Falls at the Geriatric Hospital Ward in the Context of Risk Factors of Falling Detected in a Comprehensive Geriatric Assessment
Abstract
:1. Introduction
2. Materials and Methods
2.1. Prevention Strategies and Interventions Implemented at Geriatric Ward
2.2. Data Collected
2.3. Statistical Analysis
3. Results
3.1. Prevalence and Circumstances of In-Hospital Falls and Their Consequences
3.2. Study Cohort Characteristics—Sociodemographic and Medical Correlates of Falls
3.3. Study Cohort Characteristics—Pharmacotherapy Correlates of Falls
3.4. Study Cohort Characteristics—Mental and Physical Abilities and Nutritional Correlates of Falls
3.5. Study Cohort Characteristics—Abilities in Performing Activities of Daily Living Correlates of Falls
3.6. Prediction of Falls in a Multivariable Logistic Regression Analysis
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Characteristic | All | In-Patient Non-Fallers | In-Patient Fallers | p Value a | Missing Values |
---|---|---|---|---|---|
No. (%) of patients | 416 (100.0) | 402 (96.7) | 14 (3.3) | - | - |
Age (y), Md (IQR) | 82 (77.0–86.0) | 82 (77.0–86.0) | 81 (76.0–86.0) | 0.78 | - |
Age (75+), n (%) | 350 (84.1) | 337 (83.8) | 13 (92.9) | 0.32 | - |
Sex (men), n (%) | 94 (22.6) | 88 (21.9) | 6 (42.9) | 0.07 | - |
Residence (rural), n (%) | 87 (20.9) | 85 (21.1) | 2 (14.3) | 0.41 | - |
Length of hospital stay, days, Md (IQR) | 8 (5.0–9.0) | 8 (5.0–9.0) | 13 (8.8–17) | <0.001 | - |
Number of chronic diseases b, Md (IQR) | 5.0 (3.0–6.0) | 5.0 (3.0–6.0) | 6.5 (5.0–8.0) | 0.001 | - |
Multimorbidity, n (%) | 239 (57.5) | 226 (56.2) | 13 (92.9) | 0.004 | - |
Falls in the last 12 months, n (%) | 157 (43.9) | 147 (42.4) | 10 (90.9) | 0.001 | 58 |
Hospitalization in the last 12 months, n (%) | 122 (29.5) | 116 (29.0) | 6 (42.9) | 0.20 | 3 |
Parkinson’s disease, n (%) | 55 (13.2) | 50 (12.4) | 5 (35.7) | 0.01 | - |
Dementia, n (%) | 133 (32.0) | 127 (31.6) | 6 (42.9) | 0.27 | - |
Depression, n (%) | 181 (56.9) | 172 (56.2) | 9 (75.0) | 0.12 | 98 |
Diabetes, n (%) | 126 (30.3) | 116 (28.9) | 10 (71.4) | 0.001 | - |
Hypertension, n (%) | 327 (78.6) | 315 (78.4) | 12 (85.7) | 0.39 | - |
Orthostatic hypotension, n (%) | 57 (16.2) | 51 (15.0) | 6 (42.9) | 0.01 | 63 |
Ischemic heart diseases, n (%) | 223 (53.6) | 213 (53.0) | 10 (71.4) | 0.13 | - |
Osteoporosis, n (%) | 74 (17.8) | 73 (18.2) | 1 (7.1) | 0.25 | - |
Osteoarthritis, n (%) | 324 (77.9) | 313 (77.9) | 11 (78.6) | 0.62 | - |
Chronic cardiac failure, n (%) | 378 (90.9) | 364 (90.6) | 14 (100.0) | 0.22 | - |
