title: Fall risk factors in elderly patients with cognitive impairment on rehabilitation wards.
abstract: BACKGROUND
  Confusion and cognitive impairment, are risk factors for falls in hospital. Evidence for reducing falls in cognitively-impaired patients is limited and to date no intervention has consistently been shown to reduce falls in this group of patients. We explored characteristics associated with falls in cognitively-impaired patients in a rehabilitation setting.
  
  
  METHODS
  In a prospective observational study, 825 consecutive patients were studied. Patient characteristics were assessed on admission. Factors predisposing to falls in cognitively-impaired patients were identified.
  
  
  RESULTS
  Cognitively-impaired patients were more likely to be fallers or recurrent fallers and more likely to sustain an injury than cognitively intact patients. They had a higher incidence of nursing home discharges and a significantly higher mortality. Logistic regression analysis showed that an unsafe gait (P < 0.001; 95% confidence interval, 0.13-0.57) was the only independent risk factor for falls in this group of patients. There was a cumulative higher risk of falling associated with an unsafe gait demonstrable throughout the patients' stay.
  
  
  CONCLUSIONS
  Unsafe gait was the only significant independent risk factor for falls among cognitively-impaired patients in a rehabilitation environment. Interventions that improve gait patterns or that enhance safety for patients with abnormal gait are required if fall reduction in this group of patients is to be achieved.
authors.affiliation: Royal Bournemouth Hospital, Bournemouth, UK. michael.vassallo@rbch.nhs.uk
authors.forename: Michael
authors.initials: M
authors.lastname: Vassallo
authors.forename: Santhosh Kumar
authors.initials: SK
authors.lastname: Mallela
authors.forename: Andrew
authors.initials: A
authors.lastname: Williams
authors.forename: Joseph
authors.initials: J
authors.lastname: Kwan
authors.forename: Steve
authors.initials: S
authors.lastname: Allen
authors.forename: Jagdish C
authors.initials: JC
authors.lastname: Sharma
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000369:Aged, 80 and over; D003072:Cognition Disorders / Q000150:complications*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012047:Rehabilitation Centers; D012307:Risk Factors