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Pro-active fall-risk management is mandatory to sustain in hospital-fall prevention in older patients - validation of the lucas fall-risk screening in 2,337 patients

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Prevention of in-hospital falls contributes to improvement of patient safety. However, the identification of high-risk patients remains a challenge despite knowledge of fall-risk factors. Hence, objective was to prospectively validate the performance of the LUCAS (Longitudinal Urban Cohort Ageing Study) fall-risk screening, based on routine data (fall history, mobility, mental status) and applied by nurses.

Design

Observational study comparing two groups of patients who underwent different fall-risk screenings; the LUCAS screening (2010 – 2011) and the STRATIFY (St Thomas’s Risk Assessment Tool In Falling Elderly Inpatients) (2004 – 2006).

Setting

Urban teaching hospital.

Participants

Consecutively hospitalized patients (≥ 65 years old) were screened on admission; LUCAS n = 2,337, STRATIFY n = 4,735.

Measurements

The proportions of fallers were compared between the STRATIFY and the LUCAS time periods. The number of fallers expected was compared to that observed in the LUCAS time period. Standardized fall-incidence recording included case-note checks for unreported falls. Plausibility checks of fall-risk factors and logistic regression analysis for variable fall-risk factors were performed.

Results

The proportions of fallers during the two time periods were LUCAS n = 291/2,337 (12.5 %) vs. STRATIFY n = 508/4,735 (10.7 %). After adjustment for risk-factor prevalence, the proportion of fallers expected was 14.5 % (334/2,337), the proportion observed was 12.5 % (291/2,337) (p = 0.038).

Conclusion

In-hospital fall prevention including systematic use of the LUCAS fallrisk screening reduced the proportion of fallers compared to that expected from the patients’ fall-risk profile. Raw proportions of fallers are not suitable to evaluate fall prevention in hospital because of variable prevalence of patients’ fall-risk factors over time. Continuous communication, education and training is needed to sustain in-hospital falls prevention.

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References

  1. Oliver D, Healey F, Haines TP. Preventing falls and fall-related injuries in hospitals. Clin Geriatr 2010;26:645–692.

    Article  Google Scholar 

  2. Healey F, Scobie S, Oliver D et al. Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports. Qual Saf Health Care 2008;17:424–430.

    Article  PubMed  CAS  Google Scholar 

  3. Heinrich S, Rapp K, Rissmann U et al. Cost of falls in old age: a systematic review. Osteoporos Int 2010;21:891–902.

    Article  PubMed  CAS  Google Scholar 

  4. Hill KD, Vu M, Walsh W. Falls in the acute hospital setting—impact on resource utilisation. Aust Health Rev 2007;31:471–477.

    Article  PubMed  Google Scholar 

  5. Geriatric Medicine Section & Broad of U.E.M.S.Geriatric Medicine. Download: http://uemsgeriatricmedicine.org/UEMS1/dok/geriatric_medicine_definition.pdf Accessed 15 December 2014.

  6. Bloch F, Blandin M, Ranerison R et al. Anxiety after a fall in elderly subjects and subsequent risk of developing post traumatic stress disorder at two months. A pilot study. J Nutr Health Aging 2014;18:303–306.

    Article  PubMed  CAS  Google Scholar 

  7. Petitpierre NJ, Trombetti A, Carroll I et al. The FIM® instrument to identify patients at risk of falling in geriatric wards: a 10-year retrospective study. Age Ageing 2010;39:326–331.

    Article  PubMed  Google Scholar 

  8. Renteln-Kruse von W, Dapp U, Anders J et al. The LUCAS consortium–interdisciplinary research on ageing and health care for older people in an urban community. Z Gerontol Geriatr 2011;44:250–255.

    Article  Google Scholar 

  9. Cameron ID, Gillespie LD, Robertson MC et al. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 2012;12:CD005465.

    PubMed  Google Scholar 

  10. Close JC, Lord SR. Fall assessment in older people. BMJ 2011;343:d5153.

    Article  PubMed  Google Scholar 

  11. Oliver D, Britton M, Seed P et al. Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: casecontrol and cohort studies. BMJ 1997;315:1049–1053.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  12. Renteln-Kruse von W, Krause T. Incidence of in-hospital falls in geriatric patients before and after the introduction of an interdisciplinary team-based fall-prevention intervention. J Am Geriatr Soc 2007;55:2068–2074.

    Article  Google Scholar 

  13. Haines TP, Hill K, Walsh W et al. Osborne R. Design-related bias in hospital fall risk screening tool predictive accuracy evaluations: systematic review and meta-analysis. J Gerontol A Biol Sci Med Sci 2007;62:664–672.

