Factors associated with the incidence of patient falls in hospitals:A scoping review

When a patient falls within a hospital setting,there is a significant increase in the risk of severe injury or health complications.Recognizing factors associated with such falls is crucial to mitigate their impact on patient safety.This review seeks to analyze the factors contributing to patient falls in hospitals.The main goal is to enhance our understanding of the reasons behind these falls,enabling hospitals to devise more effective prevention strategies.This study reviewed literature published from 2013 to 2022,using the Arksey and O’Malley methodology for a scoping review.The research literature was searched from seven databases,namely,PubMed,ScienceDirect,Wiley Library,Garuda,Global Index Medicus,Emerald Insight,and Google Scholar.The inclusion criteria comprised both qualitative and quantitative primary and secondary data studies centered on hospitalized patients.Out of the 893 studies analyzed,23 met the criteria and were included in this review.Although there is not an abundance of relevant literature,this review identified several factors associated with falls in hospitals.These encompass environmental,patient,staff,and medical factors.This study offers valuable insights for hospitals and medical personnel aiming to enhance fall prevention practices.Effective prevention efforts should prioritize early identification of patient risk factors,enhancement of the care environment,thorough training for care staff,and vigilant supervision of high-risk patients.By comprehending the factors that contribute to patient falls,hospitals can bolster patient safety and mitigate the adverse effects of falls within the health-care setting.

Analysis of the Clinical Interventions for Falls in Elderly Patients in the Community From 2002 To 2022:A Bibliometric Analysis

Objective:To analyze and provide a comprehensive overview of the knowledge structure and research hotspots of clinical interventions for falls in elderly patients in the community.Methods:The search for publications related to clinical interventions for falls in elderly patients in the community from 2002 to 2022 was conducted on the Web of Science Core Collection(WoSCC)database.VOSviewers,CiteSpace,and the R package“bibliometrix”were used to conduct this bibliometric analysis.Results:2091 articles from 70 countries,primarily the United States and Australia,were included.The number of publications related to clinical interventions for falls in elderly patients is increasing yearly.The main research institutions in this field were the University of Sydney,Harvard University,and the University of California.BioMed Central(BMC)Geriatrics was the most popular journal in this field and Journals of the American Geriatrics Society was the most co-cited journal.These publications came from 8984 authors among which author Lord SR had published the most papers and author Tinetti Me had the most co-citations.The main keywords in this research field were“balance,”“exercise,”and“risk factor.”Conclusion:This was the first bibliometric study that comprehensively summarized the research hot spots and development of clinical interventions for falls in elderly patients in the community.This paper aims to provide a reference for scholars and researchers in this particular field.

Effectiveness of Extended Care in Preventing Falls in Disabled Elderly and Its Impact on Quality of Life

Objective:To analyze the value of extended care interventions for disabled elderly in preventing falls and optimizing quality of life.Methods:A sample of 60 cases of disabled elderly in a tertiary hospital from May 2022 to May 2023 was selected and grouped by the random number table method.The observation group received extended care,while the control group adopted routine care.The differences in complication rate,fall rate,36-Item Short Form Health Survey(SF-36)score,health knowledge awareness score,and nursing satisfaction were compared.Results:The complication rate and fall rate of the disabled elderly in the observation group were lower than those in the control group,P<0.05;the SF-36 score,health knowledge score,and nursing satisfaction of the observation group were higher than those of the control group,P<0.05.Conclusion:Extended care for the disabled elderly can reduce the risk of falls and complications related to disability,as well as optimize their cognition and improve their quality of life,which is efficient and feasible.

Falls Lake水库内溶解物输运模拟

溶解物在水库内的输运过程受人为因素影响较大。为研究水库内物质输运的过程和机制,以美国北卡罗来纳州的Falls Lake水库为研究对象,运用EFDC三维数值模型对物质在水库内的输运过程进行模拟研究,分析示踪物平均年龄和滞留时间的分布以及变化。结果显示:理想状态下,流量决定溶解物的输运过程;实际情况中,除流量外,水库的即时蓄水量是影响输运过程的另一个重要因素;水库结构和径流分布是导致示踪物在各区域局地滞留时间存在差异的主要因素。

Prevalence and Related Factors of Falls among the Elderly in an Urban Community of Beijing

