Division of Bone Diseases, Department of Internal Medicine Specialties, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland.
Division of Geriatrics, Department of Internal Medicine, Rehabilitation, and Geriatrics, Geneva University Hospitals and Faculty of Medicine, Thônex, Switzerland.
J Bone Miner Res. 2018 May;33(5):852-859. doi: 10.1002/jbmr.3382. Epub 2018 Feb 5.
Falls are common among older inpatients and remain a great challenge for hospitals. Despite the relevance of physical impairments to falls, the prognostic value of performance-based functional measures for in-hospital falls and injurious falls remains unknown. This study aimed to determine the predictive ability and accuracy of various functional tests administered at or close to admission in a geriatric hospital to identify in-hospital fallers and injurious fallers. In this prospective study, conducted in a geriatric hospital in Geneva, Switzerland, 807 inpatients (mean age 85.0 years) were subjected to a battery of functional tests administered by physiotherapists within 3 days (interquartile range 1 to 6) of admission, including Short Physical Performance Battery (SPPB), simplified Tinetti, and Timed Up and Go tests. Patients were prospectively followed up for falls and injurious falls until discharge using mandatory standardized incident report forms and electronic patients' records. During a median length of hospital stay of 23 days (interquartile range 14 to 36), 329 falls occurred in 189 (23.4%) patients, including 161 injurious falls of which 24 were serious. In-hospital fallers displayed significantly poorer functional performances at admission on all tests compared with non-fallers (p < 0.001 for all). In multivariate analysis controlling for age, sex, previous falls, and fall as cause of admission, poorer functional performances on all functional tests predicted in-hospital falls and injurious falls (p < 0.001 for all). The SPPB only significantly predicted serious injurious falls (adjusted odds ratio [OR] = 0.76; 95% confidence interval [CI] 0.60-0.96) and fractures (adjusted OR = 0.76; 95% CI 0.59-0.98). In conclusion, poor functional performances, as assessed by SPPB, are independent predictors of in-hospital falls, injurious falls, and fractures in patients admitted to a geriatric hospital. These findings should help to design preventive strategies for in-hospital falls and support the adoption of objective performance-based functional measures into routine hospital practice. © 2018 American Society for Bone and Mineral Research.
跌倒在老年住院患者中很常见，仍然是医院面临的一大挑战。尽管身体损伤与跌倒有关，但在医院内跌倒和受伤跌倒方面，基于表现的功能测量的预后价值仍不清楚。本研究旨在确定在瑞士日内瓦的一家老年医院入院时或入院后不久进行的各种功能测试对识别院内跌倒者和受伤跌倒者的预测能力和准确性。在这项前瞻性研究中，对 807 名住院患者（平均年龄 85.0 岁）进行了一系列功能测试，这些测试由物理治疗师在入院后 3 天内（四分位距 1 至 6）进行，包括简短体能测试、简化的 Tinetti 测试和计时起立行走测试。使用强制性标准化事件报告表和电子患者记录对患者进行前瞻性随访，以确定跌倒和受伤跌倒情况，直至出院。在中位住院时间 23 天（四分位距 14 至 36）期间，189 名患者（23.4%）发生了 329 次跌倒，其中 161 次为受伤跌倒，其中 24 次为严重受伤跌倒。与非跌倒者相比，入院时跌倒者在所有测试中的功能表现明显较差（所有测试 p < 0.001）。在多变量分析中，校正年龄、性别、既往跌倒和跌倒作为入院原因后，所有功能测试的功能表现较差均预测院内跌倒和受伤跌倒（所有测试 p < 0.001）。简短体能测试仅显著预测严重受伤跌倒（调整后比值比 [OR] = 0.76；95%置信区间 [CI] 0.60-0.96）和骨折（调整后 OR = 0.76；95% CI 0.59-0.98）。总之，在入住老年医院的患者中，简短体能测试评估的功能表现较差是院内跌倒、受伤跌倒和骨折的独立预测因素。这些发现应该有助于设计院内跌倒预防策略，并支持将基于表现的客观功能测量纳入常规医院实践。
