Fall Risk Assessment in Geriatric-Psychiatric Inpatients to Lower Events (FRAGILE). Falls in frequent neurological diseases--prevalence, risk factors and aetiology. Factors associated with falling in elderly hospital patients. Incidence and prediction of falls in Parkinson's disease: a prospective multidisciplinary study Risk factors for falls in post-stroke patients treated in a neurorehabilitation ward. Multidisciplinary management in geriatric day-hospital is beneficial for elderly fallers: a prospective study of 28 cases. Falls on a neurorehabilitation unit: reassessment of a prevention program. A multifactorial approach to understanding fall risk in older people. Prevention of fall incidents in patients with a high risk of falling: design of a randomised controlled trial with an economic evaluation of the effect of multidisciplinary transmural care Characteristics and circumstances of falls in a hospital setting Risk Factors Associated with Falls in Older Adults with Dementia: A Systematic Review. Yale FICSIT: risk factor abatement strategy for fall prevention. Exercise for fall risk reduction in community-dwelling older adults: a systematic review. Risk factors for falls in stroke patients during inpatient rehabilitation Determinants of disparities between perceived and physiological risk of falling among elderly people: cohort study Hospital falls: development of a predictive model for clinical practice. Predictors for recurrent falls among the home-dwelling elderly.
The objectives of this retrospective case-control study were to identify risk factors of falls in geriatric-psychiatric in patients and develop a screening tool to accurately predict falls . The study sample consisted of 225 geriatric-psychiatric in patients at a Midwestern referral facility . The sample included 136 in patients who fell and a r and om stratified sample of 89 in patients who did not fall . Data collected included age , gender , activities of daily living , and nursing parameters such as bathing assistance , bed height , use of bed rails , one-on-one observation , fall warning system , Conley Scale fall risk assessment , medical diagnosis , and medications . History of falls , impaired judgment , impaired gait , dizziness , delusions , delirium , chronic use of sedative or antipsychotic agents , and anticholinergic urinary bladder medications significantly increased fall risk . Alzheimer 's disease , acute use of sedative or anti-psychotic agents , and depression reduced fall risk . A falls risk tool , Fall Risk Assessment in Geriatric-psychiatric In patients to Lower Events ( FRAGILE ) , was developed for assessment and risk stratification with new diagnoses or medications The prevalence of falls among neurological patients is unknown , although disturbances of gait and posture are common . Falls may lead to burdens for the patient , the caregivers and the health system . We design ed a prospect i ve study and investigated all patients for a history of falls admitted to a neurological hospital during a 100-day period . Clinical investigation was carried out and several disease specific rating scales were applied . A total of 548 patients were investigated . Of all patients 34 % had fallen once or more often during the last twelve months . A disturbance of gait was blamed for the fall in 55 % , epileptic seizures in 12 % , syncope in 10 % and stroke in 7 % . Intrinsic risk factors for falls were high age , disturbed gait , poor balance and a fear of falling . As extrinsic factors we identified the treatment with antidepressants , neuroleptics and different cardiovascular medications , adverse environmental factors in the patients ' home and the use of walking aids . Within the diagnoses , falls were most frequent in Parkinson 's disease ( 62 % ) , syncope ( 57 % ) and polyneuropathy ( 48 % ) . According to these findings falls in neurological in- patients are twice as frequent as in an age-matched population living in the community . Falls in neurological patients are particularly linked to medication and disorders affecting gait and balance Forty-four patients aged 65 years and over who fell whilst in an acute hospital and 44 patients who did not fall during their hospital stay underwent structured medical examinations to identify factors associated with falling . The control subjects were matched for age ( + /- 3 years ) , sex , patient type , and primary diagnosis . The examination was based on established assessment s of posture , balance and gait , the musculoskeletal system , vision , cardiovascular status , and neurological function . Bivariate analyses revealed seven assessment measures that were significantly associated with falls : cognitive impairment , particularly impaired orientation ; evidence of previous cerebrovascular accident ; incoordination as measured clinical ly ; inability to perform the ' Get-up- and -go ' test , especially an inability to turn around after a 5-metre walk , and the use of psycho-active medications . Of these variables , impaired orientation , psycho-active drug use , evidence of stroke , and impaired performance in the ' Get-up- and -go ' test were included in a stepwise logistic regression which correctly classified 80 % of the patients into faller and non-faller groups . Falling was also related to the number of these identified risk factors . These findings suggest that a simple screening protocol , taking about 5 min to complete , can assist in the identification of patients at risk of falls whilst in hospital Objectives : To accurately establish the incidence of falls in Parkinson 's disease ( PD ) and to investigate predictive risk factors for fallers from baseline data . Methods : 109 subjects with idiopathic PD diagnosed according to the brain bank criteria underwent a multidisciplinary baseline assessment comprising demographic and historical data , disease specific rating scales , physiotherapy assessment , tests of visual , cardiovascular and autonomic function , and bone densitometry . Patients were then prospect ively followed up for one year using weekly prepaid postcards along with telephone follow up . Results : Falls occurred in 68.3 % of the subjects . Previous falls , disease duration , dementia , and loss of arm swing were independent predictors of falling . There were also significant associations between disease severity , balance impairment , depression , and falling . Conclusions : Falls are a common problem in PD and some of the major risk factors are potentially modifiable . There is a need for future studies to look at interventions to prevent falls in PD BACKGROUND AND PURPOSE Patients with neurological disorders , including post-stroke patients , are at high risk for falls . The purpose of the study was to estimate the number and type of falls and fall-related injuries in patients of a neurological rehabilitation ward and to identify risk factors for falls . MATERIAL AND METHODS 353 consecutive post-stroke patients of the Neurorehabilitation Unit at the Institute of Psychiatry and Neurology in Warsaw were enrolled into the study and observed during the hospital stay . Falls occurring in patients during their hospital stay were registered and an analysis of fall-related data and the routinely obtained medical data was performed . RESULTS In the evaluated group , 35 ( 10 % ) patients suffered 50 falls , which corresponds to an incidence rate of 5.02 [ 95 % confidence interval ( 95 % CI ) : 3.70 - 6.52 ] falls per 1000 patient-days . Most falls occurred in patients ' rooms ( 80 % ) , most of them taking place while transferring from one place to another or while changing position . 2 % of falls caused severe injury . There was a higher percentage of patients with unilateral neglect in the group of fallers ( p=0.0007 ) , who also demonstrated poorer performance in activities of daily living as expressed by the Rankin score ( p < 0.0002 ) and the Barthel Index ( p < 0.0001 ) , and greater neurological deficit in the Sc and inavian Stroke Scale ( SSS ) ( p=0.002 ) at admission as well as at discharge from hospital than non-fallers . The risk of a fall showed greatest association with low Barthel Index at admission ( < 15/20 ; RR=10.3 ; 95 % CI : 2.8 - 50.7 ) , performance in the Rankin score of > 3 ( RR=5.12 ; 95 % CI : 2,41 - 14,8 ) , low SSS score on admission ( 0 - 39 ; RR=3.40 ; 95 % CI : 1.62 - 9.14 ) , and the presence of hemispatial neglect ( RR=3.42 ; 95 % CI : 1.23 - 6.53 ) . The multiple-fallers group did not differ significantly from the group of single-fallers . CONCLUSIONS Among post-stroke patients , falls are a complication especially affecting persons with a large neurological deficit , severe disability and the neglect syndrome We determined whether management including medical , psychological , and physiotherapeutic approaches , over a period of 6 weeks , has a beneficial effect on motor abilities , psychological status , and independence of elderly fallers with psychomotor disadaptation syndrome ( PDS ) . We included 28 subjects ( mean age 81.4 years ) . They were assessed from a medical , motor , and psychological point of view at both the inclusion and the end of the multidisciplinary intervention . A follow-up was conducted with multidisciplinary assessment at 6 and 9 months after the beginning of the study in order to evaluate duration of benefits of the management . The statistical analysis concerned only subjects who took part in the total multidisciplinary program , i.e. , 14 subjects . The multidisciplinary intervention had an overall positive impact on motor abilities as shown by the increase in the mini-motor test scores , the rate of success in rising from the floor and decrease of time for the dual task . This study also showed a reduction in the fear of falling and a decrease in the rate of fallers . This positive effect on motor abilities , fear of falling and rate of fallers was sustained until 9 months after the beginning of the multidisciplinary management . This study shows the importance of a multidisciplinary management of elderly fallers with PDS We conducted a retrospective case-control study of falls over a four year period on a 30 bed neurorehabilitation unit at the Burke Rehabilitation Hospital to characterize the nature of falls and identify factors associated with falling . The most common diagnoses treated on the unit were traumatic spinal cord injury , brain injury , and multiple sclerosis ; stroke patients are treated on another service . Falls represented 72 percent of all incident reports made to the Nursing Office during the study period . One hundred seventeen ( 117 ) falls occurred in 82 patients during a time when the unit census was 28,622 patient days , yielding a rate of 1,439 falls per 1,000 patient years . One hundred fourteen ( 114 ) patients admitted with no history of falling during the same period were selected r and omly for comparison . Most falls were associated with no injury ( n = 96 ) or minor injury ( n = 18 ) . The most significant injuries occurred in three cases with lacerations requiring sutures . Falls occurred with greatest frequency during the first and fourth quartiles of the hospital stay , during the evening and while bed transfers were being performed . No association between falling and patient age , sex , diagnosis , number of medications , use of sedating medications , presence of motor , visual or cognitive impairment or orthostatic hypotension was evident . An increased risk of falling was associated with physician orders for Posey restraints . The implication of these findings for falls prevention programs is discussed OBJECTIVE To identify the interrelationships and discriminatory value of a broad range of objective ly measured explanatory risk factors for falls . DESIGN Prospect i ve cohort study with 12-month follow-up period . SETTING Community sample . PARTICIPANTS Five hundred community-dwelling people aged 70 to 90 . MEASUREMENTS All participants underwent assessment s on medical , disability , physical , cognitive , and psychological measures .  Fallers were defined as people who had at least one injurious fall or at least two noninjurious falls during a 12-month follow-up period . RESULTS Univariate regression analyses identified the following fall risk factors : disability , poor performance on physical tests , depressive symptoms , poor executive function , concern about falling , and previous falls . Classification and regression tree analysis revealed that balance-related impairments were critical predictors of falls . In those with good balance , disability and exercise levels influenced future fall risk-people in the lowest and the highest exercise tertiles were at greater risk . In those with impaired balance , different risk factors predicted greater fall risk-poor executive function , poor dynamic balance , and low exercise levels . Absolute risks for falls ranged from 11 % in those with no risk factors to 54 % in the highest-risk group . CONCLUSIONS A classification and regression tree approach highlighted interrelationships and discriminatory value of important explanatory fall risk factors . The information may prove useful in clinical setting s to assist in tailoring interventions to maximize the potential benefit of falls prevention strategies Background Annually , about 30 % of the persons of 65 years and older falls at least once and 15 % falls at least twice . Falls often result in serious injuries , such as fractures . Therefore , the prevention of accidental falls is necessary . The aim is to describe the design of a study that evaluates the efficacy and cost-effectiveness of a multidisciplinary assessment and treatment of multiple fall risk factors in independently living older persons with a high risk of falling . Methods / Design The study is design ed as a r and omised controlled trial ( RCT ) with an economic evaluation . Independently living persons of 65 years and older who recently experienced a fall are interviewed in their homes and screened for risk of recurrent falling using a vali date d fall risk profile . Persons at low risk of recurrent falling are excluded from the RCT . Persons who have a high risk of recurrent falling are blindly r and omised into an intervention ( n = 100 ) or usual care ( n = 100 ) group . The intervention consists of a multidisciplinary assessment and treatment of multifactorial fall risk factors . The transmural multidisciplinary appraoch entails close cooperation between geriatrician , primary care physician , physical therapist and occupational therapist and can be extended with other specialists if relevant . A fall calendar is used to record falls during one year of follow-up . Primary outcomes are time to first and second falls . Three , six and twelve months after the home visit , question naires for economic evaluation are completed . After one year , during a second home visit , the secondary outcome measures are reassessed and the adherence to the interventions is evaluated . Data will be analysed according to the intention-to-treat principle and also an on-treatment analysis will be performed . Discussion Strengths of this study are the selection of persons at high risk of recurrent falling followed by a multidisciplinary intervention , its transmural character and the evaluation of adherence . If proven effective , implementation of our multidisciplinary assessment followed by treatment of fall risk factors will reduce the incidence of falls . Trial registration Current Controlled Trials IS RCT N11546541 OBJECTIVE : To describe the epidemiology of hospital inpatient falls , including characteristics of  patients who fall  , circumstances of falls  , and  fall-related injuries . DESIGN : Prospect i ve descriptive study of inpatient falls . Data on patient characteristics , fall circumstances , and injury were collected through interviews with patients and /or nurses and review of adverse event reports and medical records . Fall rates and nurse staffing levels were compared by service . SETTING : A 1,300-bed urban academic hospital over 13 weeks . PATIENTS : All inpatient falls reported for medicine , cardiology , neurology , orthopedics , surgery , oncology , and women and infants services during the study period were included . Falls in the psychiatry service and falls during physical therapy sessions were excluded . MEASUREMENTS AND MAIN RESULTS : A total of 183 patients fell during the study period . The average age of patients who fell was 63.4 years ( range 17 to 96 ) . Many falls were unassisted ( 79 % ) and occurred in the patient ’s room ( 85 % ) , during the evening/overnight ( 59 % ) , and during ambulation ( 19 % ) . Half of the falls ( 50 % ) were elimination related , which was more common in patients over 65 years old ( 83 % vs 48 % ; P<.001 ) . Elimination-related falls increased the risk of fall-related injury ( adjusted odds ratio , 2.4 ; 95 % confidence interval 1.1 to 5.3 ) . The medicine and neurology services had the highest fall rates ( both were 6.12 falls per 1,000 patient-days ) , and the highest patient to nurse ratios ( 6.5 and 5.3 , respectively ) . CONCLUSIONS : Falls in the hospital affect young as well as older patients , are often unassisted , and involve elimination-related activities . Further studies are necessary to prevent hospital falls and reduce fall injury rates Purpose : People with dementia fall more often than cognitively healthy older adults , but their risk factors are not well understood . A review is needed to determine a fall risk profile for this population . The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia . Methods : Articles published between January 1988 and October 2014 in EMBASE , PubMed , PsycINFO , and CINAHL were search ed . Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment , prospect i ve cohort design , detailed fall definition , falls as the primary outcome , and multi-variable regression analysis . Two authors independently review ed and extracted data on study characteristics , quality assessment , and outcomes . Adjusted risk estimates were extracted from the articles . Results : A total of 17 studies met the inclusion criteria . Risk factors were categorized into demographic , balance , gait , vision , functional status , medications , psychosocial , severity of dementia , and other . Risk factors varied with living setting and were not consistent across all studies within a setting . Conclusion : Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors , some shared with older adults in general and others unique to the disease . Risk factors vary between community- and institution-dwelling sample s of adults with dementia or cognitive impairment Based on finding a strong association between number of impairments and risk of falling in earlier studies , Yale FICSIT investigators are conducting an intervention trial comparing the effectiveness of usual care plus social visits ( SV ) and a targeted risk abatement intervention ( TI ) strategy in reducing falls among at risk community elderly persons . Subjects include members of a participating HMO who are > or = 70 years of age , cognitively intact , not terminally ill , not too physically active , and possess at least one fall risk factor . The targeted risk factors include postural hypotension ; sedative use ; at least four targeted medications ; upper and lower extremity strength and range of motion impairments ; foot problems ; and balance , gait , and transfer dysfunctions . The interventions include medication adjustments , behavioral change recommendations , education and training , and home-based exercise regimens targeting the identified risk factors . The interventions are carried out by the study nurse practitioner and physical therapist in TI subjects ' homes . The SV subjects receive a comparable number of home visits as the TI subjects during which a structured life review is performed by social work students . The primary outcome is occurrence of falls during the 12-month followup . Secondary outcomes include change in mobility performance and fall-related efficacy PURPOSE To evaluate the influence of exercise on falls and fall risk reduction  in community-dwelling older adults and to present an up date d synthesis of outcome measures for the assessment of fall risk in community-dwelling older adults . METHOD A systematic review was performed , considering English- language articles published from 2000 to 2006 and accessible through MEDLINE , CINAHL , PEDro , EMBASE , and /or AMED . Included were r and omized controlled clinical trials ( RCTs ) that used an exercise or physical activity intervention and involved participants over age 50 . Screening and method ological quality for internal validity were conducted by two independent review ers . RESULTS The search retrieved 156 abstract s ; 22 articles met the internal validity criteria . Both individualized and group exercise programmes were found to be effective in reducing falls and fall risk . The optimal type , frequency , and dose of exercise to achieve a positive effect have not been determined . A variety of outcome measures have been used to measure fall risk , especially for balance . CONCLUSIONS Falls and fall risk can be reduced with exercise interventions in the community-dwelling elderly , although the most effective exercise variables are unknown . Future studies in population s with comorbidities known to increase fall risk will help determine optimal , condition-specific fall-prevention programmes . Poor balance is a key risk factor for falls ; therefore , the best measure of this variable should be selected when evaluating patients at risk of falling Objectives : To assess the incidence and circumstances of falls among stroke patients in a rehabilitation ward , the frequency of fall-related fractures , the relationship between falls and rehabilitation outcomes , and risk factors for falls . Design : Prospect i ve observational study . Setting : Neurological rehabilitation ward . Patients : In total 1155 patients ( 56 % men ; mean age 61.5 ± 14.3 years ) admitted to the neurological rehabilitation ward after a stroke .  Median ( interquartile range ) time since stroke onset was 36.5 ( 68 ) days . Main measures : Patients ' falls were registered during hospitalization ( 1—74 days ) and variables relating to the type and symptoms of stroke , current medications , neurological deficit ( Sc and inavian Stroke Scale ) and disability ( Barthel Index ) were collected from medical records . Results : A total of 252 falls were recorded for 189 ( 16.3 % ) patients and 45 patients experienced 108 repeated falls . The incidence rate for falls was 7.6/1000 patient-days ( 95 % confidence interval ( CI ) 6.6—8.5 ) . Most patients fell while being transferred ( 33.9 % ) and while seated ( 21.5 % ) , and 1.2 % of falls result ed in fractures ( n = 3 ) . Increased risk of both first and multiple falls was strongly associated with initial Barthel score below 15 ( hazard ratio ( HR ) 5.2 and 4.5 , respectively ) and time since stroke onset ≥12 weeks ( HR 2.3 and 2.3 , respectively ) . First falls were significantly associated with visuo-spatial neglect ( HR 1.5 ) . Repeated falls were related to age greater than 65 years ( HR 1.4 ) . Conclusions : Patients with severe stroke-related disability in the early period after stroke are prone to falls during rehabilitation . Multiple falls are most frequent in patients over 65 years of age Objectives To gain an underst and ing of elderly people ’s fear of falling by exploring the prevalence and determinants of perceived and physiological fall risk and to underst and the role of disparities in perceived and physiological risk in the cause of falls . Design Prospect i ve cohort study . Setting Community sample drawn from eastern Sydney , Australia . Participants 500 men and women aged 70–90 years . Main outcome measures Baseline assessment of medical , physiological , and neuropsychological measures , with physiological fall risk estimated with the physiological profile assessment , and perceived fall risk estimated with the falls efficacy scale international . Participants were followed up monthly for falls over one year . Results Multivariate logistic regression analyses showed that perceived and