Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors

Figures & data

Table 1 Components of the fall prevention program implemented in the Department of Geriatrics at University Hospital Number 7 SUM, Katowice, Poland

I)	Components of the fall prevention program
	1) Comprehensive geriatric assessment with fall risk evaluation at admission and the documentation and analysis of all patient fall data irrespective of fall complications
	2) Patient and caregiver education (including ward layout and instruction on use of the nurse call button, safe footwear, orthopedic equipment as well as the necessity of requesting staff assistance during ambulation)
	3) Addressing vision and hearing impairment where possible
	4) Medication review and reduction where possible, especially minimization of psychoactive drugs or those with anticholinergic activity. In addition, adjustments are made to avoid overly aggressive antihypertensive, antiarrhythmic, and antihyperglycemic treatment
	5) Adequate hydration and feeding
	6) Treatment of chief complaint and comorbidities
	7) Pain relief
	8) Individualized rehabilitation, including physiotherapy, for maintenance of mobility
	9) Matching orthopedic devices with patients when necessary along with instruction on how to properly use the equipment
	10) Patient monitoring and surveillance adjusted to individual mental and physical status
II)	Symptoms and signs indicating high fall risk (any of the following conditions)
	Recurrent falls or syncope reported by the patient or their caregiver, recent fall or syncope as reason for hospitalization, substantial balance or gait disorders, fear of falling, severe weakness, serious mental disorders (disorientation and agitation), advanced uncorrected vision or hearing impairment, symptomatic orthostatic hypotension, positive Romberg or other neurological signs of impaired balance, modified Get-up and Go Test^Citation24 score below 6 points, or Tinetti POMA^Citation25 score below 19 points
III)	Symptoms and signs indicating moderate fall risk (any of the following conditions)
	Fall or syncope in the last 12 months reported by the patient or their caregiver, mild balance or gait disorders, moderate weakness, mild mental disorders, moderate vision or hearing impairment, asymptomatic orthostatic hypotension, minor neurological signs of potential balance impairment, modified Get-up and Go Test^Citation24 score 6–7 points, or Tinetti POMA^Citation25 score 19–23 points

Abbreviation: POMA, Performance-Oriented Mobility Assessment.

Table 2 Demographic, clinical, and functional differences between patients who experienced falls during hospitalization (group F) as compared with patients who did not (group C)

Variable	Group F (n=26)	Group C (n=762)	Group F vs group C
	Mean ± SD or percentage		P-value
Age, years	86.0±5.0	79.3±7.6	<0.001
Sex, percentage of females	66.5	53.8	0.179
Hypertension, %	73.1	76.1	0.721
Diabetes mellitus, %	34.6	29.7	0.587
Myocardial infarction in anamnesis, %	11.5	11.8	0.789
Congestive heart failure, %	34.6	23.9	0.210
Stroke in anamnesis, %	7.69	12.8	0.632
Peripheral artery disease, %	7.69	6.96	0.805
Parkinson’s disease, %	0.00	7.34	0.296
Dementia in anamnesis, %	46.2	21.5	0.003
Delirium in anamnesis, %	7.69	2.63	0.350
Cancer in anamnesis, %	15.4	11.3	0.739
Falls in anamnesis, %	61.5	35.2	0.006
Fall-related injuries in anamnesis, %	23.1	8.27	0.009
Behavioral disorders in anamnesis, %	26.9	11.3	0.015
Pressure ulcers, %	0.00	3.15	0.735
Urinary incontinence, %	46.2	41.3	0.624
Bladder catheterization, %	3.85	8.01	0.686
Number of used medications	5.15±2.38	5.06±2.59	0.892
Neuroleptic treatment before admission, %	30.8	15.5	0.037
High fall risk, %	76.9	62.6	0.496
BMI, kg/m^2	24.3±3.7	27.5±5.8	0.003
Heart rate, beats per minute	72.1±10.0	71.8±12.4	0.529
Systolic blood pressure, mmHg	131.9±24.0	134.5±19.4	0.427
Diastolic blood pressure, mmHg	74.8±10.4	76.8±10.1	0.533
CAM, points	1.12±1.73	0.16±0.74	0.037
MMSE score	20.7±6.6	22.6±7.9	0.040
Barthel Index	57.9±26.3	70.2±29.2	0.011
Lawton IADL	16.0±6.0	18.5±6.4	0.038
Modified Get-up and Go Test	3.65±2.61	4.47±2.77	0.094
Hemoglobin, mmol/L	7.30±1.34	7.76±1.14	0.052
White blood cells, G/L	7.93±3.23	7.60±3.75	0.361
Total protein, g/L	66.2±6.2	70.4±7.4	0.003
Albumin, g/L	32.0±5.8	35.2±6.1	0.008
Glucose, mmol/L	5.84±2.04	6.27±2.11	0.108
Bilirubin, µmol/L	11.10±5.90	11.23±8.82	0.830
Alanine transaminase, nmol/L/s	604±1,438	332±317	0.286
Creatinine, µmol/L	90.0±27.0	92.3±56.3	0.398
Estimated GFR using BIS_creatinine equation, mL/min/1.73 m^2	53.6±18.4	62.1±24.8	0.041
Thyrotropin, mIU/L	1.91±1.39	2.57±6.38	0.817
Vitamin B12, pmol/L	264.9±152.0	310.7±202.2	0.304
Total cholesterol, mmol/L	4.00±0.89	4.53±1.17	0.095
LDL-cholesterol, mmol/L	2.31±0.74	2.64±0.98	0.196
HDL-cholesterol, mmol/L	1.19±0.49	1.36±0.43	0.201
Triglycerides, mmol/L	1.26±0.56	1.16±0.47	0.475
C-reactive protein, mg/L	23.2±29.2	23.0±47.0	0.126
Sodium, mmol/L	137.8±5.0	139.2±4.1	0.189
Potassium, mmol/L	4.12±0.73	4.18±0.54	0.551
Calcium, mmol/L	2.26±0.12	2.33±0.17	0.009
Delirium incident during hospitalization, %	30.8	3.81	<0.001
Neuroleptic use during hospitalization, %	42.3	14.6	<0.001