    Article  PubMed  Google Scholar 

  14. Walsh W, Hill KD, Bennell K et al. Local adaptation and evaluation of a falls risk prevention approach in acute hospitals. Int J Qual Health Care 2011;23:134–141.

    Article  PubMed  Google Scholar 

  15. Neumann L, Hoffmann VS, Golgert S et al. In-hospital fall-risk screening in 4,735 geriatric patients from the LUCAS project. J Nutr Health Aging 2013;17:264–269.

    Article  PubMed  CAS  Google Scholar 

  16. Lübke N, Meinck M, von Renteln-Kruse W. The Barthel Index in geriatrics. A context analysis for the Hamburg Classification Manual. Z Gerontol Geriatr 2004;37:316–326 (in German).

    PubMed  Google Scholar 

  17. Hempel S, Newberry S, Wang Z et al. Hospital fall prevention: a systematic review of implementation, components, adherence, and effectiveness. J Am Geriatr Soc 2013;61:483–494.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Rösler A, Hofmann W, von Renteln-Kruse W et al. Special care units for the treatment of acutely ill, cognitively impaired geriatric patients in Germany. Z Gerontol Geriatr 2010;43:249–253 (in German).

    Article  PubMed  Google Scholar 

  19. Kellogg International Work Group on the Prevention of Falls by the Elderly, Gibson MJS, Andres RO et al. The prevention of falls in later life: a report of the Kellogg International Work Group on the Prevention of Falls by the Elderly. Dan Med Bull 1987;34 Suppl4:1–24.

    Google Scholar 

  20. Hill AM, Hoffmann T, Hill K et al. Measuring falls events in acute hospitals -a comparison of three reporting methods to identify missing data in the hospital reporting system. J Am Geriatr Soc 2010;58:1347–1352.

    Article  PubMed  Google Scholar 

  21. Renteln-Kruse von W, Krause T. Fall events in geriatric hospital in-patients–results of prospective recording over a 3-year period. Z Gerontol Geriatr 2004;37:9–14 (in German).

    Article  Google Scholar 

  22. Ellis G, Whitehead MA, O’Neill D et al. Comprehensive geriatric assessement for older adults admitted to hospital. Cochrane Database Syst Rev 2011;7: CD006211.

    PubMed  Google Scholar 

  23. Hauer K, Lamb SE, Jørstad EC et al. Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing 2006;35:5–10.

    Article  PubMed  Google Scholar 

  24. Chapman J, Bachand D, Hyrkäs K. Testing the sensitivity, specificity and feasibility of four falls risk assessment tools in a clinical setting. J Nurs Manag 2011;19:132–142.

    Article  Google Scholar 

  25. Miake-Lye IM, Hempel S, Ganz DA et al. Inpatient fall prevention programs as a patient safety strategy: a systematic review. Ann Intern Med 2013;158:390–396.

    Article  PubMed  Google Scholar 

  26. Lafont C, Gérard S, Voisin T et al. Reducing «iatrogenic disability» in the hospitalized frail elderly. J Nutr Health Aging 2011;15:645–660.

    Article  PubMed  CAS  Google Scholar 

  27. Beauchet O, Dubost V, Revel Delhom C et al. How to manage recurrent falls in clinical practice: guidelines of the French Society of Geriatrics and Gerontology. J Nutr Health Aging 2011;15:79–84.

    Article  PubMed  Google Scholar 

  28. Henriksen K, Brady J. The persuit of better diagnostic performance: a human factors perspective. BMJ Qual Saf 2013;22 Suppl 2:ii1–ii5.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Joray S, Wietlisbach V, Bula CJ. Cognitive impairment in elderly medical inpatients: detection and associated six-month outcomes. Am J Geriatr Psychiatry 2004;12:639–647.

    PubMed  Google Scholar 

  30. Shenkin SD, Russ TC, Ryan TM et al. Screening for dementia and other causes of cognitive impairments in general hospital in-patients. Age Ageing 2014;43:166–168.

    Article  PubMed  Google Scholar 

  31. O’Keefe ST, Lavan JN. Clinical significance of delirium subtypes in older people. Age Ageing 1999;28:115–119.

    Article  Google Scholar 

  32. Zieschang T, Dutzi I, Müller E et al. Improving care for patients with dementia hospitalized for acute somatic illness in a specialized care unit: a feasibility study. Int Psychogeriatr 2010;22:139–146.

    Article  PubMed  Google Scholar 

  33. Brand CA, Sundararajan V. A 10-year cohort study of the burden and risk of in-hospital falls and fractures using routinely collected hospital data. Qual Saf Health Care 2010;19:e51.

    Google Scholar 

  34. Hauer K, Marburger C, Oster P. Motor performance deteriorates simultaneously cognitive tasks in geriatric patients. Arch Phys Med Rehabil 2002;83:217–223.