Atrial fibrillation, n (%) | 98 (23.6) | 95 (23.6) | 3 (21.4) | 0.57 | - |
Peripheral arterial disease, n (%) | 64 (15.4) | 61 (15.2) | 3 (21.4) | 0.36 | - |
Stroke/ TIA, n (%) | 56 (13.5) | 53 (13.18) | 3 (21.4) | 0.28 | - |
Rheumatoid arthritis, n (%) | 20 (4.81) | 20 (5.0) | 0 (0.0) | 0.39 | - |
Cholesterol- total, mg/dL, Md (IQR) | 178 (146.0–212.0) | 179 (147.0–213.0) | 133.5 (112.0–165.0) | <0.001 | 27 |
LDL, mg/dL, Md (IQR) | 118 (87.0–143.0) | 120 (88.0–144.5) | 76.0 (67.0–87.0) | <0.001 | 118 |
HDL, mg/dL, Md (IQR) | 48 (39.0–57.0) | 49 (40.0–58.0) | 40.5 (32.0–42.0) | <0.001 | 101 |
Creatinin, mg/dL Md (IQR) | 0.98 (0.84–1.19) | 0.97 (0.84–1.18) | 1.3 (0.9–1.41) | 0.04 | 11 |
eGFR, mL/min/1.73 m2, M (SD) | 57.9 (46.0–71.6) | 58.1 (46.1–71.9) | 49.4 (40.5–66.6) | 0.13 | 11 |
TSH, mU/L, Md (IQR) | 1.4 (0.82–2.1) | 1.4 (0.82–2.1) | 1.8 (1.2–2.3) | 0.24 | 35 |
Vitamin B12, pg/mL, Md (IQR) | 334.5 (242.6–430.6) | 336.2 (242.8–430.6) | 299.7 (221.8–343.8) | 0.46 | 38 |
Na, mmol/L, Md (IQR) | 140.0 (138.0–141.0) | 140.0 (138.0–141.0) | 142.0 (134.0–142.0) | 0.60 | 10 |
Ca, mmol/L, Md (IQR) | 4.6 (4.4–4.7) | 4.6 (4.4–4.7) | 4.5 (4.3–4.6) | 0.17 | 102 |
Hemoglobin, g/dL, Md (IQR) | 12.6 (11.5–13.7) | 12.6 (11.5–13.7) | 12.6 (11.3–13.2) | 0.70 | 12 |
Albumin ≥ 35 mg/mL, n (%) | 58 (14.9) | 54 (14.4) | 4 (28.6) | 0.14 | 27 |
Systolic BP at admittance, mmHg, Md (IQR) | 130.0 (120.0–140.0) | 130.0 (120.0–140.0) | 131.0 (120–140.0) | 0.84 | 7 |
Diastolic BP at admittance, mmHg, Md (IQR) | 70.0 (60.0–80.0) | 70.0 (60.0–80.0) | 70.0 (60.0–80.0) | 0.41 | 7 |
CHA2DS2-VASc, Md (IQR) | 4.0 (3.0–5.0) | 4.0 (3.0–5.0) | 5.5 (4.0–6.0) | 0.005 | 2 |
Parameter | All | In-Patient Non-Fallers | In-Patient Fallers | p Value a | Missing Values |
---|---|---|---|---|---|
No. (%) of patients | 416 (100.0) | 402 (96.7) | 14 (3.3) | - | - |
Number of drugs at admittance, Md (IQR) | 6.0 (5.0–9.0) | 7.0 (5.0–9.0) | 10.5 (6.0–12.0) | 0.01 | 9 |
Polypharmacy, n (%) | 322 (79.1) | 309 (78.6) | 13 (92.9) | 0.17 | 9 |
α1-blockers, n (%) | 25 (6.1) | 23 (5.9) | 2 (14.3) | 0.19 | 10 |
ß-blockers, n (%) | 258 (63.6) | 250 (63.8) | 8 (57.1) | 0.40 | 10 |
Calcium channel blockers, n (%) | 144 (28.1) | 110 (28.1) | 4 (28.6) | 0.58 | 10 |
ACEI/ ARB, n (%) | 222 (54.3) | 212 (53.7) | 10 (71.4) | 0.18 | 7 |
Thiazide/ loop diuretics, n (%) | 196 (42.3) | 188 (48.0) | 8 (57.1) | 0.34 | 10 |
Aldosterone- receptor antagonists (spironolactone, eplerenone), n (%) | 71 (17.5) | 66 (16.8) | 5 (35.7) | 0.07 | 10 |
Statins, n (%) | 142 (35.0) | 133 (33.4) | 9 (64.3) | 0.01 | 10 |
Digoxin, n (%) | 30 (7.4) | 28 (7.1) | 2 (14.3) | 0.27 | 10 |
Antiarrhythmics, n (%) | 9 (2.2) | 9 (2.3) | 0 (0.0) | 0.56 | 10 |
Insulin, n (%) | 31 (7.6) | 26 (6.6) | 5 (35.7) | <0.001 | 10 |
Metformin, n (%) | 65 (16.0) | 58 (14.8) | 7 (50.0) | <0.001 | 10 |
Oral anti-diabetic drugs (SM, metformin), n (%) | 90 (22.2) | 82 (20.1) | 8 (57.1) | 0.001 | 10 |
Anti-diabetic drugs (SM, metformin, insulin), n (%) | 105 (25.9) | 96 (24.5) | 9 (64.3) | <0.001 | 10 |
Thyroid hormones, n (%) | 30 (7.4) | 28 (7.1) | 2 (14.3) | 0.28 | 10 |
Cholecalciferol, n (%) | 88 (21.7) | 86 (22.0) | 2 (14.3) | 0.49 | 10 |
BDA, n (%) | 45 (11.1) | 41 (10.4) | 4 (28.6) | 0.03 | 9 |
SSRI, n (%) | 115 (28.3) | 108 (27.5) | 7 (50.0) | 0.07 | 10 |
Antidepressants (SSRI, mianserin), n (%) | 133 (32.8) | 126 (32.1) | 7 (50.0) | 0.13 | 10 |
Quetiapine, n (%) | 49 (12.0) | 45 (11.5) | 4 (28.6) | 0.05 | 10 |
Neuroleptics (quetiapine, haloperidol), n (%) | 54 (13.3) | 50 (12.8) | 4 (28.6) | 0.08 | 10 |
AChE-I (donepezil, rivastigmine), n (%) | 41 (10.10) | 38 (9.7) | 3 (21.4) | 0.15 | 10 |
Procognitive medications (AChEIs, memantine), n (%) | 46 (11.3) | 43 (11.0) | 3 (21.4) | 0.20 | 10 |
Characteristic | All | In-Patient Non-Fallers | In-Patient Fallers | p Value a | Missing Values |
---|---|---|---|---|---|
No. (%) of patients | 416 (100.0) | 402 (96.7) | 14 (3.3) | - | - |
AMTS, Md (IQR) | 8.0 (6.0–9.0) | 8.0 (6.0–9.0) | 7.0 (6.0–8.0) | 0.32 | 35 |
MMSE, Md (IQR) | 21.0 (16.0–24.0) | 21.0 (16.0–25.0) | 19.0 (16.5–21.5) | 0.40 | 231 |
GDS, Md (IQR) | 7.0 (3.0–10.0) | 6.5 (4.0–10.0) | 8.5 (3.0–11.0) | 0.36 | 52 |
POMA, Md (IQR) | 23.0 (17.0–28.0) | 23.0 (18.0–28.0) | 17.0 (14.0–23.5) | 0.03 | 94 |
POMA < 26, n (%) | 199 (61.8) | 188 (60.7) | 11 (91.7) | 0.02 | 94 |
POMA < 19, n (I%) | 95 (29.5) | 88 (28.4) | 7 (58.3) | 0.02 | 94 |
TUG, s, Md (IQR) | 17.4 (11.9–28.0) | 17.2 (11.7–27.7) | 25.3 (20.7–29.1) | 0.11 | 115 |
Gait speed, m/s, Md (IQR) | 0.65 (0.4–0.96) | 0.66 (0.4–0.59) | 0.43 (0.32–0.63) | 0.10 | 102 |
Gait speed ≤ 0.8 m/s, n (%) | 166 (52.9) | 158 (52.0) | 8.0 (80.0) | 0.08 | 102 |
Handgrip strength, kg, Md (IQR) | 18.2 (13.7–22.8) | 18.1 (13.8–22.8) | 19.4 (13.2–22.5) | 0.92 | 66 |
Dynapenia, n (%) | 233.0 (66.6) | 223.0 (66.2) | 10.0 (76.9) | 0.32 | 66 |
Norton scale, Md (IQR) | 17.0 (15.0–19.0) | 17.0 (15.0–19.0) | 16.0 (15.0–18.0) | 0.25 | 6 |
Clinical Frailty Scale, Md (IQR) | 5.0 (4.0–5.0) | 5.0 (4.0–5.0) | 5.5 (5.0–6.0) | 0.01 | - |
Clinical Frailty Scale classification | 0.06 | - | |||