Objective To understand the prevalence, consequences and risk factors of falls among urban community-dwelling elderly in Beijing. Methods A cross-sectional study was conducted in Longtan Community, Beijing. A total of 1512 individuals aged 60 years or over were selected by stratified cluster sampling. Data regarding the frequency of falls in the previous year, as well as circumstances, consequence and related factors of falls were collected from the elderly through face-to-face interviews with questionnaires in their home. Results The prevalence of falls was 18.0% on the average among 1512 participants, higher in women （20.1%） than in men （14.9%） （P=0.006）, and increased with age （Х^2 for trend=10.37, P=0.001）. The total rate of falls-induced injuries among the fallers was 37.7%. Falls usually resulted in soft-tissues bruises （58.7%）, fear of repeated episodes of falls （58.8%）, loss of independence and confidence in movement （35.7%） and even in hip fracture. In addition to the burden of medical care, falls also generated a big economic burden. Occurrence of falls was significantly associated with both intrinsic and extrinsic factors. The related factors of falls in the elderly included age≥60-70 years, femininity, less physical activities, fear of future falls, living alone, severely impaired vision, health problem-impacted activities of daily living, chronic diseases （diabetes, hypertension, postural hypotension, stroke sequela, cataract, arthritis, dementia and depression）, medications （psychoactive, anti-diabetic）, gait imbalance, high bed and faintly-lighted stairway. Conclusion The prevalence of falls among urban community-dwelling elderly in Beijing is closely associated with significant associated with intrinsic and extrinsic factors. Efforts to prevent falls in the elderly should be made at community level.

Falls from height： A retrospective analysis

BACKGROUND: Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of falls from height and their relationship to the mortality.METHODS: A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively. Demographic parameters, fall characteristics and their effect to mortality were evaluated statistically. RESULTS: The study comprised of 292(63.5%) men and 168(36.5%) women patients. The mean age of all patients was 27±24.99 years. Twenty-six(5.6%) patients died and the majority of them were in ≥62 years old group. The highest percentage of falls was at 0–5 years age group(28.3%). People fell mainly from 1.1–4 metres(m) level(46.1%). The causes of falls were ordered as unintentional(92.2%), workplace(8.1%) and suicidal(1.7%). Skin and soft tissue injuries(37.4%) were the main traumatic lesions. CONCLUSION: Age, fall height, fall place, linear skull fracture, subarachnoidal hemorrhage, cervical fracture, thoracic vertebra fracture and trauma scores had statistically significant effect on mortality. The casualties died because of subarachnoid hemorrhage mostly.

Incidence and Associated Factors for Single and Recurrent Falls among the Elderly in an Urban Community of Beijing

Objective To investigate the incidence of falls and recurrent falls, and explore associated factors for single and recurrent falls among urban community-dwelling elderly in Beijing. Methods A cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district, Beijing in 2009. Data regarding the incidence of fall and recurrent falls in the previous year, as well as associated factors were collected from the elderly through face-to-face interviews. Results The incidence of falls and recurrent falls was 17.8% and 6.1%, respectively, and it increased with age （X^2for trend=21.06, 19.20, P=0.001, 0.002）. Binary logistic stepwise regression analysis showed that age （OR=2.20）, living alone （OR=4.67） and gait disturbance （OR=1.27） were risk factors, while housing with elevators （OR=0.35）, appropriate width/height of stair steps （0R=0.78）, sufficient lighting for stairway （OR=0.45） and regular exercise （OR=0.12） could lower the risk for single fall; factors such as low monthly family income （OR=1.39）, poor vision （OR=1.83）, low physical ability （OR=4.47）, abnormal static balance （OR=2.48）, and fear of falls（OR=2.23） were risk factors, while appropriate width/height of stair steps （OR=0.49） and easiness of access to daily supplies （OR=0.41） were protective factors for recurrent falls. Conclusion The incidence of falls in commun and their related injuries have been associated ty-dwelling elderly people in Beijing is common, and falls with both intrinsic and extrinsic factors.

