Journal of Gerontological Nursing

CNE Article 

Older Adult Inpatient Falls in Acute Care Hospitals: Intrinsic, Extrinsic, and Environmental Factors

Yunchuan (Lucy) Zhao , RN, MSN, MPAff; Heejung Kim, PhD, RN

Abstract

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Read the article, “Older Adult Inpatient Falls in Acute Care Hospitals: Intrinsic, Extrinsic, and Environmental Factors” found on pages 29–43, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

This activity is valid for continuing education credit until June 30, 2018.

Contact Hours

This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Activity Objective

Identify major risk factors as well as the significance of inpatient falls.

Disclosure Statement

Neither the planners nor the authors have any conflicts of interest to disclose.

The current integrative literature review of 23 studies aimed to identify multidimensional risk factors of falls among older adult patients in acute care hospitals. The incidence rate of fall-related injuries ranged from 6.8% to 72.1%. Advanced age was a major intrinsic risk factor, whereas being a patient in a geriatric unit was a significant extrinsic factor for inpatient falls and fall-related injuries based on statistical significance obtained from quantitative data analyses. Other critical risk factors were: (a) cognitive impairment; (b) impaired mobility; (c) prolonged length of hospital stay; and (d) fall history. Environmental/situational factors, such as patient ambulation and fall locations, also contributed to inpatient falls. In clinical practice, nurses need to know who are the most vulnerable patients in the hospital and develop comprehensive interventions to decrease intrinsic, extrinsic, and environmental risk factors. Prospective mixed-methods studies are needed to examine psychosocial factors and consequences of falls. [Journal of Gerontological Nursing, 41(7), 29–43.]

Ms. Zhao is Doctoral Student, University of Kansas School of Nursing, Kansas City, Kansas, and Clinical Assistant Professor, Boise State University School of Nursing, Boise, Idaho. Dr. Kim is Assistant Professor, Kansas School of Nursing, Kansas City, Kansas, and Assistant Professor, College of Nursing, Yonsei University, Seoul, South Korea.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Yunchuan (Lucy) Zhao, RN, MSN, MPAff, Clinical Assistant Professor, Boise State University School of Nursing, 1910 University Drive, Mail Stop 1840, Boise, ID 83725; e-mail: lucyzhao@boisestate.edu.

Received: February 12, 2015
Accepted: May 20, 2015

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Abstract

How to Obtain Contact Hours by Reading This Article
Instructions

1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must:

Read the article, “Older Adult Inpatient Falls in Acute Care Hospitals: Intrinsic, Extrinsic, and Environmental Factors” found on pages 29–43, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz.

Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study.

Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated.

This activity is valid for continuing education credit until June 30, 2018.

Contact Hours

This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated.

Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.

Activity Objective

Identify major risk factors as well as the significance of inpatient falls.

Disclosure Statement

Neither the planners nor the authors have any conflicts of interest to disclose.

The current integrative literature review of 23 studies aimed to identify multidimensional risk factors of falls among older adult patients in acute care hospitals. The incidence rate of fall-related injuries ranged from 6.8% to 72.1%. Advanced age was a major intrinsic risk factor, whereas being a patient in a geriatric unit was a significant extrinsic factor for inpatient falls and fall-related injuries based on statistical significance obtained from quantitative data analyses. Other critical risk factors were: (a) cognitive impairment; (b) impaired mobility; (c) prolonged length of hospital stay; and (d) fall history. Environmental/situational factors, such as patient ambulation and fall locations, also contributed to inpatient falls. In clinical practice, nurses need to know who are the most vulnerable patients in the hospital and develop comprehensive interventions to decrease intrinsic, extrinsic, and environmental risk factors. Prospective mixed-methods studies are needed to examine psychosocial factors and consequences of falls. [Journal of Gerontological Nursing, 41(7), 29–43.]

Ms. Zhao is Doctoral Student, University of Kansas School of Nursing, Kansas City, Kansas, and Clinical Assistant Professor, Boise State University School of Nursing, Boise, Idaho. Dr. Kim is Assistant Professor, Kansas School of Nursing, Kansas City, Kansas, and Assistant Professor, College of Nursing, Yonsei University, Seoul, South Korea.

The authors have disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Yunchuan (Lucy) Zhao, RN, MSN, MPAff, Clinical Assistant Professor, Boise State University School of Nursing, 1910 University Drive, Mail Stop 1840, Boise, ID 83725; e-mail: lucyzhao@boisestate.edu.

Received: February 12, 2015
Accepted: May 20, 2015

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Inpatient falls are prevalent and a serious concern with patient care. In acute care hospitals, patient falls are the most common incidents reported (Anderson, Boshier, & Hanna, 2012; Cameron et al., 2012; National Patient Safety Agency [NPSA], 2007; Oliver, Healey, & Haines, 2010), ranging from 3 to 5 falls per 1,000 patient bed days in the Unites States, constituting approximately 1 million inpatient falls annually (NPSA, 2007; Oliver et al., 2010). Consequences of falls are associated with increased burden to patients and care facilities.

A recently published study using data from the National Database of Nursing Quality Indicators found a total of 315,817 falls (rate = 3.56 falls per 1,000 patient days) and 82,332 (26.1%) fall-related injuries (rate = 0.93 per 1,000 patient days) in U.S. hospitals between July 1, 2006, and September 30, 2008 (Bouldin et al., 2013). The proportions of falls resulting in injuries range from 30% to 50% (Oliver et al., 2010), with 10% to 15% resulting in serious injuries, such as cranial trauma or fractures (Deandrea et al., 2013), leading to prolonged length of stay, increased direct patient care costs, and health care resource use (NPSA, 2007; Oliver et al., 2010). Compared to non-fallers, patients with serious fall-related injuries have to stay an additional 6 to 12 days with an average additional cost of $13,316 (Wong et al., 2011). Fall-related indirect costs, such as litigation cost, loss of income, and placement in a skilled nursing facility or nursing home, also can occur as the result of inpatient falls in the hospital (Oliver et al., 2010; Wong et al., 2011).