Robust, n (%) | 62 (14.9) | 62 (15.4) | 0 (0) | ||
Pre-frail, n (%) | 124 (29.8) | 122 (30.3) | 2 (14.3) | ||
Frail, n (%) | 230 (55.3) | 218 (54.2) | 12 (85.7) | ||
Severe frailty (CFS = 6 or 7), n (%) | 102 (24.5) | 95 (23.6) | 7 (50.0) | 0.02 | - |
MNA-SF, Md (IQR) | 12.0 (9.0–13.0) | 12.0 (9.0–13.0) | 12.0 (7.0–13.0) | 0.54 | 12 |
MNA-SF score < 8, n (%) | 198 (49.0) | 192 (49.2) | 6 (42.9) | 0.42 | 12 |
BMI, kg/m2, M (SD) | 28.5 (25.0–33.6) | 28.5 (24.9–33.7) | 30.3 (27.0–31.6) | 0.55 | 62 |
BMI < 24 kg/m2, n (%) | 66 (18.6) | 65 (19.0) | 1 (8.3) | 0.31 | 62 |
BMI > 30 kg/m2, n (%) | 148 (41.8) | 141 (41.2) | 7 (58.3) | 0.18 | 62 |
WHR, Md (IQR) | 0.90 (0.87–0.95) | 0.90 (0.87–0.96) | 0.93 (0.87–0.96) | 0.45 | 63 |
MAC, cm, Md (IQR) | 28.0 (26.0–30.0) | 28.0 (26.0–30.0) | 28.5 (26.0–30.0) | 0.70 | 49 |
MAC ≤ 22 cm, n (%) | 89 (24.3) | 87 (24.7) | 2 (14.3) | 0.29 | 49 |
CC, cm, Md (IQR) | 34.0 (31.5–37.0) | 34.0 (31.0–37.0) | 35.5 (33.0–40.0) | 0.12 | 51 |
CC < 31 cm, n (%) | 74 (20.3) | 72 (20.5) | 2 (14.3) | 0.43 | 51 |
Characteristic | All | In-Patient Non-Fallers | In-Patient Fallers | p Value a | Missing Values |
---|---|---|---|---|---|
Barthel Index, Md (IQR) | 90.0 (70.0–100.0) | 90.0 (70.0–100.0) | 77.5 (55.0–85.0) | 0.06 | 6 |
Independent in: | |||||
Bowel control, n (%) | 360 (87.4) | 346 (86.9) | 14 (100.0) | 0.15 | 4 |
Feeding, n (%) | 343 (83.0) | 332 (83.2) | 11 (78.6) | 0.65 | 3 |
Grooming, n (%) | 333 (80.6) | 332 (80.7) | 11 (78.6) | 0.84 | 3 |
Transferring (bed to chair and back), n (%) | 297 (72.1) | 289 (72.6) | 8 (57.1) | 0.20 | 4 |
Mobility on level surfaces, n (%) | 292 (70.4) | 284 (70.8) | 8 (57.1) | 0.27 | 1 |
Toilet use, n (%) | 280 (67.8) | 276 (69.2) | 4 (28.6) | <0.001 | 3 |
Dressing, n (%) | 276 (66.8) | 270 (67.7) | 6 (42.9) | 0.05 | 3 |
Stairs managing, n (%) | 227 (55.2) | 219 (55.2) | 8 (57.1) | 0.88 | 5 |
Bladder control, n (%) | 218 (53.0) | 214 (53.9) | 4 (28.6) | 0.05 | 5 |
Bathing, n (%) | 209 (21.4) | 206 (51.9) | 3 (21.4) | 0.02 | 5 |
IADL, Md (IQR) | 7.0 (3.0–11.0) | 7.0 (3.0–11.0) | 4.5 (2.0–8.0) | 0.07 | 10 |
Independent in: | |||||
Phone talk, n (%) | 273 (66.8) | 267 (67.6) | 6 (42.9) | 0.05 | 7 |
Taking medicines, n (%) | 235 (57.5) | 229 (58.0) | 6 (42.9) | 0.26 | 7 |
Disposing of money, n (%) | 230 (56.4) | 226 (57.4) | 4 (28.6) | 0.03 | 9 |
Making meals, n (%) | 177 (43.7) | 174 (44.5) | 3 (21.4) | 0.07 | 11 |
Going shopping, n (%) | 126 (31.1) | 125 (32.0) | 1 (7.1) | 0.03 | 11 |
Doing housework, n (%) | 101 (25.0) | 101 (25.8) | 0 (0.0) | 0.02 | 11 |
