Department of Geriatric Cardiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
Outpatient Department of Geriatrics, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, 250021, China.
BMC Geriatr. 2022 Aug 1;22(1):632. doi: 10.1186/s12877-022-03321-y.
Falls are an important cause of injury and death of older people. Hence, analyzing the multifactorial risk of falls from past cases to develop multifactorial intervention programs is clinically significant. However, due to the small sample size, there are few studies on fall risk analysis of clinical characteristics of fallers, especially among older hospitalized patients.
We collected data on 153 inpatients who fell (age ≥ 60 years) from the hospital nursing adverse event reporting system during hospitalization at Shandong Provincial Hospital Affiliated to Shandong First Medical University, China, from January 2018 to December 2020. Patient characteristics at the time of the fall, surrounding environment, primary nurse, and adverse fall events were assessed. The enumeration data were expressed as frequency and percentage, and the chi-squared was performed between recurrent fallers and single fallers, and non-injurious and injurious fall groups.
Cross-sectional data showed 18.3% of the 153 participants experienced an injurious fall. Compared with single fallers, a large proportion of older recurrent fallers more often experienced preexisting conditions such as cerebrovascular disease or taking hypoglycemic drugs. They were exposed to higher risks and could experience at least 3 fall times in 3 months. Besides, the credentials of their responsible nurses were often higher. Factors that increased the risk of a fall-related injury were hypoglycemic drugs (OR 2.751; 95% CI 1.114-6.795), and nursing adverse events (OR 47.571; 95% CI 14.392-157.247). Older inpatients with bed rails (OR 0.437; 95% CI 0.190-1.005) or falling at the edge of the bed (OR 0.365; 95% CI 0.138-0.964) were less likely to be injured than those without bed rails or not falling at the edge of the bed. Fall risks were significantly correlated with more severe fall-related injuries. Older patients with moderate (OR 5.517; CI 0.687-44.306) or high risk (OR 2.196; CI 0.251-19.219) were more likely to experience fall-related injuries than those with low risk.
Older inpatient falls are an ongoing challenge in hospitals in China. Our study found that the incidence of fall-related injuries among inpatients aged ≥ 60 years remained at a minor level. However, complex patient characteristics and circumstances can contribute to fall-related injuries. This study provides new evidence on fall-related injuries of older inpatients in China. Based on the factors found in this study, regular fall-related injury epidemiological surveys that investigate the reasons associated with the injuries were crucial when considering intervention measures that could refine fall-related injuries. More prospective studies should be conducted with improved and updated multidisciplinary fall risk assessment and comprehensive geriatric assessment as part of a fall-related injury prevention protocol.
跌倒对老年人的伤害和死亡是一个重要原因。因此，分析过去跌倒病例的多因素风险，制定多因素干预计划，在临床上具有重要意义。然而，由于样本量小，关于跌倒风险分析的临床特征的研究很少，尤其是在老年住院患者中。
我们从 2018 年 1 月至 2020 年 12 月，从中国山东省第一医科大学附属山东省立医院的医院护理不良事件报告系统中收集了 153 名跌倒（年龄≥60 岁）住院患者的数据。评估了患者跌倒时的特征、周围环境、初级护士和不良跌倒事件。计数数据用频率和百分比表示，对复发性跌倒者和单次跌倒者、非伤害性跌倒组和伤害性跌倒组进行卡方检验。
横断面数据显示，153 名参与者中有 18.3%发生了伤害性跌倒。与单次跌倒者相比，大量复发性跌倒的老年患者更常患有既往疾病，如脑血管病或服用降糖药。他们面临更高的风险，可能在 3 个月内至少经历 3 次跌倒。此外，他们负责护士的资质往往更高。增加跌倒相关伤害风险的因素包括降糖药（OR 2.751；95%CI 1.114-6.795）和护理不良事件（OR 47.571；95%CI 14.392-157.247）。使用床栏（OR 0.437；95%CI 0.190-1.005）或跌倒在床边（OR 0.365；95%CI 0.138-0.964）的老年住院患者比没有床栏或不在床边跌倒的患者受伤可能性更小。跌倒风险与更严重的跌倒相关伤害显著相关。中危（OR 5.517；CI 0.687-44.306）或高危（OR 2.196；CI 0.251-19.219）的老年患者发生跌倒相关伤害的可能性高于低危患者。
在中国医院，老年住院患者的跌倒仍然是一个持续存在的挑战。我们的研究发现，≥60 岁住院患者跌倒相关伤害的发生率仍处于较低水平。然而，复杂的患者特征和情况可能导致跌倒相关伤害。本研究为中国老年住院患者跌倒相关伤害提供了新的证据。基于本研究中发现的因素，在考虑可能减少跌倒相关伤害的干预措施时，应进行定期的跌倒相关伤害流行病学调查，以调查与伤害相关的原因。应开展更多的前瞻性研究，改进和更新多学科跌倒风险评估和全面老年评估，作为跌倒相关伤害预防方案的一部分。
