Bed Moves, Ward Environment, Staff Perspectives and Falls for Older People with High Falls Risk in an Acute Hospital: A Mixed Methods Study

Figures & data

Table 1 Clinical and Demographic Characteristics of the Patient Cohort

	Summary Statistic	Experienced a Fall During Hospitalisation		Total
		No	Yes
		(N= 370)	(N=27)	(N=397)
Age	Mean [SD]	84.9 [7.2]	84.1 [6.5]	84.8 [7.2]
Female	N (%)	214 (57.8%)	14 (51.9%)	228 (57.4%)
Length of stay	Median [min–max]	5 [1–48]	2 [1–7]	5 [1–57]
Number of bed moves	Median [min–max]	17 [4–57]	3 [1–8]	2 [1–8]
Falls Risk Characteristics (N=396; 27 Individuals with a Fall)^a,b
1. Had a fall in the past 12 months	N (%)	326 (88.4%)	25 (92.6%)	351 (88.6%)
2. Unsteady when walking/transferring or uses a walking aid	N (%)	365 (98.9%)	27 (100%)	392 (99.0%)
3. Confused, known cognitive impairment or incorrectly answers questions	N (%)	267 (72.4%)	26 (96.3%)	293 (74.0%)
4. Has urinary or faecal frequency/urgency of nocturia	N (%)	279 (75.6%)	20 (74.1%)	299 (75.5%)
At least one of falls risk characteristics 2, 3, or 4 in any assessment during hospitalisation	N (%)	368 (99.7%)	27 (100%)	395 (99.8%)

Notes: ^aIndications of whether a fall was experienced in the past 12 months (falls risk characteristic 1) represent records from risk assessments recorded either in the ED or first ward, or whether admission was related to a fall. For all other falls risk characteristics, the summaries represent the proportion of patients documented with the specific criteria on any assessment during hospitalisation. ^bOne patient was deemed suitable for inclusion in the study in the ED, although individual FRAMP criteria were not completed on the form.

Abbreviation: SD, standard deviation.

Figure 1 Patients included in comparisons between fallers and non-fallers; and for the generalised linear mixed effects model analyses.

Notes: *Two patients fell during these readmissions (and had not fallen on the first admission). **Two of these patients fell while in an included ward.

Table 2 Multivariate Logistic Regression Results: Experienced a Fall During Hospital Admission (Event=“Yes”)

Variable	OR	95% CI	P-Value
Length of Stay
One std dev (9.59 days) increase	1.04	(0.99, 1.09)	0.076
Number of Moves During Stay
One move increase	1.56	(1.11, 2.18)	0.010
			Estimate
Akaike’s information criterion			173.36
Bayesian information criterion			185.25

Abbreviations: OR, odds ratio; CI, confidence interval.

Table 3 Environmental Audit Scores (Median Number of Falls Risk Hazard Types Identified, and Most Common Hazards Identified)

Environment	Ward A – Median	Ward B – Median	Ward C – Median	Ward D – Median	Across All 4 Wards – Median	Items with Greatest Environmental Hazards NOT Present – n (%)
Bathrooms and Toilets; (maximum possible=15)	3	3.5	1	2	3	Availability of soap on a rope (92.2%) Shower chairs/commode with safety belt/safety rail (68.8%)
Floor surfaces; (maximum possible=8)	0	0	0	0	0	Non-skid flooring (4.7%)
Furniture; (maximum possible=5)	0	0	0	0	0
Lighting; (maximum possible=14)	2	2	1	1	2	Switches marked with luminous tape (92.2%) Firm & colour contrasted handrails in passageways (45.3%)
Security; (maximum possible=3)	2	3	1	2	2	All exits secure to avoid confused patients leaving (84.1%) Clear walking routes where patients can walk without becoming lost (72.6%)

Table 4 Scores for the Person-Centred Care of Older People with Cognitive Impairment in Acute Care Scale (POPAC), the Person-Centred Health Care for Older Adults Survey (PCHCOAS), and the Assessment of Interprofessional Team Collaboration Scale.