Patients 65 or older are the most vulnerable population to falls and relevant consequences (U.S. Census Bureau, 2010). Higher fall incidences have been reported in older adult patients (Anderson et al., 2012; Cameron et al., 2012; NPSA, 2007; Oliver et al., 2010), ranging from four to 14 falls per 1,000 patient bed days (Anderson et al., 2012). Serious fall-related injuries in older adults can cause reduced mobility and functioning ability, resulting in loss of independency and decreased quality of life (Oliver et al., 2010). Among older adults with a history of falls, approximately 50% have the fear of falling and 27% develop chronic posttraumatic stress disorder (Chung et al., 2009). Due to fear of falling, 13% to 50% of older adults restrict their physical and social activities, which can further cause functional decline, depression, social isolation, and decreased quality of life (Fletcher, Guthrie, Berg, & Hirdes, 2010; Hawkins et al., 2011).

Given the consequences of falls with hospitalized patients and an increasing financial burden to the health care system, several federal policies have been developed and enacted to prevent inpatient falls. Reducing falls and fall-associated deaths and serious injuries is one of the major goals of Healthy People 2020 (U.S. Department of Health and Human Services, 2010). The Agency for Health Care Research and Quality (AHRQ; 2013) developed a toolkit to prevent inpatient falls in hospitals. To reduce the cost associated with inpatient falls and fall-related injuries and improve patient care quality, the Centers for Medicare & Medicaid Services (CMS; 2008) implemented a new policy on October 1, 2008, that eliminated the reimbursement to hospitals for treatment of injuries resulting from falls occurring during hospitalization.

However, a gap exists in the literature (specifically targeting older adult inpatients), impeding achievement of these national goals. In recent years, several reviews have investigated risk factors for falls in hospitalized older adult patients. However, the review focused on older adults either in rehabilitation hospitals (Vieira, Freund-Heritage, & da Costa, 2011) or nursing homes (Deandrea et al., 2013). No reviews have focused on unique risk factors for falls among older adult patients in acute care hospitals. Different care settings are likely to be associated with admitted patient characteristics, interventional efforts at unit level, and environmental factors at a hospital level. For example, older adult patients in acute care hospitals often have chronic or acute conditions that may affect their independence and mobility (NPSA, 2007; Palmisano-Mills, 2007), thus they may require pain relief and/or other medications or certain surgeries (Oliver et al., 2010). The different environment in the hospital can further affect their mobility and independence. All of these factors can potentially place older adult patients in acute care hospitals at higher risk for falls than those in other facilities or at home (Deandrea et al., 2013; NPSA, 2007; Oliver et al., 2010).

Given the gap on the studies of risk factors for falls among older adult patients in acute care hospitals, the current study aimed to identify risk factors for inpatient falls in older adult patients in acute care hospitals through an integrative literature review. Four research questions were proposed:

  1. What is the fall prevalence in older adult patients in acute care settings?

  2. What are the major risk factors for falls in older adult patients in acute care hospitals regarding patient characteristics and care settings?

  3. What are the fall-related outcomes in older adult patients in acute care hospitals?

  4. What conceptual and methodological issues should be considered for research and practice?

Method

For the current integrative literature review, an initial literature search was conducted from September to December 2014. The literature of interest was limited to 10 years of recent publications from 2004 to 2014 to examine the most up-to-date information regarding inpatient falls, especially in older adult inpatients. Searching was completed through multiple electronic databases, including PubMed, Cochrane Library, Cumulative Index of Nursing and Allied Health Literature, MEDLINE, and PsycINFO. Based on reference lists obtained from retrieved articles, manual searching was completed using Google Scholar. A librarian specializing in health care literature was consulted for search terms and strategy. The following terms were used (in combination) while searching the databases: fall(s); predictor(s), risk factor(s), or characteristics; older adult(s) or elderly; patient(s), inpatient(s), or hospitalized; and acute care setting or hospitals. Initial results totaled 681 items; 23 studies were selected for review (Figure).

Flow chart of search strategy.

Figure.

Flow chart of search strategy.

Titles, abstracts, and full text were examined by applying the following inclusion and exclusion criteria. Studies were included if: (a) study participants were hospitalized in-patients ages 17 or older; (b) study settings were acute care hospitals; (c) they used a quantitative measure of fall risk; (d) they were published in peer-reviewed academic journals; and (e) they were written in English.

Studies with the following characteristics were excluded: (a) study participants included patients ages 16 or younger; (b) the age of study participants was not specified or reported; (c) study settings were outpatient settings, including home, community resident settings, psychiatric settings, or rehabilitation settings; and (d) grey literature, including dissertation, conference proceeding paper or abstract, and editorials.

Initially, the authors tried to retrieve studies whose participants were only adults ages 65 or older. However, only nine of 23 studies met strict eligibility criteria, although the majority of study participants in other studies were older adults. Thus, the authors decided to select studies whose adult inpatients were ages 17 or older, and specified age characteristics with more details in data analysis. When the age of study participant ranged from 17 to older, the proportion of older adults ages 65 or older was checked. The study was included if the proportion was >50%. If the article explained falls in older adults in general, including systematic review, Cochrane review, literature review, or expert opinion, it was used as background information and references were examined, but the article was not included in the analysis table.

Results

Description of 23 Selected Studies

Table 1 lists the characteristics of the selected studies. All 23 selected studies were quantitative observational design, conducted in a single (n = 17, 74%) or multiple acute care hospital settings (n = 6, 26%). The majority of studies were cross-sectional studies (70%), with five case-control studies (21%) and two longitudinal studies (9%). The majority of studies (74%) were retrospective, whereas six (26%) were prospective cohort studies. Among 23 studies included in the review, most were conducted in the Unites States (39%) and Europe (39%), whereas five additional studies (22%) were conducted in Australia.

Characteristics of 23 Selected StudiesCharacteristics of 23 Selected StudiesCharacteristics of 23 Selected Studies

Table 1:

Characteristics of 23 Selected Studies

The number of study participants ranged from 71 to 34,972, depending on the study design. Average patient age ranged from 57.8 to 85.9 years, and the percentage of male participants ranged from 37% to 72%. Major medical conditions of study participants included cognitive impairment/confusion/dementia/neurological diseases; cardiovascular diseases/hypertension; urinary/fecal incontinence; musculoskeletal problems; visual/hearing impairment; and cancer. Overall fall prevalence ranged from 0.41 to 7.8 falls per 1,000 patient bed days or 0.1 to 57.7 falls per year.

Risk Factors for Inpatient Falls

Within the 23 studies reviewed, 28 risk factors were found; non-relevant risk factors were also determined based on statistical significance (Table 2).

