Changes in falls risk factors for geriatric diagnostic groups across inpatient, outpatient and domiciliary rehabilitation settings.

PURPOSE

To compare falls event rates and risk factors for falls across three rehabilitation settings.

METHODS

A multi-centre prospective longitudinal cohort study was conducted of 1682 participants referred for rehabilitation from 18 sites (across two Australian states) and receiving physiotherapy treatment. Falls risk factors across multiple domains (rehabilitation settings, medical diagnoses, age, gender, standing balance, functional capacity, cognition, prior living arrangements, pre-admission use of gait aid and past history of falls) were collected by treating physiotherapists on admission to rehabilitation. Falls were measured by incident reporting and review of medical histories in the inpatient settings and by weekly interviews in the outpatient and domiciliary settings.

RESULTS

Overall, outpatient and domiciliary settings demonstrated lower falls event rates compared to inpatient [IRR (95% CI): 0.58 (0.36-0.93) and 0.35 (0.24-0.51)], respectively. Cognitive status, functional ability and past history of falls were consistent risk factors across settings. However medical diagnoses of stroke, other neurological conditions, elective orthopaedic and other orthopaedic together with standing balance were inconsistent as risk factors or protective factors across settings.

CONCLUSIONS

Risk factors for falls, including medical diagnosis, are not necessarily universal across settings. Balance performance was a significant risk factor for outpatient and domiciliary settings but was not a risk factor for inpatients. Cognitive status and a previous history of falls were, however, consistent risk factors across all settings. This suggests that different approaches for the prevention of falls may be required for the same diagnostic group of patients depending on the location of the rehabilitation setting.