Model 1 | Model 2 | |||||
---|---|---|---|---|---|---|
OR | 95% CI | p Value | OR | 95% CI | p Value | |
Falls in the last 12 months | 10.89 | 1.28–92.56 | 0.03 | 50.92 | 1.84–1412.6 | 0.02 |
Orthostatic hypotension | 4.76 | 1.13–19.97 | 0.03 | 14.53 | 1.12–189.27 | 0.04 |
CFS | 2.63 | 1.08–6.42 | 0.03 | 2.84 | 0.96–8.47 | 0.06 |
Parkinson’s disease | 37.64 | 2.71–522.02 | 0.007 | |||
Statins | 20.91 | 1.23–355.31 | 0.04 | |||
Insulin | 56.79 | 3.66–880.59 | 0.004 | |||
Benzodiazepines | 31.11 | 2.41–540.72 | 0.009 | |||
Negelkerk’s R2 | 0.208 | 0.579 | ||||
% correctly predicted | 96.7% | 98.2% | ||||
sensitivity | 0% | 44.4% | ||||
specificity | 100% | 100% | ||||
Hosmer–Lemeshow goodness of fit | 0.877 | 0.939 | ||||
Block 1 | Block 2 | |||||
Variables in block 1 and block 2 | Falls in the last 12 months, orthostatic hypotension, POMA, CFS | Barthel index, IADL, sex, DM, Parkinson’s disease, number of diseases, statins, insulin, SM, metformin, quetiapine, neuroleptics, BDA, SSRI, cholesterol, creatinine |
Model 3 | |||
---|---|---|---|
OR | 95% CI | p Value | |
Falls in the last 12 months | 41.74 | 2.47–705.95 | 0.010 |
Orthostatic hypotension | 21.53 | 2.25–206.28 | 0.008 |
Parkinson’s disease | 40.89 | 3.28–510.16 | 0.004 |
Statins | 43.96 | 2.97–651.72 | 0.006 |
Insulin | 34.76 | 3.33–362.75 | 0.003 |
Benzodiazepines | 34.93 | 2.82–432.16 | 0.006 |
Negelkerk’s R2 | 0.541 | ||
% correctly predicted | 97.5% | ||
sensitivity | 27.3% | ||
specificity | 100% | ||
Hosmer–Lemeshow goodness of fit | 0.703 |
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Magnuszewski, L.; Wojszel, A.; Kasiukiewicz, A.; Wojszel, Z.B. Falls at the Geriatric Hospital Ward in the Context of Risk Factors of Falling Detected in a Comprehensive Geriatric Assessment. Int. J. Environ. Res. Public Health 2022, 19, 10789. https://doi.org/10.3390/ijerph191710789
Magnuszewski L, Wojszel A, Kasiukiewicz A, Wojszel ZB. Falls at the Geriatric Hospital Ward in the Context of Risk Factors of Falling Detected in a Comprehensive Geriatric Assessment. International Journal of Environmental Research and Public Health. 2022; 19(17):10789. https://doi.org/10.3390/ijerph191710789
Chicago/Turabian StyleMagnuszewski, Lukasz, Aleksandra Wojszel, Agnieszka Kasiukiewicz, and Zyta Beata Wojszel. 2022. "Falls at the Geriatric Hospital Ward in the Context of Risk Factors of Falling Detected in a Comprehensive Geriatric Assessment" International Journal of Environmental Research and Public Health 19, no. 17: 10789. https://doi.org/10.3390/ijerph191710789