What contributes to severe falls in hospitalized patients?

Older admitted patients, especially women, appear to be at a higher risk of more severe falls during hospitalization, a recent study has found. Higher-severity falls are also more likely to occur during toileting or showering.

Researchers conducted a retrospective cohort analysis of 3,705 patients (mean age 68.5 years, 40.2 percent women) whose inpatient records were accessed. Fall severity was classified according to the Severity Assessment Code (SAC): SAC1 meant high severity, with the fall causing serious harm or death; SAC2 corresponded to medium-severity falls leading to moderate or minor harm; and SAC3 falls led to no harm.

Logistic regression analysis found that older participants were more likely to experience higher-severity falls. Compared with those <50 years old, patients aged 65–74 years (adjusted odds ratio [OR], 1.195, 95 percent confidence interval [CI], 1.044–1.367; p=0.01), 75–84 years (adjusted OR, 1.293, 95 percent CI, 1.133–1.477; p<0.001), and >84 years (adjusted OR, 1.391, 95 percent CI, 1.210–1.599; p<0.001) saw higher odds of falling at a higher severity level.

Moreover, the risk of more severe falls was 15 percent greater in women (adjusted OR, 1.151, 95 percent CI, 1.063–1.247; p=0.001).

Similarly, higher-severity falls were more likely to occur during toileting and showering (adjusted OR, 1.145, 95 percent CI, 1.022–1.284; p=0.02), or when patients were in communal areas (vs the bathroom: adjusted OR, 1.257, 95 percent CI, 1.003–1.576; p=0.047).

Other notable risk factors included severe depression, being under the influence of alcohol or illicit substances, and being on any medication.

“Identification of underlying risk factors associated with the severity of falls may provide information that can inform the implementation of fall prevention strategies that mitigate the risk of injurious falls,” the researchers said.