Assessment Tool	Ward A – Mean (SD)	Ward B – Mean (SD)	Ward C – Mean (SD)	Ward D – Mean (SD)	Across All 4 Wards – Mean (SD)	Comparative Data From Other Studies
Person-Centred Care of Older People with Cognitive Impairment in Acute Care Scale (POPAC)						Nilson et al^Citation32 – Sweden^a	Grealish et al^Citation33 – Australia^a
Using cognitive assessments and care interventions; (5 items, rated 1–5) – average score/item	3.8 (0.6)	4.1 (0.5)	3.7 (0.5)	3.8 (0.6)	3.9 (0.6)	4.2 (0.4)	N/R
Using evidence and expertise in cognition; (3 items, rated 1–5) – average score/item	4.0 (0.7)	4.3 (0.6)	3.7 (0.7)	3.7 (0.9)	4.0 (0.7)	2.8 (0.9)	N/R
Individualizing care; (7 items, rated 1–5) – average score/item	3.3 (0.7)	3.8 (0.7)	3.1 (0.5)	3.4 (0.7)	3.4 (0.7)	3.3 (0.7)	N/R
Total POPAC scores (15 items, rated 1–5) average score/item	3.6 (0.6)	4.0 (0.6)	3.4 (0.4)	3.6 (0.7)	3.7 (0.6)	N/R	4.4 (0.58)
Person-Centred Health Care for Older Adults Survey (PCHCOAS)
Total PCHCOAS score	121.0 (15.8)	122.1 (15.4)	120.9 (10.6)	122.0 (11.7)	121.5 (14.0)	N/R
Assessment of Interprofessional Team Collaboration Scale						Hellman et al^Citation34 – Sweden^b
Partnership (maximum possible score=95)	78.6 (7.6)	78.5 (12.7)	75.3 (8.1)	76.5 (10.6)	77.6 (9.9)	74.5 (15.2)
Cooperation (maximum possible score=55)	46.7 (5.4)	45.4 (6.8)	41.9 (3.4)	45.0 (6.7)	45.3 (6.1)	44.7 (7.2)
Coordination (maximum possible score=35)	27.8 (3.7)	27.3 (4.8)	25.1 (4.3)	26.9 (5.1)	27.1 (4.4)	16.7 (3.4)
Total score (maximum possible=185)	153.1 (15.1)	151.7 (23.9)	142.4 (13.2)	147.8 (21.7)	150.1 (19.2)	N/R

Notes: ^aComparison sample = acute hospital medically oriented units. ^bComparison sample = community team-based pain rehabilitation. N/R – no comparison sample identified. Comparison data reported were available.

Table 5 Focus Group Participant Characteristics

Participant Characteristic (N=21)	N (%)
Age (years)
19–29	5 (23.8)
30–39	3 (14.3)
50–49	5 (23.8)
50–59	3 (14.3)
60+	3 (14.3)
Missing	2 (9.5)
Role
Staff Development Nurse or Clinical Nurse	4 (19)
Registered Nurse or Enrolled Nurse	14 (66.7)
Assistant in Nursing or Student Nurse	3 (14.3)
Current Employment Status
Permanent full time	9 (42.9)
Permanent part-time (8–9 days/fortnight)	10 (47.6)
Permanent part-time (<8 days/fortnight)	0 (0)
Practicum	2 (9.5)
Length of Time Employed on Current Ward (years)
<1	2 (9.5)
1–3	7 (33.3)
4–6	6 (28.6)
7–9	1 (4.8)
10+	2 (9.5)
Missing or not applicable	3 (14.3)
Length of Time in Current Profession (years)
<1	0 (0)
1–5	9 (43)
6–10	2 (10)
11–15	2 (10)
16+	5 (24)
Missing or not applicable	3 (13)
Highest Level of Education
Diploma	3
Bachelor degree	13
Post-graduate qualification	2
Missing or not applicable	3
Ward (Nurses on All Participating Wards Invited)
A	10
C or D	11

Nilsson A, Lindkvist M, Rasmussen BH, Edvardsson D. Measuring levels of person-centeredness in acute care of older people with cognitive impairment: evaluation of the POPAC scale. BMC Health Serv Res. 2013;13:327. doi:10.1186/1472-6963-13-32723958295

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