Prevalence And Risk Factors For FallsPrevalence And Risk Factors For FallsPrevalence And Risk Factors For FallsPrevalence And Risk Factors For Falls

Table 2:

Prevalence And Risk Factors For Falls

Intrinsic Risk Factors for Falls: Patient Level. Advanced age was a major significant factor for falls (nine times identified, 39%). Falls were prevalent among older adult inpatients in the selected studies. Costa-Dias et al. (2014) found that 89% of falls occurred in adult inpatients 60 and older, whereas more than 40% of falls occurred among older adults ages 80 to 89. Among inpatients who fell, some studies found that approximately 40% to more than 50% were 65 or older (Hitcho et al., 2004; Mion et al., 2012), whereas some studies found that approximately one half of patients experiencing an inpatient fall were 80 or older (Brand & Sundararajan, 2010; Tommasini, Talamini, Bidoli, Sicolo, & Palese, 2008).

Other risk factors were categorized to (a) medical and (b) non-medical conditions. Major medical conditions identified as important risk factors for increasing falls included: mental status deficits, including cognitive impairment, confusion, dementia, and delirium (12 times identified, 52%); impaired mobility or musculoskeletal problems (six times identified, 26.1%); stroke (four times identified, 17.4%); hypertension (three times identified, 13%); urinary incontinence (two times identified, 8.7%); and visual impairment (two times identified, 8.7%).

Common non-medical conditions found as risk factors increasing falls included: prolonged length of hospital stay (four times identified, 17.4%); fall history (three times identified, 13%); male gender (three times identified, 13%); female gender (two times identified, 8.7%); and care dependency (two times identified, 8.7%). Taking certain medications, such as psychotropic agents (three times identified, 13%), antipsychotic agents (three times identified, 13%), and antidepressant agents (two times identified, 8.7%), was also identified as a statistically significant risk factor for falls.

Some factors were identified as protective factors, which could decrease falls. For example, fall risk screening upon admission reduced inpatient falls (Chari, McRae, Varghese, Ferrar, & Haines, 2013). Hispanic patients were likely to have less falls in the hospital compared to African American, Caucasian, and Asian patients (Dharmarajan, Avula, & Norkus, 2006).

However, there were inconsistent reports regarding risk factors. First, few studies reported whether age was a statistically nonsignificant factor for general inpatient falls, impulsive falls, or injurious falls (Ferrari, Harrison, & Lewis, 2012; Mion et al., 2012). Second, gender was controversial. Male gender was identified as a statistically significant risk factor for falls in several studies (Chen, Liu, Chan, Shen, & van Nguyen, 2010; Chen, van Nguyen, Shen, & Chan, 2011; Neumann, Hoffmann, Golgert, Hasford, & von Renteln-Kruse, 2013), whereas others reported that female gender was a risk factor (Schwendimann, Bühler, De Geest, & Milisen, 2008; Tommasini et al., 2008). However, the remaining nine studies (39%) reported that gender did not matter. Third, visual impairment was statistically significant in two studies (Chen et al., 2010, 2011) but identified as nonsignificant in two other studies (Corsinovi et al., 2009; Neumann et al., 2013). Fourth, having certain medical problems (e.g., urinary incontinence) was identified as a statistically significant risk factor in some studies (Chen et al., 2010, 2011), but statistically nonsignificant in other studies (Corsinovi et al., 2009; Ferrari et al., 2012; Härlein, Halfens, Dassen, & Lahmann, 2011).

Extrinsic Risk Factors for Falls: Staff and Care Setting Characteristics. Limited information is available to explain how staff and care settings relate to inpatient falls. First, fall incidence rates differed among diverse types of units. Compared to other units in the hospital, geriatric units had the highest fall incidence followed by internal medicine and neurological units (Fischer et al., 2005; Härlein et al., 2010; Heinze, Halfens, & Dassen, 2007; Hitcho et al., 2004; Schwendimann et al., 2008). Being an inpatient in a geriatric unit was identified as a statistically significant factor for inpatient falls (four times identified, 17.4%). Second, falls were found to be associated with the time when falls occurred. Shift change periods were associated with increased inpatient falls (Chen et al., 2011). Findings from several studies suggested high incidence of falls during evening and night shifts (Chari et al., 2013; Hitcho et al., 2004; Schwendimann et al., 2008), whereas Mion et al. (2012) found more falls occurred between 7 and 11 a.m.

Environmental/Situational Factors. Environmental or situational factors can increase inpatient falls in older adults. Certain patient activities contributed to inpatient falls. Among patients who fell in the hospital, approximately 25% to 70.3% were walking or transferring (Chen et al., 2011; Schwendimman et al., 2008; Tzeng, 2010), and approximately 12% to 69% of falls were related to urinary and bowel elimination needs (Boelig et al., 2011; Chen et al., 2011; Hitcho et al., 2004; Mion et al., 2012; Tzeng, 2010). In addition, 15.9% to 51% of patients fell out of bed (Corsinovi et al., 2009; Schwendimman et al., 2008; Tommasini et al., 2008). Regarding the location of falls, the majority occurred in patient rooms (62% to 77.1%), with 11.4% to 68% in the bathroom and 4.9% to 13% in the hallway (Chen et al., 2011; Corisnovi et al., 2009; Fischer et al., 2005; Mion et al., 2012; Rhalimi, Helou, & Jaecker, 2009; Schwendimann et al., 2008; Tommasini et al., 2008).

Consequences of Falls Among Older Adult Patients

Inpatient falls had negative consequences in patients, particularly in older adult patients. In general, the incidence rates of fall-related injuries ranged from 6.8% to 72.1%. Fall-related injuries included 12% to 82% minor injuries (e.g., abrasions), 2.2% to 53.6% moderate injuries (e.g., lacerations), and 0.5% to 29% major injuries (e.g., fractures, death [0.2% to 2%]) (Brand & Sundararajan, 2010; Chari et al., 2013; Chen et al., 2011; Corsinovi et al., 2009; Fischer et al., 2005; Mion et al., 2012; Neumann et al., 2013; Rhalimi et al., 2009; Schwendimann et al., 2009; Tommasini et al., 2008; Tzeng, 2010). After an injurious fall, 4% of patients had to undergo surgical procedures to treat the injuries (Mion et al., 2012). Compared to younger adults, older adults were at higher risk for experiencing fall-related injuries. Older adult patients were more likely to experience major or serious injuries from inpatient falls than other age groups (Fischer et al., 2005; Hitcho et al., 2004; Schwendimann et al., 2008). Adults 80 and older were 1.5 times more likely to experience fractures resulting from inpatient falls compared to younger patients (Chari et al., 2013). Brand and Sundararajan (2010) found that approximately 60% of fall-related fractures occurred in patients older than 80. Mortality rate and length of stay increased among older adult patients with injurious falls (Brand & Sundararajan, 2010; Corsinovi et al., 2009). In addition, older adult patients were more likely to be placed in nursing homes after experiencing falls in acute care hospitals (Corisnovi et al., 2009).

