Department of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.
Department for Patient Safety and Research, Lovisenberg Diaconal Hospital, Oslo, Norway.
J Clin Nurs. 2018 May;27(9-10):1826-1835. doi: 10.1111/jocn.14364.
To describe associations between patient fall risk and common symptoms among hospitalised inpatients.
Predictors of falls have been identified in a variety of populations and settings, but the role of inpatients' symptom experience has not been adequately evaluated.
Cross-sectional.
Participants included 614 medical and elective surgical patients in an acute hospital in Norway. Patient falls during hospitalisation were assessed by self-report and incident reports. Pain intensity and the occurrence and distress of 15 other symptoms were assessed by self-report.
Patient falls were associated with male sex and having more comorbidities. Medical patients were more likely to fall than elective surgical patients. In logistic regression analyses, higher symptom counts were associated with increased risk of fall, with each additional symptom conferring a 15% increase in fall risk. Symptom distress related to concentration difficulties, lack of energy, sleep problems, nausea, vomiting and diarrhoea was associated with increased risk of fall, even after adjusting for the influence of age, sex and comorbidities (odds ratios ranged 2.3-4.8). Severe pain, as well as symptom distress related to drowsiness, itching, dizziness or swelling of arms/legs, was also associated with patient falls, although these associations were attenuated after accounting for age, sex and comorbidities. Overall, symptom distress was more strongly associated with fall risk than symptom occurrence.
Symptom burden and distress may help identify hospital patients at risk for fall. Additional research is needed to determine whether symptoms are useful for assessing fall risk among hospital patients and other high-risk populations. If symptoms are useful indicators of fall risk, they should be considered for inclusion in standardised risk assessments.
Clinicians ought to pay particular attention to increased fall risk among patients reporting many symptoms and those experiencing distress from concentration difficulties, fatigue, sleep problems, nausea, vomiting and diarrhoea.
描述住院患者常见症状与患者跌倒风险之间的关联。
已在各种人群和环境中确定了跌倒的预测因素，但患者症状体验的作用尚未得到充分评估。
横断面研究。
参与者包括挪威一家急性医院的 614 名内科和择期手术患者。通过自我报告和事件报告评估患者住院期间的跌倒情况。通过自我报告评估疼痛强度和 15 种其他症状的发生和困扰情况。
患者跌倒与男性和更多合并症有关。内科患者比择期手术患者更容易跌倒。在逻辑回归分析中，较高的症状计数与跌倒风险增加相关，每增加一个症状，跌倒风险增加 15%。与注意力困难、缺乏精力、睡眠问题、恶心、呕吐和腹泻相关的症状困扰与跌倒风险增加相关，即使在调整了年龄、性别和合并症的影响后也是如此（比值比范围为 2.3-4.8）。严重疼痛以及与嗜睡、瘙痒、头晕或手臂/腿部肿胀相关的症状困扰也与患者跌倒相关，但在考虑到年龄、性别和合并症后，这些关联减弱。总的来说，症状困扰与跌倒风险的相关性强于症状发生。
症状负担和困扰可能有助于识别有跌倒风险的住院患者。需要进一步研究以确定症状是否可用于评估住院患者和其他高风险人群的跌倒风险。如果症状是跌倒风险的有用指标，则应考虑将其纳入标准化风险评估中。
临床医生应特别注意报告有许多症状的患者以及出现注意力困难、疲劳、睡眠问题、恶心、呕吐和腹泻困扰的患者跌倒风险增加。
