A 10-Year Study of the Trend of Accidental Falls in the Elderly in a Japanese Hospital

Abstract

Introduction and Methods

Elderly people are prone to falls. We established the Falls Prevention Working Group (FPWG) at our hospital in 2015 to reduce the number of falls during hospitalization. This study compared the trend of in-hospital falls in the elderly in two time periods (2008/9 and 2018/9) and determined the effects of FPWG-implemented measures. Using medical records, we counted the monthly number of falls suffered by patients during hospitalization in April 2008-March 2009 and April 2018-March 2019. We also categorized the falls according to the severity of fall-related complications.

Results

A total of 3609 hospital falls were recorded during the 2008–2019 period (2008/9: n = 433, 2018/9: n = 324). Falls were more common in patients aged 70–79 in 2008/9 but were noted in those aged ≥ 80 in 2018/9. The mean number of falls/month (27.3 ± 6.4, range: 12–45) was stable throughout the year. The incidence of falls in 2018/9 (1.90/1000 per persons per day) was significantly lower than in 2008/9 (2.30/1000, p = 0.006). Level ≥ 3b accidents, reflecting serious accidents with complications, were encountered in 12 of 433 accidents in 2008/9 compared with significantly fewer accidents (2 of the same severity among 324 accidents) in 2018/9 (p = 0.030).

Discussion and Conclusion

Our results showed a decrease in in-hospital falls in 2018/9 and that the sufferers were older relative to 10 years earlier. A multidisciplinary team should recommend measures to prevent falls and an environment “resilient” to falls, and encourage patients to be aware of possible falls.

Zusammenfassung

Einleitung und Methoden

Ältere Menschen sind anfällig für Stürze. Wir haben 2015 in unserem Krankenhaus eine Arbeitsgruppe zur Sturzprävention (FPWG) gegründet, um die Zahl der Stürze während des Krankenhausaufenthalts zu reduzieren. Ziel dieser Studie war es, die Entwicklung der Stürze bei älteren Menschen im Krankenhaus in 2 Zeiträumen (2008/09 und 2018/19) zu vergleichen und die Auswirkungen der FPWG durchgeführten Maßnahmen zu ermitteln. Wir verwendeten die Krankenakten, um die monatliche Anzahl der Stürze zu erfassen, die Patienten während ihres Krankenhausaufenthalts im April 2008/März 2009 und im April 2018/März 2019 erlitten. Außerdem kategorisierten wir die Stürze nach dem Schweregrad der sturzbedingten Komplikationen.

Ergebnisse

Im Zeitraum 2008–2019 wurden insgesamt 3609 Krankenhausstürze erfasst (2008/09: n = 433, 2018/19: n = 324). Stürze traten 2008/09 häufiger bei Patienten im Alter von 70–79 Jahren auf, wurden aber 2018/19 auch bei Patienten im Alter von ≥ 80 Jahren beobachtet. Die durchschnittliche Anzahl der Stürze pro Monat (27,3 ± 6,4, Bereich: 12–45) war über das Jahr hinweg stabil. Die Inzidenz von Stürzen war 2018/19 (1,90/1000 Personen pro Tag) deutlich niedriger als 2008/09 (2,30/1000, p = 0,006). Unfälle der Stufe ≥ 3b, welche schwere Unfälle mit Komplikationen widerspiegeln, traten 2008/09 bei 12 von 433 Unfällen auf. Im Vergleich gab es 2018/19 deutlich weniger Unfälle (2 Unfälle der gleichen Stufe bei 324 Unfällen; p = 0,030).

Diskussion und Schlussfolgerung

Unsere Ergebnisse zeigen, dass die Zahl der Stürze im Krankenhaus 2018/19 zurückgegangen ist und dass die Sturzopfer im Vergleich zu vor 10 Jahren älter waren. Ein multidisziplinäres Team sollte Maßnahmen zur Vorbeugung von Stürzen und eine „sturzresiliente“ Umgebung empfehlen sowie die Patienten fördern, sich der Sturzgefahr bewusst zu sein.

Keywords

accidental falls - interdisciplinary team - longevity - risk management - prevention and control

Schlüsselwörter

Sturzunfälle - interdisziplinäres Team - Langlebigkeit - Risikomanagement - Prävention und Kontrolle