Discussion

To the authors’ knowledge, the current integrative review is the first synthesis on multidimensional risk factors for falls focusing on older adult inpatients in acute care hospitals. Although several literature reviews have been performed on risk factors for inpatient falls, they did not examine factors specifically for the older adult population in hospital settings. Given the unique impact of inpatient falls on older adult patients, the current study provides important knowledge on risk factors for falls at different levels, including intrinsic, extrinsic, and situational factors. Compared to the AHRQ (2013) toolkit for preventing falls in hospitals, the current study findings center on identifying (a) how fall assessment processes connect to outcomes; (b) important risk factors for falls in a specific setting; and (c) challenges in current practice.

In the current study, the authors found that advanced age was a key risk factor to increased inpatient falls. More than one third of studies identified advanced age increased falls, specifically in patients older than 65. In addition, being an inpatient in the geriatric unit may be correlated to advanced age as a risk factor. This finding is consistent with the result of a recent systematic review of studies on older adults in nursing homes and hospitals, in which Deandrea et al. (2013) found that the odds ratio for inpatient falls for a 5-year increase in age was 1.1. Thus, 80-year-old adults are 1.2 times more likely to have a fall, and 95-year-old adults are 1.4 times more likely to have a fall compared to 65-year-old adults.

Certain medical conditions were found to be highly associated with falls, such as altered mental status (e.g., confusion, cognitive impairment, delirium), impaired mobility, stroke, and hypertension. Negative effects secondary to confusion and cognitive impairment have been well established in a previous review related to inpatient falls (Deandrea et al., 2013). In addition, it was also found that increased falls were among those patients who had a history of falls or took certain medications, such as psychotropic, anti-psychotic, or antidepressant agents (Deandrea et al., 2013).

Environmental and situational factors are also important regarding inpatient falls. The findings of patient activities while falling suggest mobile patients were at a higher risk of falling than non-mobile patients. A prolonged length of hospital stay and insufficient physical assistance may negatively affect mobile older adults. However, the current authors believe that a prolonged length of stay was not an independent risk factor because it was considered as a consequence of inpatient falls in some studies (Brand & Sundararajan, 2010; Corsinovi et al., 2009).

Limitations

Major data collection methods were patient medical records and fall incident report reviews. The data collection duration ranged from 4 to 120 months (mean = 33.1 months, with one study not reporting data collection duration). Study limitations and methodological concerns are noted in the 23 selected studies.

First, the definition and operationalization of falls differ among studies. In general, a fall was defined as an unintentional sudden change in body position coming to rest on the ground, floor, or other lower level (Chen et al., 2010; Mion et al., 2012; Neumann et al., 2013; Salgado, Lord, Ehrlich, Janji, & Rahman, 2004). Some studies defined a fall similarly but more detailed: “sudden, unintentional loss of posture causing an individual to inadvertently rest at a lower level, without use of overwhelming external force” (Dharmarajan et al., 2006, p. 288) or “a sudden, unexpected descent from a standing, sitting, or horizontal position” (Fischer et al., 2005, p. 823). The most frequent operationalization of falls was a count of falls per 1,000 patient days or during study periods. Different usage of diverse types of definitions may affect the wide range of fall prevalence, non-compatible rate across studies, or inconsistent significance of risk factors. Health care providers and researchers should be careful to use study findings from multiple studies. For example, in the current study, the fall prevalence was converted to compare the prevalence across studies (Table 2).

Second, a concern exists regarding reliability of data collection. Most studies were secondary data analyses using data extracted from patient medical records or clinical incident reports. The primary data record did not note study fall prevalence and its risk factors; thus, there was no control for training health care providers to record fall incidence accurately. Moreover, the potential underreporting of falls in the incident report system may occur because most reviewed studies depended on data reported by nurses or other health care providers (Shorr et al., 2008). Moreover, although several common risk factors were identified in the review, the definitions and categorizations of the risk factors were inconsistent among the reviewed studies. For example, several different terms were used to indicate abnormal level of consciousness, including mental alteration (Neumann et al., 2013), cognitive impairment (Ferrairi et al., 2012; Härlein et al., 2011), dementia (Chen et al., 2011), mental status deficits (Tzeng, 2010), and confusion (Salgado et al., 2004).

Third, most studies did not control confounding effect from extraneous factors; thus, it is difficult to compare their findings across different study settings and countries. Because different countries have different regulations and policies for acute care hospitals, the risk factors identified among inpatients in European acute care hospitals may not be directly comparable with those in Australian or American acute care hospitals; therefore, generalizability of study findings in a specific country will be limited in other countries.

Fourth, study design was another major methodological issue. Retrospective design was used in most studies (76%), whereas several studies used prospective design (24%). With retrospective design, it is challenging to identify causal relationship because reverse causality could occur (Shadish, Cook, & Campbell, 2002). It is unclear whether factors such as impaired mobility, confusion, or prolonged length of stay were the cause or consequence of falls.

Implications for Clinical Practice and Research

Findings from the current literature review have important implications for clinical practice. All health care providers need to acknowledge that older adult patients with advanced age are at increased risk for falls. In general, both single and multifactorial fall prevention interventions have been developed and implemented to prevent inpatient falls and fall-related injuries in hospitals. According to a recent Cochrane review on fall prevention interventions, single interventions include: exercise; Vitamin D with calcium supplements; environment adaptations; using assistive technology, such as bed exit alarms for communication aids; staff training; service model change; patient knowledge improvement through education; and multifactorial interventions that incorporate several single intervention components (Cameron et al., 2010).

