setting. DESIGN: This was a descriptive study. Data were collected over a 6-month time period. Patients on a 28-bed acute care geriatric psychiatric unit provided the sampling frame. RESULTS: Twenty-eight patients fell during the study period for a total 45 falls. Six patients experienced multiple falls during their stay. Most of the falls that occurred did not result in serious injury. Individuals who experienced a fall were about 3 years older than nonfallers (73.6 years versus 76.36 years). There was no difference by gender as to rate of falls. Activity level was higher for the patients who had a fall, and medication had the strongest relationship to a falls episode. When census was low, the fall rate was slightly higher. CONCLUSIONS: There are many variables that contribute to the phenomenon of falls in an acute geriatric psychiatric inpatient unit. Use of research findings will allow the development of a fall risk prevention protocol to provide the safest environment and best quality of care possible for the geriatric patient.

Development and Validation of A New Tool for Assessing Risk of Falls in Acute Psychiatric Settings

“…Our tool, named IPFRAT, comprises 11 items, and is easy to understand and use in a real setting. The 10 fall episodes observed during the study period confirm the data found in literature about the frequency and therefore the importance of the event (Blair, 2005;Kerzman et al, 2004).…”

“…Incidence of falls in this population ranges from 13.1 to 25 per 1,000 patient bed days. (Blair, 2005) Despite these considerations, few papers are available on this topic; only in recent times, two scales have been published, which assess the risk of falls in the psychiatric population, the Edmonson Psychiatric Fall Risk Assessment Tool -(EPFRAT) and the Wilson-Sims Fall Risk Assessment Tool (WSFRAT). The first has better predictive values than generic scales, but has unsatisfactory sensitivity (0.63).…”

Preventing falls in In-Patient Older Adult Mental Health Services: Different Causative Factors in Mental and Neurocognitive Disorders

“…In 2010-11, 1.3 million patient days (or one in every 10 days spent in hospital) by a person aged 65 and older was directly attributable to an injurious fall. Fall rates for inpatient psychiatric services can be three to four times higher than rates in general hospitals [13].…”

“…The more medication taken by an older adult, the greater the risk of falls, and in some instances medication is associated with the highest frequency and severity of falls in an older adult mental health services [13]. High rates of poly-pharmacology have been reported in psychiatric hospitals [38].…”

“…However psychotropic medications are over prescribed in mental health settings [13,44] with some suggesting there is little relationship between the type of psychotropic drug prescribed and the symptoms for which it had been dispensed [45,46]. Examining psychotropic medications associated with falls in this study identified high use (more than five occasions) of mood stabilisers (Sodium Valproate), benzodiazepines (Loarazepam, Oxazepam, Clonazepam, and Diazepam), antipsychotic medications (Queitapine, Risperidone, and Haloperidol) and antidepressants (Mirtazapine), in the 24 hours prior to the fall in the absence of diagnosed psychosis.…”