Publication History

Received: 05 March 2022

Accepted after revision: 24 February 2024

Article published online:
11 April 2024

• References

• 1 Lake ET, Shang J, Klaus S. et al. Patient falls: Association with hospital Magnet status and nursing unit staffing. Res Nurs Health 2010; 33: 413-425 DOI: 10.1002/nur.20399.
• 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 DOI: 10.1136/qshc.2007.024695. (PMID: 19064657)
• 3 Sugihara K, Ishizuki M. [Current status of falls in Tsuchiura Kyodo General Hospital: An attempt to create a new score sheet]. J Ibaraki Soc Rural Med 2005; 18: 5-9
• 4 Sato N, Hase N, Osaka A. et al. Falls among Hospitalized Patients in an Acute Care Hospital: Analyses of Incident Reports. J Med Invest 2018; 65: 81-84 DOI: 10.2152/jmi.65.81.
• 5 Chiba M, Sanada Y, Kawano S. et al. [Study of incident reports in pediatric wards]. Jap J Pediatr Surg 2010; 42: 31-35
• 6 Kawakami Y, Shimoda K, Akasaka Y. [Analysis of incident and accident reports in Horonan hospital: Gender of patients and patient-nurse relationship]. Med J KKR Sapporo Med Center 2006; 3: 27-36
• 7 Takahashi M, Mima Y, Higashine T. et al. [Preventive measures against falls from a rehabilitation department]. Tokushima Red Cross Hosp Med J 2003; 8: 110-116
• 8 Morris R, O’Riordan S. Prevention of falls in hospital. Clin Med (Lond) 2017; 17: 360-362 DOI: 10.7861/clinmedicine.17-4-360. (PMID: 28765417)
• 9 McCallum J. Ageing research directions for Australia. Australas J Ageing 2011; 30 (Suppl. 2) 1-3 DOI: 10.1111/j.1741-6612.2011.00566.x. (PMID: 22032762)
• 10 Jeon MY, Jeong H, Petrofsky J. et al. Effects of a randomized controlled recurrent fall prevention program on risk factors for falls in frail elderly living at home in rural communities. Med Sci Monit 2014; 20: 2283-2291 DOI: 10.12659/MSM.890611. (PMID: 25394805)
• 11 Higuchi T, Kaneko Y, Nakazawa S. et al. [Analysis of incidents of falls in acute care hospitals]. J Niigata Prefect Central Hosp 2017; 25: 11-16
• 12 Cumming RG, Salkeld G, Thomas M. et al. Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol A Biol Sci Med Sci 2000; 55: 299 DOI: 10.1093/gerona/55.5.m299. (PMID: 10819321)
• 13 Tinetti ME. Clinical practice. Preventing falls in elderly persons. N Engl J Med 2003; 348: 42-49 DOI: 10.1056/NEJMcp020719. (PMID: 12510042)
• 14 Gschwind YJ, Kressig RW, Lacroix A. et al. A best practice fall prevention exercise program to improve balance, strength/power, and psychosocial health in older adults: study protocol for a randomized controlled trial. BMC Geriatr 2013; 13: 105-105 DOI: 10.1186/1471-2318-13-105. (PMID: 24106864)
• 15 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 [Anonym]. 1987; 34: 1-24
• 16 Tadenuma H, Sakai Y, Maniwa S. [Analysis and countermeasures of risk factors for falls in hospitalized patients]. J Shimane Med Assoc 2006; 26: 264-269
• 17 Ikuta E, Takeshita H, Namikawa T. et al. [Fact-finding survey for fall prevention among hospitalized patients at our hospital]. J Otsu Munic Hosp 2006 2006: 26-30
• 18 Kubo J, Yamada T, Tamai Y. et al. [Relationship between drugs and accidents of falls at our hospital]. J Hokkaido Soc Rural Med 2007; 39: 31-34
• 19 Matsuda E. [Current status and future issues of falls among inpatients in an acute care hospital: A survey of fall accident reports]. Tokushima Red Cross Hosp Med J 2010; 15: 139-143
• 20 Hirai Y, Fujii Y, Obayashi M. et al. [A survey on the actual conditions of fall accidents in Kagawa Rosai Hospital during the year 2010]. Med J Kagawa Rosai Hosp 2011 2011; 95-100
• 21 Naya C, Yamada R. [The actual status of falls among elderly patients with cognitive impairment in acute care hospitals in Japan, and the current status and issues of fall prevention care]. J School Nursing Soc Serv Health Sci Univ Hokkaido 2017; 13: 27-34
• 22 Tsuno R, Motoyoshi A, Fukushima M. et al. [Factor analysis of fall cases in acute care hospitals: A study from the standpoint of physical therapists]. J Kochi Rehab Inst 2012; 13: 17-21
• 23 Teramoto H, Uchida K, Nakanishi K. et al. [A study of fracture cases caused by falls in hospitals]. Kyosai Med J 2011; 60: 214-218
• 24 Gaebler S. Predicting which patient will fall again ... and again. J Adv Nurs 1993; 18: 1895-1902 DOI: 10.1046/j.1365-2648.1993.18121895.x. (PMID: 8132920)
• 25 Häggqvist B, Stenvall M, Fjellman-Wiklund A. et al. “The balancing act”--licensed practical nurse experiences of falls and fall prevention: a qualitative study. BMC Geriatr 2012; 12: 62-62 DOI: 10.1186/1471-2318-12-62.
• 26 Ohki Y, Iijima S, Anzai Y. et al. [Development of fall prophylaxis corresponding to patients’ risk of falling in acute care hospitals]. Jap J Qual Saf Healthc 2012; 7: 142-153
• 27 Rohde JM, Myers AH, Vlahov D. Variation in risk for falls by clinical department: implications for prevention. Infect Control Hosp Epidemiol 1990; 11: 521-524 DOI: 10.1086/646085. (PMID: 2230041)
• 28 Suda M, Iwao S. [Appropriate evaluation of the material environment in patients’ hospitalization: Research on the construction of safety in treatment and living environments]. Ann Rep Inst Living Environm Sci 2010; 42: 7-13
• 29 Toyabe S. Characteristics of Inpatient Falls not Reported in an Incident Reporting System. Glob J Health Sci 2015; 8: 17-25 DOI: 10.5539/gjhs.v8n3p17. (PMID: 26493421)
• 30 Ocker SA, Barton SA, Bollinger N. et al. Preventing Falls Among Behavioral Health Patients. Am J Nurs 2020; 120: 61-68 DOI: 10.1097/01.NAJ.0000688256.96880.a3.
• 31 Williams TA, King G, Hill AM. et al. Evaluation of a falls prevention programme in an acute tertiary care hospital. J Clin Nurs 2007; 16: 316-324 DOI: 10.1111/j.1365-2702.2005.01410.x. (PMID: 17239067)