When nurses combine multiple single interventions, the long-term and short-term effects should be considered to maximize the preventive effects. For example, taking vitamin D and calcium supplements generates long-term effect to prevent fractures secondary to falls for older adults from acute care hospitals to the community. However, it is difficult to expect short-term effect during the limited period of hospital stay. Thus, it is more appropriate to educate older adults about the importance of taking vitamin D and calcium supplements when they return home. In contrast, because most falls are elimination-related, nursing and other staff should provide assistance to patients using toilets, particularly to patients with urinary or bowel incontinence, during hospital stays as short-term intervention.

Although some multifactorial interventions have shown positive effect in reducing inpatient falls, falls and fall-related injuries remain prevalent among older adults in hospitals. When health care providers in acute care hospitals care for older adult patients, they need to focus on identified risk factors of falls to maximize the preventive effect with limited time and resources. To prevent falls and fall-related injuries, nursing and other health care professionals should perform a thorough assessment on patients and implement appropriate fall prevention interventions from admission to discharge. Comorbid conditions, medications, mobility, and cognition should be evaluated to determine comprehensive fall risk. In addition, comprehensive assessment, including patient characteristics and situational factors, is required continuously. Environmental modification in care settings focusing on patient room, bathroom, and hallway is also needed.

More organizational strategies should be designed and implemented considering the extrinsic and environmental risk factors of older adult inpatient falls identified in the current review. Using the AHRQ (2013) toolkit to prevent inpatient falls in hospitals as a framework, hospitals could incorporate the following strategies when developing fall prevention programs: (a) assessing the culture of safety, organizational attention to, and leadership support for fall prevention programs; (b) staff education for the best practices; and (c) collecting the necessary data to evaluate falls and fall-related injuries. Resource identification, use, and distribution should be emphasized specifically for older adult in-patients.

Prospective studies are needed to examine the associations between risk factors and inpatient falls in acute care settings. Prospective studies allow differentiating risk factors for falls from potential consequences of falls (e.g., impaired mobility, prolonged length of stay). In addition, mixed-methods studies are needed to examine psychosocial factors and consequences of falls by interviewing patients to learn their lived experiences. Patient perspectives regarding falls will be beneficial to design patient-centered intervention and outcome measures. For example, fear of falling, a psychosocial risk factor, was not examined in any of the 23 studies identified. Fear of falling occurs in 35% to 55% of older adults and has been found to be predictive of future falls among community-dwelling older adults (Fletcher et al., 2010). Future studies in acute care settings need to examine the association between patient-perceived fall risk factors and the consequences of falls so as to develop patient-centered interventions for older adult patients at high risk for falls.

Conclusion

Falls are prevalent among adult inpatients in acute care hospitals and have adverse impact on patients, particularly older adults. The current integrative literature review identified several key risk factors, including intrinsic and extrinsic factors, as well as environmental/situational factors. The findings from this literature review provide updated knowledge on risk factors for inpatient falls and implications for future research and clinical practice regarding fall prevention among patients, particularly older adult patients in acute care hospitals.

