Temporal association between hospitalization and rate of falls after discharge.
BACKGROUND
Evidence suggests that acute illness and hospitalization may increase the risk for falls.


OBJECTIVE
To evaluate the rate of falls, and associated risk factors, for 90 days following hospital discharge.


METHODS
We consecutively enrolled 311 patients, aged 65 years and older, discharged from the hospital after an acute medical illness and receiving home-nursing services. Patients were assessed within 5 days of discharge for prehospital and current functioning by self-report, and balance, vision, cognition, and delirium by objective measures. Patients were followed up weekly for 13 weeks for falls, injuries, and health care use.


RESULTS
The rate of falls was significantly higher in the first 2 weeks after hospitalization (8.0 per 1000 person-days) compared with 3 months later (1.7 per 1000 person-days) (P =.002). Fall-related injuries accounted for 15% of all hospitalizations in the first month after discharge. Independent prehospital risk factors significantly associated with falls included dependency in activities of daily living, use of a standard walker, 2 or more falls, and more hospitalizations in the year prior. Posthospital risk factors included use of a tertiary amine tricyclic antidepressant, probable delirium, and poorer balance, while use of a cane was protective.


CONCLUSIONS
The rate of falls is substantially increased in the first month after medical hospitalization, and is an important cause of injury and morbidity. Posthospital risk factors may be potentially modifiable. Efforts to assess and modify risk factors should be integral to the hospital and posthospital care of older adults (those aged >/=65 years).
Mahoney
J E
JE
Department of Medicine, University of Wisconsin Medical School, 2870 University Ave, Suite 100, Madison, WI 53705, USA. jemahone@facstaff.wisc.edu
Palta
M
M
Johnson
J
J
Jalaluddin
M
M
Gray
S
S
Park
S
S
Sager
M
M
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living / Q000145:classification; D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D015577:Geriatric Assessment / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010351:Patient Discharge / Q000706:statistics & numerical data; D012307:Risk Factors; D013997:Time Factors; D014922:Wisconsin / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology