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In-hospital fall-risk screening in 4,735 geriatric patients from the LUCAS project

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

In-hospital falls in older patients are frequent, but the identification of patients at risk of falling is challenging. Aim of this study was to improve the identification of high-risk patients. Therefore, a simplified screening-tool was developed, validated, and compared to the STRATIFY predictive accuracy.

Design

Retrospective analysis of 4,735 patients; evaluation of predictive accuracy of STRATIFY and its single risk factors, as well as age, gender and psychotropic medication; splitting the dataset into a learning and a validation sample for modelling fall-risk screening and independent, temporal validation.

Setting

Geriatric clinic at an academic teaching hospital in Hamburg, Germany.

Participants

4,735 hospitalised patients ≥65 years.

Measurements

Sensitivity, specificity, positive and negative predictive value, Odds Ratios, Youden-Index and the rates of falls and fallers were calculated.

Results

There were 10.7% fallers, and the fall rate was 7.9/1,000 hospital days. In the learning sample, mental alteration (OR 2.9), fall history (OR 2.1), and insecure mobility (Barthel-Index items ‘transfer’ + ‘walking’ score = 5, 10 or 15) (OR 2.3) had the most strongest association to falls. The LUCAS Fall-Risk Screening uses these risk factors, and patients with ≥2 risk factors contributed to the high-risk group (30.9%). In the validation sample, STRATIFY SENS was 56.8, SPEC 59.6, PPV 13.5 and NPV 92.6 vs. LUCAS Fall-Risk Screening was SENS 46.0, SPEC 71.1, PPV 14.9 and NPV 92.3.

Conclusions

Both the STRATIFY and the LUCAS Fall-Risk Screening showed comparable results in defining a high-risk group. Impaired mobility and cognitive status were closely associated to falls. The results do underscore the importance of functional status as essential fall-risk factor in older hospitalised patients.

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Author information

Authors and Affiliations

  1. Albertinen-Haus Geriatrics Centre, University of Hamburg, Sellhopsweg 18-22, D-22459, Hamburg, Germany

    L. Neumann, S. Golgert & Wolfgang von Renteln-Kruse

  2. Institute of Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Marchionistrasse 15, 81377, Munich, Germany

    V. S. Hoffmann & J. Hasford

  3. Scientific Department at the University of Hamburg, Sellhopsweg 18-22, D-22459, Hamburg, Germany

    Wolfgang von Renteln-Kruse

Authors
  1. L. Neumann
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  2. V. S. Hoffmann
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  3. S. Golgert
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  4. J. Hasford
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  5. Wolfgang von Renteln-Kruse
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Corresponding author

Correspondence to Wolfgang von Renteln-Kruse.

Additional information

Lilli Neumann and Verena Hoffmann contributed equally to this work.

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Neumann, L., Hoffmann, V.S., Golgert, S. et al. In-hospital fall-risk screening in 4,735 geriatric patients from the LUCAS project. J Nutr Health Aging 17, 264–269 (2013). https://doi.org/10.1007/s12603-012-0390-8

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