References

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  • Chung, M.C., McKee, K.J., Austin, C., Barkby, H., Brown, H., Cash, S. & Pais, T. (2009). Posttraumatic stress disorder in older people after a fall. International Journal of Geriatric Psychiatry, 24, 955–964. doi:10.1002/gps.2201 [CrossRef]
  • Corsinovi, L., Bo, M., Aimonino, N.R., Marinello, R., Gariglio, F., Marchetto, C. & Molaschi, M. (2009). Predictors of falls and hospitalization outcomes in elderly patients admitted to an acute geriatric unit. Archives of Gerontology and Geriatrics, 49, 142–145. doi:10.1016/j.archger.2008.06.004 [CrossRef]
  • Costa-Dias, M.J., Oliveira, A.S., Martins, T., Araújo, F.T., Santos, A.S., Moreira, C.N. & José, H. (2014). Medication fall risk in old hospitalized patients: A retrospective study. Nurse Education Today, 34, 171–176. doi:10.1016/j.nedt.2013.05.016 [CrossRef]
  • Deandrea, S., Bravi, F., Turati, F., Lucenteforte, E., La Vecchia, C. & Negri, E. (2013). Risk factors for falls in older people in nursing homes and hospitals: A systematic review and meta-analysis. Archives of Gerontology and Geriatrics, 56, 407–415. doi:10.1016/j.archger.2012.12.006 [CrossRef]
  • Dharmarajan, T.S., Avula, S. & Norkus, E.P. (2006). Anemia increases risk for falls in hospitalized older adults: An evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients. Journal of the American Medical Directors Association, 7, 287–293. doi:10.1016/j.jamda.2005.10.010 [CrossRef]
  • Ferrari, M., Harrison, B. & Lewis, D. (2012). The risk factors for impulsivity-related falls among hospitalized older adults. Rehabilitation Nursing, 37, 145–150. doi:10.1002/RNJ.00046 [CrossRef]
  • Fischer, I.D., Krauss, M.J., Dunagan, W.C., Birge, S., Hitcho, E., Johnson, S. & Fraser, V.J. (2005). Patterns and predictors of inpatient falls and fall-related injuries in a large academic hospital. Infection Control and Hospital Epidemiology, 26, 822–827. doi:10.1086/502500 [CrossRef]
  • Fletcher, P.C., Guthrie, D.M., Berg, K. & Hirdes, J.P. (2010). Risk factors for restriction in activity associated with fear of falling among seniors within the community. Journal of Patient Safety, 6, 187–191. doi:10.1097/PTS.0b013e3181f1251c [CrossRef]
  • Härlein, J., Halfens, R.J., Dassen, T. & Lahmann, N.A. (2011). Falls in older hospital inpatients and the effect of cognitive impairment: A secondary analysis of prevalence studies. Journal of Clinical Nursing, 20, 175–183. doi:10.1111/j.1365-2702.2010.03460.x [CrossRef]
  • Hawkins, K., Musich, S., Ozminkowski, R.J., Bai, M., Migliori, R.J. & Yeh, C.S. (2011). The burden of falling on the quality of life of adults with Medicare supplement insurance. Journal of Gerontological Nursing, 37(8), 36–47. doi:10.3928/00989134-20110329-03 [CrossRef]
  • Heinze, C., Halfens, R.J. & Dassen, T. (2007). Falls in German in-patients and residents over 65 years of age. Journal of Clinical Nursing, 16, 495–501. doi:10.1111/j.1365-2702.2006.01578.x [CrossRef]
  • Hitcho, E.B., Krauss, M.J., Birge, S., Dunagan, W.C., Fischer, I., Johnson, S. & Fraser, V.J. (2004). Characteristics and circumstances of falls in a hospital setting: A prospective analysis. Journal of General Internal Medicine, 19, 732–739. doi:10.1111/j.1525-1497.2004.30387.x [CrossRef]
  • Mecocci, P., von Strauss, E., Cherubini, A., Ercolani, S., Mariani, E., Senin, U. & Frati-glioni, L. (2005). Cognitive impairment is the major risk factor for development of geriatric syndromes during hospitalization: Results from the GIFA study. Dementia & Geriatric Cognitive Disorders, 20, 262–269. doi:10.1159/000087440 [CrossRef]
  • Mion, L.C., Chandler, A.M., Waters, T.M., Dietrich, M.S., Kessler, L.A., Miller, S.T. & Shorr, R.I. (2012). Is it possible to identify risks for injurious falls in hospitalized patients?Joint Commission Journal on Quality and Patient Safety, 38, 408–413.
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  • Neumann, L., Hoffmann, V.S., Golgert, S., Hasford, J. & von Renteln-Kruse, W. (2013). In-hospital fall-risk screening in 4,735 geriatric patients from the LUCAS project. Journal of Nutrition Health and Aging, 17, 264–269.. doi:10.1007/s12603-012-0390-8 [CrossRef]
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  • Palmisano-Mills, C. (2007). Common problems in hospitalized older adults: Four programs to improve care. Journal of Gerontological Nursing, 33(1), 48–54.
  • Rhalimi, M., Helou, R. & Jaecker, P. (2009). Medication use and increased risk of falls in hospitalized elderly patients: A retrospective, case-control study. Drugs & Aging, 26, 847–852. doi:10.2165/11317610-000000000-00000 [CrossRef]
  • Salgado, R.I., Lord, S.R., Ehrlich, F., Janji, N. & Rahman, A. (2004). Predictors of falling in elderly hospital patients. Archives of Gerontology and Geriatrics, 38, 213–219. doi:10.1016/j.archger.2003.10.002 [CrossRef]
  • Schmid, A.A., Wells, C.K., Concato, J., Dallas, M.I., Lo, A.C., Nadeau, S.E. & Bravata, D.M. (2010). Prevalence, predictors, and outcomes of poststroke falls in acute hospital setting. Journal of Rehabilitation Research & Development, 47, 553–562. doi:10.1682/JRRD.2009.08.0133 [CrossRef]
  • Schwendimann, R., Bühler, H., De Geest, S. & Milisen, K. (2008). Characteristics of hospital inpatient falls across clinical departments. Gerontology, 54, 342–348. doi:10.1159/000129954 [CrossRef]
  • Shadish, W.R., Cook, T.D. & Campbell, D.T. (2002). Experimental and quasi-experimental designs for generalized causal inference. Boston, MA: Houghton Mifflin.
  • Shorr, R.I., Mion, L.C., Chandler, A.M., Rosenblatt, L.C., Lynch, D. & Kessler, L.A. (2008). Improving the capture of fall events in hospitals: Combining a service for evaluating inpatient falls with an incident report system. Journal of the American Geriatrics Society, 56, 701–704. doi:10.1111/j.1532-5415.2007.01605.x [CrossRef]
  • Tommasini, C., Talamini, R., Bidoli, E., Sicolo, N. & Palese, A. (2008). Risk factors of falls in elderly population in acute care hospitals and nursing homes in North Italy: A retrospective study. Journal of Nursing Care Quality, 23, 43–49. doi:10.1097/01.NCQ.0000303804.15080.76 [CrossRef]
  • Tzeng, H.M. (2010). Inpatient falls in adult acute care settings: Influence of patients’ mental status. Journal of Advanced Nursing, 66, 1741–1746. doi:10.1111/j.1365-2648.2010.05343.x [CrossRef]
  • U.S. Census Bureau. (2010). The older population in the United States: 2010 to 2050. Retrieved from http://www.census.gov/prod/2010pubs/p25-1138.pdf
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  • Vieira, E.R., Freund-Heritage, R. & da Costa, B.R. (2011). Risk factors for geriatric patient falls in rehabilitation hospital settings: A systematic review. Clinical Rehabilitation, 25, 788–799. doi:10.1177/0269215511400639 [CrossRef]
  • Walker, P.C., Alrawi, A., Mitchell, J.F., Regal, R.E. & Khanderia, U. (2005). Medication use as a risk factor for falls among hospitalized elderly patients. American Journal of Health-System Pharmacy, 62, 2495–2499. doi:10.2146/ajhp050116 [CrossRef]
  • Wong, C.A., Recktenwald, A.J., Jones, M.L., Waterman, B.M., Bollini, M.L. & Dunagan, W. (2011). The cost of serious fall-related injuries at three Midwestern hospitals. Joint Commission Journal on Quality & Patient Safety, 37, 81–87.

Characteristics of 23 Selected Studies

Study Participants Data Collection
Study (Year) Care Setting (Country) Study Design N Age (years) Fall Prevalence Method Duration (Months) Fall Measures
Costa-Dias et al. (2014) Single acute hospital (Portugal)

Retrospective

Observational

Cross-sectional

193 fallers 20 to 101 M (SD) = 75 (13.1) 89% >60 214 fall cases (0.42 per year)

Patient medical record review

42 Fall incidence within the study period
Chari, McRae, Varghese, Ferrar, & Haines (2013) Multiple hospitals (Australia)

Retrospective

Observational

Cross-sectional

24,218 fall cases ≥18 M (SD) = 70.1 (17.3) median = 74.35 24,218 fall cases (57.7 per year)

Patient medical record review

Clinical incident report review

35 Fall incidence within the study period
Neumann, Hoffmann, Golgert, Hasford, & von Renteln-Kruse (2013) Single acute hospital (Germany)

Retrospective

Observational

Cross-sectional

4,735 participants 65 to 101 median = 82 7.8 falls during 1,000 hospital days

Patient medical record review

Clinical incident report review

36 Fall number per 1,000 hospital days
Ferrari, Harrison, & Lewis (2012) Single acute hospital (United States)

Retrospective

Observational

Cross-sectional

233 fallers 65 to 98 M (SD) = 78 (7.9) 233 fall cases (1.62 per year)

