Blind Spots in Hospital Fall Prevention: Falls in Stroke Patients Occurred Not Only in Those at a High Risk of Falling

Seigo Inoue; Yohei Otaka; Naoki Mori; Daisuke Matsuura; Masahiro Tsujikawa; Michiyuki Kawakami; Kunitsugu Kondo

doi:10.1016/j.jamda.2023.10.034

Blind Spots in Hospital Fall Prevention: Falls in Stroke Patients Occurred Not Only in Those at a High Risk of Falling

J Am Med Dir Assoc. 2024 Jan;25(1):160-166.e1. doi: 10.1016/j.jamda.2023.10.034. Epub 2023 Dec 15.

Authors

Seigo Inoue¹, Yohei Otaka², Naoki Mori³, Daisuke Matsuura³, Masahiro Tsujikawa¹, Michiyuki Kawakami⁴, Kunitsugu Kondo¹

Affiliations

¹ Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan.
² Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan. Electronic address: otaka119@mac.com.
³ Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Aichi, Japan.
⁴ Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Chiba, Japan; Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan.

PMID: 38109942
DOI: 10.1016/j.jamda.2023.10.034

Abstract

Objectives: Although the standard falls prevention strategy is to identify and respond to patients with high-risk conditions, it remains unclear whether falls in patients with high fall risk account for most observed falls. In this study, fall risk and number of falls were calculated based on patients' motor and cognitive abilities, and the relationship between the two was examined.

Design: We conducted a retrospective cohort study.

Setting and participants: We included 2518 consecutive patients with stroke who were admitted to a rehabilitation hospital.

Methods: Data on falls during hospitalization and biweekly assessed Functional Independence Measure scores were retrieved from the medical records. The average Functional Independence Measure scores for the motor and cognitive items were obtained and categorized as complete dependence, modified dependence, and independence. The fall rate (falls/1000 person-days) and number of observed falls in each combined condition were investigated.

Results: Modified dependence on motor ability and complete dependence on cognitive ability had the highest risk of falls, with a fall rate of 10.8/1000 person-days and 51 fall observations, which accounted for 4.3% of all falls. Independent motor and cognitive ability had the lowest risk of falls, a fall rate of 2.6/1000 person-days and 146 observed falls, accounting for 12.4% of all falls, which was 2.8 times higher than the number of falls observed in the highest risk of falls condition.

Conclusions and implications: The combined motor-cognitive ability with the highest risk of falls in stroke inpatients did not have the highest number of observed falls. Rather, the combined motor-cognitive ability with the lowest risk of falls tended to have a high number of observed falls. A different strategy is needed to reduce the total number of falls.

Keywords: Activities of daily living; cerebrovascular disorders; fall; inpatients; rehabilitation; safety.

MeSH terms

Hospitalization
Hospitals
Humans
Retrospective Studies
Risk Factors
Stroke* / prevention & control