Reducing costly falls after total knee arthroplasty

AIM To investigate whether adductor canal nerve block(ACB) reduces patient falls when compared to femoral nerve block(FNB) after total knee arthroplasty(TKA). METHODS We conducted an institutional review of all-cause falls after TKA from January 2013 to August 2016 using a quality improvement database. Our inclusion criteria were patients with diagnosis of primary knee osteoarthritis who underwent primary unilateral TKA with either a FNB or an ACB and sustained a fall during their hospitalization. We excluded patients who had revision TKA and extensor mechanism reconstruction. We also excluded patients with a history of post-traumatic arthritis, prior history of lower extremity fracture, history of neurological disease, or cerebrovascular disease. RESULTS A total of 834 patients had TKA with femoral nerve block and knee immobilizer(FNB + KI). Of those patients, 11(1.3%) experienced a fall during their hospital stay. In contrast, 791 patients had TKA with ACB. Of those patients, only one(0.13%) patient fall was recorded within this group. We used the Fisher's exact test to compare the differences between the two groups. The difference between the two groups achieves statistical significance(P = 0.006). We also found that 11 out of the 12 patients that fell had a right TKA procedure while one patient had a left TKA procedure. Nine out of twelve patients that fell were female, while only three patients were male.CONCLUSION Given the reduction in the number of falls with ACB, it is recommended that ACB be considered the preferred analgesia for patients undergoing a TKA procedure.

Psychological risk factors associated with falls among elderly people in Baghdad city, Iraq

Background: Ageing of the population is one of the most important demographic facts that come to the foreground in the 21st century. Objective: To assess the relationship between psychological factors (depression, loneliness, using anti anxiety medication, fear from falls and internal displacement of the population) and falls among elderly people in Baghdad city, Iraq. Methods: A matched 1:1 community based case-control study involving 716 elderly respondents, recruited randomly from six Non Governmental Organization (NGO) in different areas of Baghdad. Interviews to each respondent were done accordingly. Geriatric depression scale (GDS) was used to assess the depression among the elderly people. Results: The minimum age for cases and controls was 60 years old while the maximum age for cases was 87 and for controls was 85 years old. The female was predominant than male, 53.6% to 46.4% respectively. The relation between depression, fear from fall, using anti anxiety medication, internal displacement and falls was statistically significant

Handgrip strength and falls in community-dwelling Egyptian seniors

Purpose: To establish a relationship between falls and handgrip strength (GS) in communitydwelling senior citizens in Egypt. Subjects: Crosssectional study enrolling 132 subjects, all ≥60 years old. Materials and Methods: History of falls in the past year and their number as well as GS measurement in both hands using Baseline? pneumatic squeeze handheld dynamometer. Results: There is a highly significant difference between the GS of fallers and non-fallers in both hands (P = 0.000). There is a highly significant negative correlation between the mean GS and the number of falls (P = 0.003). There is a highly significant positive correlation between GS of the right hand with the number of falls (R = 0.226, P = 0.009), as for the correlation with the left GS it was a weaker positive correlation (R = 0.209, P = 0.16). Conclusion: Seniors with history of falls have a lower GS in both dominant and nondominant hands and it is directly related to the number of falls. GS is decreased in senior fallers even if within the normal range.

Establishing the Reliability and Validity of Health in Motion^©Automated Falls Screening Tool

Introduction: Blue Marble Health Company has created a digital fall risk screening tool (Health in Motion&#169;) that can be used by means of self-report (touch/mouse) or by means of motion capture (Microsoft Kinect Sensor). Health in Motion&#169;consists of automated versions of the Fall Risk Question-naire, 30-Second Chair Stand Test, and the One Leg Stance Test. Methods: We compared the three methods (self-report, sensor, and clinical standard measurement) using stopwatch and observation in 15 community-dwelling older adults, aged 63 - 80 years old. Each version was completed three times each in random order, for a total of nine trials. Results: Health in Motion&#169;falls screening tool accessible via self-report and sensor is a valid and reliable automated at-home self-assessment for falls risk. Conclusion: Results support the use of Health in Motion&#169;falls screening tools as viable alternatives to standard falls risk assessments for use by older adults at home.