Patient medical record review

12 Fall incidence within the study period
Mion et al. (2012) Single acute hospital (United States)

Retrospective

Observational

Cross-sectional

784 fallers 20 to 90 M (SD) = 63.3 (15.8) 47% >65 784 fall cases (5.4 per year)

Patient medical record review

Clinical incident report review

Interviews with patients and nurses

26 Fall incidence within the study period
Härlein, Halfens, Dassen, & Lahmann (2011) Multiple hospitals (Germany)

Retrospective

Observational

Cross-sectional

9,246 participants ≥65 M (SD) = 77 (7.6) 489 fall cases (1.13 per year)

Patient medical record review

Clinical incident report review

36 Fall incidence within the study period
Chen, van Nguyen, Shen, & Chan (2011) Single acute care hospital (Australia)

Retrospective

Observational

Case-control

408 (339 fallers and 69 non-fallers) ≥65 M (SD) = 80 (10.1) 339 fall cases (0.94 per year)

Patient medical record review

Clinical incident report review

30 Fall incidence within the study period
Boelig et al. (2011) Single acute care hospital (United States)

Retrospective

Observational

Cross-sectional

3,562 fall cases 20 to 80 M (SD) = 57.8 (14.4) 3,562 falls (604 falls per year) 3.3 SCD-related falls per year

Patient medical record review

Clinical incident report review

59 Fall incidence within the study period
Brand & Sundararajan (2010) Multiple acute care hospitals (Australia)

Retrospective

Observational

Longitudinal

21,250 fall cases 18 to 90 50.9% >80 0.41 to 0.88 falls per 1,000 bed days

Hospital incident reporting system

120 Fall number per 1,000 hospital days
Chen, Liu, Chan, Shen, & van Nguyen (2010) Single acute care hospital (Australia)

Retrospective

Observational

Case-control

507 (438 fallers and 69 non-fallers) ≥65 M (SD) = 80 (10.1) 438 fall cases (1.22 per year)

Patient medical record review

Clinical incident report review

30 Fall incidence within the study period
Schmid et al. (2010) Multiple acute care hospitals (United States)

Retrospective

Observational

Cross-sectional

1,269 participants ≥65 M (SD) = 71.2 (13.3) 65 fall cases (0.1 per year) (5%)

Patient medical record review

60 Fall incidence within the study period
Tzeng (2010) Single acute care hospital (United States)

Retrospective

Observational

Cross-sectional

1,017 fall cases 17 to 103 M (SD) = 72.8 (16.2) 1,017 fall cases (1.84 per year)

Patient medical record review

Clinical incident report review

46 Fall incidence within the study period
Corsinovi et al. (2009) Single acute care hospital (Italy)

Prospective

Observational

Longitudinal

620 participants ≥65 M (SD) = 79.3 (8.9) 6 falls per 1,000 patient days

Patient medical record review

17 Fall number per 1,000 hospital days
Rhalimi, Helou, & Jaecker (2009) Single acute care hospital (France)

Retrospective

Observational

Case-control

260 (134 fallers and 126 non-fallers) ≥65 M (SD) = 84 (7) 142 fall cases (0.5 per year)

Patient medical record review

Fall incident forms review

24 Fall incidence within the study period
Schwendimann, Bühler, de Geest, & Milisen (2008) Single acute care hospital (Switzerland)

Prospective

Observational

Cross-sectional

34,972 participants 18 to 80 M (SD) = 67.3 (19.3) 91.3% >65 7 falls per 1,000 patient days

Fall reporting hospital system

60 Fall number per 1,000 hospital days
Tommasini, Talamini, Bidoli, Sicolo, & Palese (2008) Single acute care hospital (Italy)

Retrospective

Observational

Cross-sectional

71 fallers ≥65 M (SD) = 79.8 (12.2) 43.6% >80 79 fall cases (0.55 per year)

Patient medical record review

Clinical incident report review

12 Fall incidence within the study period
Heinze, Halfens, & Dassen (2007) Multiple acute care hospitals (Germany)

Retrospective

Observational

Cross-sectional

7,757 participants ≥65 M = 77 4.2 to 4.7 falls per 1,000 patient days

Patient medical record review

Fall incident form review

24 Fall number per 1,000 hospital days
Dharmarajan, Avula, & Norkus (2006) Single acute care hospital (United States)

Prospective

Observational

Case-control

362 participants 59 to 104 M (SD) = 76.9 (9.9) 73% >70 198 fall cases (0.4 per year) (54.7%)

Incident report review

42 Fall incidence within the study period
Fischer et al. (2005) Single acute care hospital (United States)

Retrospective

Observational

Cross-sectional

1,082 fallers 49 to 77 median = 62 3.1 falls per 1,000 patient days

Adverse event report review

18 Fall number per 1,000 patient days
Mecocci et al. (2005) Multiple acute care hospitals (Italy)

Prospective

Observational

Cross-sectional

13,729 participants ≥65 M (SD) = 78.3 (7.2) 69% >75 279 fall cases (1.16 per year)

Patient medical record review

20 Fall incidence within the study period
Walker, Alrawi, Mitchell, Regal, & Khanderia (2005) Single acute care hospital (United States)

Retrospective

Observational

Case-control

124 (62 fallers and 62 non-fallers) ≥65 M (SD) = 74 (6) 62 fall cases (0.43 per year)

Patient medical record review

Clinical incident report review

12 Fall incidence within the study period
Hitcho et al. (2004) Single acute care hospital (United States)

Prospective

Observational

Cross-sectional

183 fallers 17 to 96 M (SD) = 63.4 (6) 53% >65 3.38 falls per 1,000 patient days

Patient medical record review

Clinical incident report review

4 Fall number per 1,000 patient days
Salgado, Lord, Ehrlich, Janji, & Rahman (2004) Single acute care hospital (Australia)

Prospective

Observational

Cross-sectional

88 participants 80 to 89 M (SD) = 85.9 (4.2) 15 fall cases (17%)

Patient medical record review

Fall assessment record review

Not reported Fall incidence within the study period

Prevalence And Risk Factors For Falls

Other Significant Risk Factors
Study (Year) Advanced age affects fall? Intrinsic Extrinsic Environmental/Situational Factors Non-Significant Risk Factors Consequences After Falls
Costa-Dias et al. (2014) Yes

