title: Risk factors for falling in psychiatric inpatients: a prospective, matched case-control study.
abstract: Falling is one the most common types of inpatient adverse events. Most fall-related research was conducted retrospectively and focused on elderly population in general hospital settings. This study aimed to timely identify all potential risk factors associated with falls and fall-related injury in a psychiatric inpatient setting. We recruited 145 fall events and 145 sex- and room-matched psychiatric control inpatients without fall in a 1002-bed psychiatric teaching hospital in northern Taiwan. In addition to medical records, the study variables included patient characteristics, circumstances and medications, which were collected from the patients and/or their families within 24 h of receiving reports right after obtaining written informed consent. A psychiatrist and three head nurses conducted a comprehensive assessment of risk factors immediately after falls occurred. A conditional logistic regression model revealed four variables significantly associated with an increased risk of falling: the clinical global impression-severity (adjusted odds ratio (aOR) = 2.19; 95% confidence interval, CI = 1.13-4.24), the parkinsonism scores of the extrapyramidal syndrome rating scale (aOR = 1.14; 95% CI = 1.08-1.21), equivalent dosage of benzodiazepines use (aOR = 1.15; 95% CI = 1.03-1.30), and medication changes within 24 h (aOR = 10.3; 95% CI = 1.37-76.8). Acute settings (aORs = 2.06, 95% CI = 1.01-4.18), a fall history in the past six months and a lack of history of medical problems (aORs = 3.04; 95% CI = 1.46-6.33) were associated with fall-related injury (aOR = 2.70; 95% CI = 1.29-5.69). Our study identified the severity of psychotic symptoms, extrapyramidal symptoms, medications usage and other several specific measures for prevention of falls in psychiatric inpatient settings.
authors.affiliation: Department of General Psychiatry, Taoyuan Mental Hospital, Taoyuan County, Taiwan.
authors.forename: Chia-Hsiang
authors.initials: CH
authors.lastname: Chan
authors.forename: Susan Shur-Fen
authors.initials: SS
authors.lastname: Gau
authors.forename: Hung-Yu
authors.initials: HY
authors.lastname: Chan
authors.forename: Ya-Ju
authors.initials: YJ
authors.lastname: Tsai
authors.forename: Chun-Chih
authors.initials: CC
authors.lastname: Chiu
authors.forename: Shu-Mei
authors.initials: SM
authors.lastname: Wang
authors.forename: Mei-Ling
authors.initials: ML
authors.lastname: Huang
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology*; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology*; D008875:Middle Aged; D011446:Prospective Studies; D011569:Psychiatric Status Rating Scales; D018570:Risk Assessment; D012307:Risk Factors