Predictors of Falls Efficacy Scale responses among nursing home residents in China

Objectives:The objective of this study was to examine the falls efficacy of older adults in nursing homes and the related predictors of falling.Methods:A sample of 317 older adults was recruited from 18 nursing homes in the Fujian province of China.The Modified Falls Efficacy Scale(MFES)and Kessler Psychological Distress Scale(K10)were employed to collect data.Results:The falls efficacy of older adults was moderate(7.80±1.17).The falls efficacy questionnaire item“Get dressed and undressed”scored the highest(9.12±1.440),while“Crossing roads”scored the lowest(5.77±3.371).Multiple regression analysis demonstrated that mental health status,degree of self-care,age and gender were each predictors of the falls efficacy of older adults.Conclusions:Falls efficacy enhancing programs for nursing home residents should take mental health status,degree of self-care,age and gender into account.

Associations of accelerometer-determined physical activity and sedentary behavior with sarcopenia and incident falls over 12 months in community-dwelling Swedish older adults

Purpose:This study was aimed to determine associations of accelerometer-determined time and bouts of sedentary behavior,light physical activity(LPA),and moderate-to-vigorous PA(MVPA)with sarcopenia and incident falls over 12 months.Methods:A total of 3334 Swedish 70-year-olds were assessed for sarcopenia,as defined by the revised definition of the European Working Group on Sarcopenia in Older People.Assessments were based on low scores for appendicular lean mass(dual-energy X-ray absorptiometry),hand grip strength,and the Timed Up and Go test.For 7 days after baseline,total time and total number of bouts(≥10 min of continuous activity at a given intensity)of activity performed at sedentary,LPA,and MVPA intensities were assessed by accelerometer.Incident falls were self-reported 6 months and 12 months after baseline.Results:Only 1.8%of participants had probable or confirmed sarcopenia.After multivariable adjustment for other levels of activity,only greater MVPA time was associated with a decreased likelihood of having low appendicular lean mass,low hand grip strength,and slow Timed Up and Go time as defined by the European Working Group on Sarcopenia in Older People criteria(all p<0.05),and only MVPA time was associated with lower likelihood of probable or confirmed sarcopenia(odds ratio=0.80,95%confidence interval:0.71-0.91 h/week).Similar associations were identified for total number of bouts,with no evidence of threshold effects for longer duration of bouts of MVPA.A total of 14%of participants reported-1 fall,but neither total time nor bouts of activity was associated with incident falls(all p>0.05).Conclusion:Higher amounts of accelerometer-determined MVPA are consistently associated with a decreased likelihood of sarcopenia and its components,regardless of the length of bouts or amounts of sedentary behavior.

Circumstances of falls and fall-related injuries among frail elderly under home care in China

This exploratory study investigated the circumstances of falls and fall-related injuries among frail elderly people under home care.A convenience sample of 500 frail elderly(60 e99 years old)from the Wanshoulu and Yuyuantan communities in Beijing's Haidian District during February 2013 and March 2014.Fall circumstances and related injuries were characterized by detailed interviews and questionnaires.The article reports the results of a study that the overall fall incidence was 41.5%,and higher for females than males.Falls mainly occurred in individuals who were over 80 years old(50.0%)and indoors(67.9%).The percentage of subjects who experienced a combined injury after the fall was 56.3%,whereas 19.0%fell causes a fracture.Approximately 35%of the subjects were hospitalized,and 27.6%of the subjects recovered more than 30 days.Results indicate that,falls in the frail elderly caused serious damage,and fall-related circumstances should be a great concern in this population.

Risk factors for accidental falls in the elderly and intervention strategy

As the population ages, older people's health and quality of life are becoming a matter of public concern increasingly. Through review of the literatures and analysis of the reasons for falls in older people, we worked out some measures to cope with such a situation, provided the self-care knowledge of falls prevention for older people and improved the quality life of older persons. The recovery process is long, if the old people fall down, which brings a lot of inconvenience to individuals and families, and it can also cause a lot of complications. If wary of fall risk factors, the quality of life of older persons can be improved. According to the different conditions of the elderly, we should take effective measures to create suitable living environment for senior citizens, and propagandize the knowledge of the old people's health care, which has the great significance in preventing the elderly's fall, and improving their living quality.