    Article  PubMed  Google Scholar 

  35. Sheridan PL, Mat JS, Kowall N et al. Influence of executive function on locomotor function: divided attention increases gait variability in Alzheimer’s Disease. J Am Geriatr Soc 2003;51:1633–1637.

    Article  PubMed  Google Scholar 

  36. Hignett S, Sands G, Griffiths P. Exploring the contributory factors for unwitnessed in-patient falls from National Reporting and Learning System database. Age Ageing 2011;40:135–138.

    Article  PubMed  CAS  Google Scholar 

  37. Tinetti ME, Doucette J, Claus E et al. Risk factors for serious injury during falls by older persons in the community. J Am Geriatr Soc 1995;43:1214–1221.

    Article  PubMed  CAS  Google Scholar 

  38. Dinkel RH, Lebok UW. The effects of dementia in German acute care hospitals. Dement Geriatr Cogn Disord 1997;8:314–319.

    Article  PubMed  CAS  Google Scholar 

  39. Inouye SK. Delirium in older people. N Engl J Med 2006;354:1157–1165.

    Article  PubMed  CAS  Google Scholar 

  40. Hartholt KA, van der Velde N, Looman CWN et al. Trends in fall-related hospital admissions in older persons in the Netherlands. Arch Intern Med 2010;170:905–911.

    Article  PubMed  Google Scholar 

  41. Milisen K, Coussement J, Flamaing J et al. Fall prediction according to nurses’ clinical judgment: differences between medical, surgical, and geriatric wards. J Am Geriatr Soc 2012;60:1115–1121.

    Article  PubMed  Google Scholar 

  42. Webster J, Courtney M, Marsh N et al. The STRATIFY tool and clinical judgment were poor predictors of falling in an acute hospital setting. J Clin Epidemiol 2010;63:109–113.

    Article  PubMed  Google Scholar 

  43. Vassallo M, Poynter L, Sharma JC et al. Fall risk-assessment tools compared with clinical judgement: an evaluation in a rehabilitation ward. Age Ageing 2008;37:277–281.

    Article  PubMed  Google Scholar 

  44. Oliver D. Falls risk-prediction tools for hospital inpatients. Time to put them to bed? Age Ageing 2008;37:248–250.

    Article  PubMed  Google Scholar 

  45. National Institute for Health and Care Excellence(NICE). Falls: assessment and prevention of falls in older people. NICE clinical guideline 161 2013. http://www. nice.org.uk/guidance/cg161/resources/guidance-falls-assessment-and-prevention-offalls-in-older-people-pdf. Accessed 15 December 2014.

  46. Grossmann FF, Hasemann W, Graber A et al. Screening, detection and management of delirium in the emergency department–a pilot study on the feasibility of a new algorithm for use in older emergency department patients: the modified Confusion Assessment Method for the Emergency Department (mCAM-ED). Scand J Trauma Resusc Emerg Med 2014;22:19.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Campbell S, Seymour D Primrose W. ACMEPLUS Project. A systematic literature review of factors affecting outcome in older medical patients admitted to hospital. Age Ageing 2004;33:110–115.

    PubMed  Google Scholar 

  48. Bakker FC, Robben SHM, Older Rikkert MGM. Effects of hospital-wide interventions to improve care for frail older inpatients: a systematic review. BMJ Qual Saf 2011;20:680–691.

    Article  PubMed  Google Scholar 

  49. Lakhan P, Jones M, Wilson A et al. A prospective cohort study of geriatric syndromes among older medical patients admitted to acute care hospitals. J Am Geriatr Soc 2011;59:2001–2008.

    Article  PubMed  Google Scholar 

  50. Clegg A, Young J, Iliffe S et al. Frailty in elderly people. Lancet 2013;381:752–762.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

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

    V. S. Hoffmann

  2. Albertinen-Haus, Geriatrics Centre, Scientific Department at the University of Hamburg, Sellhopsweg 18-22, Hamburg, Germany

    Lilli Neumann, S. Golgert & W. von Renteln-Kruse

Authors
  1. V. S. Hoffmann
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  2. Lilli Neumann
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  3. S. Golgert
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  4. W. von Renteln-Kruse
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Corresponding author

Correspondence to Lilli Neumann.

Additional information

Verena Hoffmann and Lilli Neumann contributed equally to this work

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Hoffmann, V.S., Neumann, L., Golgert, S. et al. Pro-active fall-risk management is mandatory to sustain in hospital-fall prevention in older patients - validation of the lucas fall-risk screening in 2,337 patients. J Nutr Health Aging 19, 1012–1018 (2015). https://doi.org/10.1007/s12603-015-0662-1

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  • DOI: https://doi.org/10.1007/s12603-015-0662-1

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