al Tehewy Mahi Mahmoud, Amin Ghada Essam, Nassar Nahla Wassem
From the Faculty of Medicine, Ain Shams University, Cairo, Egypt.
J Patient Saf. 2015 Dec;11(4):210-4. doi: 10.1097/PTS.0000000000000117.
Falls represent a serious problem facing hospital-admitted patients, and the severity of fall-related complications rises steadily after the age of 65 years.
The aims of this study were (a) to calculate the rate of falls among elderly patients in the internal medicine departments in Ain Shams University Hospital, (b) to identify different predictors and characteristics of falls, and (c) to assess clinical consequences and hospitalization outcomes of falls.
An observational longitudinal study has been conducted in Ain Shams University Hospital, where 411 elderly patients admitted to the internal medicine departments were included. Upon admission, the patients were assessed for their risk for falling using the Morse Fall Scale (MFS). Information about their medical condition and drugs administered was obtained. Functional assessment of the patients regarding their ability to perform different daily activities was also performed. The patients were followed up during their stay, and once a fall event occurred, complete details regarding the circumstances and consequences of that event were obtained.
The incidence rate of falls was found to be 16.9 per 1000 patient days. The fallers had a significantly high risk for falling according to the MFS (P = 0.02). The MFS was able to predict patients at risk for falling and identified correctly 82.6% of the fallers. The most common medical conditions associated with falls were diabetes (48.7%), hypertension (58.7%), and visual impairment (41.3%). Anemia (P = 0.05) and osteoporosis (P = 0.02) showed a statistically significant difference between the fallers and the nonfallers. Presence of a history of a fall and increased length of hospital stay were highly significant (P = 0.01) factors that predisposed to falls. Logistic regression analysis showed that anemia, osteoporosis, and history of a fall were independent predictors of falls. Most falls had no serious consequences, approximately 18% had contusions, 2% had subdural hematomas, and 4% had fractures and lacerations.
Elderly patients with anemia, osteoporosis, and history of a fall are more prone to falls and should be considered in fall protective measures.
跌倒问题严重影响住院患者，65岁后与跌倒相关并发症的严重程度持续上升。
本研究旨在（a）计算艾因夏姆斯大学医院内科老年患者的跌倒发生率；（b）确定跌倒的不同预测因素和特征；（c）评估跌倒的临床后果和住院结局。
在艾因夏姆斯大学医院开展一项观察性纵向研究，纳入411名内科住院老年患者。入院时，使用莫尔斯跌倒量表（MFS）评估患者的跌倒风险。收集患者的病情信息及用药情况。对患者进行日常活动能力的功能评估。在患者住院期间进行随访，一旦发生跌倒事件，获取该事件的详细情况及后果。
跌倒发生率为每1000患者日16.9次。根据MFS，跌倒者的跌倒风险显著较高（P = 0.02）。MFS能够预测有跌倒风险的患者，正确识别出82.6%的跌倒者。与跌倒相关的最常见疾病是糖尿病（48.7%）、高血压（58.7%）和视力障碍（41.3%）。贫血（P = 0.05）和骨质疏松症（P = 0.02）在跌倒者与未跌倒者之间存在统计学显著差异。跌倒史和住院时间延长是导致跌倒的高度显著（P = 0.01）因素。逻辑回归分析表明，贫血、骨质疏松症和跌倒史是跌倒的独立预测因素。大多数跌倒没有严重后果，约18%有瘀伤，2%有硬膜下血肿，4%有骨折和撕裂伤。
患有贫血、骨质疏松症和有跌倒史的老年患者更容易跌倒，应在跌倒预防措施中予以考虑。