On the Possibility of Obtaining a High Resolution Relative Paleointensity Record of the Pringle Falls Excursion at the Type Locality of Pringle Falls, Oregon, USA

In order to further understand the full vector excursional details of the geomagnetic field, a paleomagnetic and rock magnetic study of four sites has been conducted at the type locality of Pringle Falls, Oregon where 827 samples were drilled and spaced along a distance of 5 km, for their detailed directional and relative paleointensity studies. The profiles have registered a high-reso- lution (>10 cm/kyr) paleomagnetic record of the excursion (ca. 211+/13 ka) as recorded by diatomaceous lacustrine sediments. Remanence as well as induced magnetization experiments to investigate the reproducibility of the signal throughout the profiles have been conducted. In addition, low-field susceptibility vs. temperature analysis was performed indicating that the main magnetic carrier is pure magnetite (Curie point 575 ℃). The magnetic grain size also has indicated Single Domain-Multi-Domain (SD-MD) magnetite. The demagnetization was done by alternating field (a.f.) experiments, and the mean directions were determined by principal component analyses. In addition, induced magnetic tests were done, such as magnetic susceptibility (x) analyses, saturation IRM, anhysteretic remanent magnetization (ARM70) as well as the normalization of J17.5 mT/ARM70 to attempt to obtain relative paleointensity records of these sediments in question. The results of the induced rock magnetic tests such as the normalization studies indicate a direct correlation between the decrease of the relative paleointensity variations (i.e. lows) with respect to the directional changes. The detailed behavior of the paleosignal is highly consistent, since they are rapidly deposited sediments providing a detailed representation of the paleofield. The dissected VGP paths in 3 different phases are highly internally consistent and are defined by clockwise and anticlockwise loops traveling from the high northern latitudes over eastern North America and the North Atlantic to South America and then to high southern latitudes. They then return to the high northern latitudes through the Pacific and over to Kamchatka. This VGP behavior defines the geomagnetic signature of the Pringle Falls excursion as recorded at the type locality.

Selecting the Optimal Morse Falls Scale Cut-Off Point for Patient Fall Risk

Patient falls have long been a difficult problem and topic of research in the inpatient hospital environment. Hospitals experience heavy financial burden due to patient falls. Preventing falls can improve patient outcomes as well as reduce financial burden on both the patient as well as the healthcare organization. In this study, we determine the optimal cut-off value for patients at risk for falls using a Falls Screening Tool, the Morse Falls Scale. This study was conducted at a community-owned hospital with 256 acute care private rooms and 36 critical care rooms. This study used only the admission Morse Falls Scale (MFS) score in its analysis.

Syncope-related falls in the elderly

Age-related physiological impairments of heart rate, blood pressure and cerebral blood flow, in combination with comorbid conditions and concurrent medications, account for an increased susceptibility to syncope in older adults. Common causes of syncope are orthostatic hypotension, neurally-mediated syncope (including carotid sinus syndrome) and cardiac arrhythmias. A high proportion of older patients with cardiovascular syncope present with falls and deny loss of consciousness. Patients who are cognitively normal and have unexplained falls should have a detailed cardiovascular assessment.

Influence of Proxies on the Reported Frequency of Falls, Fear of Falling and Activity Restriction in Older People

Introduction: In older populations, the help of a third person may be necessary for a certain number of individuals in order to fill in questionnaires. The influence of this assistance on the collected information can raise questions, among others concerning the concordance between the information provided by the persons themselves and by their proxies, or the introduction of a potential bias. Our study’s objective is to examine, among older people, the differences in the reported frequency of falls, fear of falling and activity restriction due to fear of falling, according to the fact that people had filled in a questionnaire with or without the help of a third person. Methods: The data used come from the secondary analysis of a cross-sectional survey using a self-administered questionnaire and conducted in 2006 in a Belgian semi-rural town among non-institutionalised persons aged 65 years and over. Results: Among the 501 questionnaires, 16.4% were filled in with the help of another person. In bivariate analysis, the persons who needed help reported fall history, fear of falling and activity restriction significantly more often. In multivariable analysis, when considering concurrently the covariates (sex, age, living alone and fall history for fear of falling and for activity restriction), the influence of having received help to fill in the survey was only significant for activity restriction. Conclusion: Our study shows that it is important to know whether or not a person has received help to fill in a questionnaire. This can actually influence the reported frequency of certain outcomes, even, for activity restriction, when considering simultaneously the effect of other covariates. Given the current and future ageing of our populations, it seems that more extensive exploration is needed of the influence of proxies on the collected information about falls, fear of falling and activity restriction among older people.