Central nervous system, psychotropic, antipsychotic, and antidepressant medications

Cancer

Gender

Anticonvulsant, opioid analgesia, antihypertensive, and oral antidiabetic medications

Chari, McRae, Varghese, Ferrar, & Haines (2014) Yes

Gender: female

Unscreened fall risk upon admission

Time: evening

Location: bedroom and hallway

Patient activity: walking and sitting

Timing

Fall-related fractures (0.94%)
Neumann, Hoffmann, Golgert, Hasford, & von Renteln-Kruse (2013) No

Gender: male

Fall history

Mental alteration

Insecure mobility

Psychotropic agents

Patient activity: frequent toileting

Age

Visual impairment

Ferrari, Harrison, & Lewis (2012) Unclear

Cognitive impairment

Inattention

Gender

UI

Mion et al. (2012) Unclear

Race: Caucasian

Antidepressant, antipsychotic, and diuretic medications

Time: 7 to 11 a.m.

Location: patient room

Patient activity: toileting

Injurious falls (29%): minor (82%); moderate (7%); major (9%); death (2%)

Discharge to: home (49%), postacute care (17%), long-term care (6%)

Hospital death (8%)

Härlein, Halfens, Dassen, & Lahmann (2011) Yes

Cognitive impairment

Greater care dependency

Impaired mobility

Geriatric unit

Gender

UI

Chen, van Nguyen, Shen, & Chan (2011) No

Gender: male

Low English literacy

Comorbidities: visual impairment, dementia, hypertension, stroke, UI, and MS problems

3 or more comorbidities

5 or more polypharmacy

Geriatric unit

Gender

UI

Hearing impairment

CHF

Atrial fibrillation

Boelig (2011) Unclear

Patient activity: toileting

SCD use

Brand & Sundararajan (2010) Yes

Comorbidities: HIV, liver disease, ataxia, PD, dementia, and delirium

Fall-related fractures (21%)

Increased LOS and mortality rate

Chen, Liu, Chan, Shen, & van Nguyen (2010) No

Gender: male

Hostel/nursing home pre-admission

Low English literacy

Comorbidities: visual impairment, dementia, hypertension, stroke, UI, and MS problems

3 or more comorbidities

5 or more polypharmacy

Time: 9 to 11 a.m., 7 to 8 p.m., midnight to 1 a.m.

Location: patient room, bathroom and hallway

Patient activity: moving, toileting, transferring, and showering

Hearing impairment

CHF

Atrial fibrillation

Injurious falls (72%): minor (53%); moderate (8%); major (0.5%)

Schmid et al. (2010) No

Greater stroke severity

Anxiety history

Loss of functional status

Gender

Sensory impairment

Gait abnormality

Tzeng (2010) Unclear

Mentalstatus deficits

Patient activity: toileting

Injurious falls (30%): minor (25%); moderate (2%); major (2%)

Corsinovi et al. (2009) Yes

Balance impairment

Comorbidities: delirium and endocrinology/metabolic disease

Polypharmacy

Location: patient bed, bathroom, and corridors

Gender

Visual impairment

UI

Sleep disturbances

Orthostatic hypotension

Injurious falls: minor (13%); major (12%)

Prolonged LOS

Nursing home placement

Rhalimi, Helou, & Jaecker (2009) No

Prolonged LOS

Medications: zolpidem, calcium channel antagonists, and meprobamate

Location: patient bed, bathroom, outside the unit, and corridor

Gender

Number of medications

Hypertension

PD

Injurious falls: minor (64%); moderate (20%); major (18%)

Schwendimann, Bühler, de Geest, & Milisen (2008) Yes

Gender: female

Prolonged LOS

Geriatric unit

Time: night shift

Location: patient room, bathroom, and hallway

Patient activity: walking, getting out of bed, and transferring

Injurious falls: minor (30%); major (5%)

Tommasini, Talamini, Bidoli, Sicolo, & Palese (2008) Yes

Gender: female

Prolonged LOS

Stroke

Hypertension

Location: patient room, bathroom, and bed

Fall history

Mental confusion

UI

Injurious falls: minor (40%); moderate (17%); major (13%)

Heinze, Halfens, & Dassen (2007) No

Care dependency

Geriatric or medical unit

Gender

Injurious falls: minor (67%); moderate/major (27%)

Dharmarajan, Avula, & Norkus (2006) No

Anemia

Prolonged LOS

Hispanic ethnicity

Gender

Place of residence

Fischer et al. (2005) Yes

Sedated mental status

Geriatric unit

Patient activity: toileting

Injurious falls (34%): moderate (54%); major (29%); death (0.2%)
Mecocci et al. (2005) Yes

Cognitive impairment

Fall history

Prolonged LOS

Severe comorbidity

Neuroleptic and benzodiazepine agents

Gender

Disability

Walker, Alrawi, Mitchell, Regal, & Khanderia (2005) Unclear

Dementia

Aspirin

Opioid analgesic, benzodiazepine, and antidepressant medications

Hitcho et al. (2004) Unclear

Gender: female

Medicine or neurology unit

Environmental obstacles or wet floor

Time: evening or night

Patient activity: unassisted transferring and toileting

Urinary problems

Diuretics

Injurious falls (42%): moderate/severe (8%)

Salgado, Lord, Ehrlich, Janji, & Rahman (2004) No

Cognitive impairment

Confusion

Fall history

Stroke history

Psychoactive medications

Impaired mobility

Injurious falls (9%)

Keypoints

Zhao, Y. & Kim, H. (2015). Older Adult Inpatient Falls in Acute Care Hospitals: Intrinsic, Extrinsic, and Environmental Factors. Journal of Gerontological Nursing, 41(7), 29–43.

  1. Inpatient falls are prevalent and a serious concern for patient care in acute care settings. Factors contributing to inpatient falls include intrinsic, extrinsic, and environmental factors.

  2. Nurses need to consider intrinsic (e.g., age), extrinsic (e.g., geriatric unit), and environmental (e.g., patient activity) factors when developing and implementing comprehensive fall prevention programs.

  3. Prospective mixed-methods studies are needed to examine psychosocial factors and consequences of falls.

10.3928/00989134-20150616-05

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