Abbreviations: BMI, body mass index; BIS, Berlin Initiative Study; CAM, Confusion Assessment Method; GFR, glomerular filtration rate; HDL, high-density lipoprotein; IADL, Instrumental Activities of Daily Living Scale; LDL, low-density lipoprotein; MMSE, Mini-Mental State Examination; SD, standard deviation.

Table 3 Variables that yield P-values of 0.1 or lower in the initial univariate logistic regression analysis of factors predictive of falls

Variable	P-value	OR	95% CI
Quantitative variables
Highest recorded CAM value, points	<0.001	1.85	1.45–2.36
Age	<0.001	1.15	1.08–1.23
Barthel index at admission, points	0.038	0.99	0.98–1.00
Estimated GFR using BIS_creatinine equation, mL/min/1.73 m^2	0.070	0.98	0.96–1.00
Lawton IADL at admission, points	0.058	0.94	0.89–1.00
Serum albumin level, g/L	0.013	0.93	0.88–0.99
Serum total protein level, g/L	0.005	0.93	0.89–0.98
BMI, kg/m^2	0.006	0.89	0.82–0.97
Serum total calcium level, mg/dL	0.052	0.58	0.33–1.01
Categorical variables
Delirium occurrence at the ward	<0.001	9.82	3.98–24.22
Neuroleptic use during hospitalization	<0.001	4.30	1.93–9.61
History of fall-related trauma	0.013	3.33	1.29–8.59
Dementia	0.005	3.13	1.42–6.89
History of falls	0.008	2.95	1.32–6.59
Behavioral disorders in anamnesis	0.020	2.90	1.18–7.09
Neuroleptic use before admission	0.042	2.43	1.03–5.71

Abbreviations: BIS, Berlin Initiative Study; BMI, body mass index; CAM, Confusion Assessment Method; CI, confidence interval; GFR, glomerular filtration rate; IADL, Instrumental Activities of Daily Living Scale; OR, odds ratio.

Figure 1 Fall probability of geriatric inpatients who experienced a fall incident during hospitalization in relation to hospitalization day.

Figure 2 Fall probability of geriatric inpatients who experienced a fall incident during hospitalization in relation to the time of day.

Figure 3 Probability of fall-free hospitalization according to (A) age <76 years compared to older age, (B) BMI ≥23.5 compared to lower values, (C) MMSE scores ≥20 compared to lower values, and (D) Barthel Index of Activities of Daily Living (BI) ≥65 compared to lower values.

Abbreviations: BMI, body mass index; MMSE, Mini-Mental State Examination.

Figure 4 Probability of fall-free hospitalization according to (A) hemoglobin level ≥7.69 mmol/L compared to lower values, (B) serum total protein level ≥70 g/L compared to lower values, (C) serum albumin level ≥32 g/L compared to lower values, and (D) serum total calcium level ≥2.27 mmol/L compared to lower values.

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