physiological fall risk were both independent predictors of future falls . Classification tree analysis was used to split the sample into four groups ( vigorous , anxious , stoic , and aware ) based on the disparity between physiological and perceived risk of falling . Perceived fall risk was congruent with physiological fall risk in the vigorous ( 144 ( 29 % ) ) and aware ( 202 ( 40 % ) ) groups . The anxious group ( 54 ( 11 % ) ) had a low physiological risk but high perceived fall risk , which was related to depressive symptoms ( P=0.029 ) , neurotic personality traits ( P=0.026 ) , and decreased executive functioning ( P=0.010 ) . The stoic group ( 100 ( 20 % ) ) had a high physiological risk but low perceived fall risk , which was protective for falling and mediated through a positive outlook on life ( P=0.001 ) and maintained physical activity and community participation ( P=0.048 ) . Conclusion Many elderly people underestimated or overestimated their risk of falling . Such disparities between perceived and physiological fall risk were primarily associated with psychological measures and strongly influenced the probability of falling . Measures of both physiological and perceived fall risk should be included in fall risk assessment s to allow tailoring of interventions for preventing falls in elderly people A retrospective case-control study related to falls was conducted at an 1,120-bed acute care tertiary hospital . The case ( fall ) sample consisted of 102 falls and 236 control ( nonfall ) charts during a 1-month period . An instrument developed by Hendrich ( 1988 ) was modified for use in the study . Demographic data and risk factors were recorded . Descriptive statistics included risk factor percentages for each sample and the corresponding univariate relative risks . Logistic regression was used to develop a multivariate risk factor model with seven risk factors . The significant risk factors were recent history of falls , depression , altered elimination patterns , dizziness or vertigo , primary cancer diagnosis , confusion , and altered mobility . The adjusted relative risks were converted to risk points to be used to assess a patient 's level of fall risk . Within the data set , a sensitivity of 77 % ( 79 of 102 ) and specificity of 72 % ( 169 of 236 ) were calculated . The model was cross-vali date d in a 1987 data set with a sensitivity of 83 % ( 59 of 71 ) and specificity of 66 % ( 106 of 161 ) OBJECTIVE Scant attention has been paid to the risk factors for recurrent falls among the home-dwelling elderly , although there are remarkable age and sex differences according to whether or not the falls recur . In this report we describe and analyse the risk factors for recurrent falls by selected clinical variables and the history of falling during the previous year . DESIGN A community-based prospect i ve study covering two years . SETTING All home-dwelling persons ( N = 1016 ) aged 70 years or older living in five municipalities in northern Finl and . OUTCOME MEASURES The risk factors of recurrent falling by selected clinical variables using cross-tabulations and multivariate analyses . RESULTS Previous falls , peripheral neuropathy , use of psychotropic medication and slow walking speed were independent risk factors for recurrent falling . The risk of recurrent falling increased with an increasing number of previous falls . CONCLUSIONS Early preventive measures should be taken among the elderly persons who are prone to falling . In order to reduce the risk of recurrent falls among the elderly , the attending physician should take a critical view of the use of psychotropic medications , and attempts should be made to treat conditions underlying peripheral neuropathies and abnormal gait
Among the multiple risk factors studied , a reduced performance in balance and gait was consistently associated with falls , while the contribution of single physical and cognitive impairments was variable in different population s. Walking aids , wheelchair characteristics and environmental hazards are significant environmental risk factors .
Falling is a common problem among young patients affected by neurological disorders , although the risk of falling for a specific individual is difficult to predict and the risk of a severe fall-related injury has not yet been established .
IMPLICATION S FOR REHABILITATION Young patients with impaired gait and balance or medium to severe motor disability appear to be at increased risk of falling .
Patients who are relatively independent and still participating in challenging activities have an increased exposure to fall-risk .
Walking aids , wheelchair characteristics and environmental hazards are significant environmental risk factors .
PURPOSE To review systematic ally the literature on fall risk factors for young patients affected by neurological disorders .