Risk factors for fall occurrence in hospitalized adult patients: a case-control study

a matched case-control study (one control for each case). A quantitative study conducted in clinical and surgical units of a teaching hospital in Southern Brazil. The sample comprised 358 patients. Data were collected over 18 months between 2013-2014. Data analysis was performed with descriptive statistics and conditional logistic regression using Microsoft Excel and SPSS version 18.0.

Results:

risk factors identified were: disorientation/confusion [OR 4.25 (1.99 to 9.08), p<0.001]; frequent urination [OR 4.50 (1.86 to 10.87), p=0.001]; walking limitation [OR 4.34 (2.05 to 9.14), p<0.001]; absence of caregiver [OR 0.37 (0.22 to 0.63), p<0.001]; postoperative period [OR 0.50 (0.26 to 0.94), p=0.03]; and number of medications administered within 72 hours prior the fall [OR 1.20 (1.04 to 1.39) p=0.01].

Conclusion:

risk for falls is multifactorial. However, understanding these factors provides support to clinical decision-making and positively influences patient safety.

Descriptors:
Accidents by Falls; Risk Factors; Adult; Hospitals; Advanced Practice Nursing; Quantitative Analysis

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Isis Marques Severo Hospital de Clínicas de Porto Alegre. Serviço de Enfermagem em Terapia Intensiva Rua Ramiro Barcelos, 2350 Bairro: Rio Branco CEP: 90035-903, Porto Alegre, RS, Brasil E-mail: isismsevero@gmail.com

Risk factors		Case		Control		Total
Risk factors		(n=179)	%	(n=179)	%	(n=358)	%
Intrinsic factors:
	Walking limitation	145	81.0	120	67.0	265	74.0
	Previous fall	80	44.6	54	30.1	134	37.4
	Disorientation/confusion	73	40.7	31	17.3	104	29.0
	Frequent urination	57	31.8	31	17.3	88	24.5
	Urinary/intestinal urgency	54	30.2	30	16.8	84	23.4
	Postoperative period	41	22.9	58	32.4	99	27.6
	Drowsiness	37	20.7	24	13.4	61	17.0
	Agitation	24	13.4	5	2.7	29	8.1
Extrinsic factors:
	Length of stay (days)*	12 (05;20)		11 (05;17)		11 (5;18)
	Absence of caregiver	116	64.8	73	40.7	189	52.7
	Absence of the nursing diagnosis Risk for Falls†	85	47.4	118	66.5	203	56.7
	Sedation therapy (within 72 hours)	81	45.3	62	34.6	143	39.9
	Benzodiazepines therapy (within 24 hours)	63	35.2	47	26.3	110	30.7

Variables	OR*	CI^† (95%)	p-value
Disorientation/confusion	4.45	[2.32 to 8.57]	<0.001
Walking limitation	3.62	[1.96 to 6.68]	<0.001
Absence of caregiver	0.42	[0.27 to 0.64]	<0.001
Absence of the nursing diagnosis Risk for Falls^‡	2.43	[1.50 to 3.96]	<0.001
Urinary/intestinal urgency	2.56	[1.44 to 4.57]	0.001
Previous fall	2.11	[1.34 to 3.34]	0.001
Agitation	3.50	[1.41 to 8.67]	0.007
Frequent urination	2.46	[1.29 to 4.69]	0.006
Number of administered medications^§	1.17	[1.41 to 1.31]	0.008
Length of stay (days)	1.06	[1.01 to 1.11]	0.01
Benzodiazepines therapy (within 24 hours)	1.78	[1.11 to 2.85]	0.01
Sedative therapy (within 72 hours)	1.92	[1.17 to 3.14]	0.01
Postoperative period	0.58	[0.34 to 0.96]	0.05
Drowsiness	1.87	[1.00 to 3.49]	0.05
Age (>60 years)	2.61	[0.58 to 11.79]	0.21

Variables	OR*	CI^† (95%)	p-value
Disorientation/confusion	4.25	[1.99 to 9.08]	<0.001
Frequent urination	4.50	[1.86 to 10.87]	0.001
Walking limitation	4.34	[2.05 to 9.14]	<0.001
Absence of caregiver	0.37	[0.22 to 0.63]	<0.001
Postoperative period	0.50	[0.26 to 0.94]	0.03
Number of medications administered prior the fall (within 72 hours)^‡	1.20	[1.04 to 1.39]	0.01