Falls in hospital and new placement in a nursing home among older people hospitalized with acute illness.
OBJECTIVE
To examine the association between falls in hospital and new placement in a nursing home among older people hospitalized with acute illness.


METHODS
This prospective cohort study of 2,945 consecutive patients discharged alive from an acute geriatric medicine service used multivariate logistic regression to model the association between one or more falls and nursing home placement (primary analysis). Secondary analyses stratified falls by injury and occurrence of multiple falls. Demographic, medical, and frailty measures were considered in adjusted models.


RESULTS
The mean age of all patients was 82.8±7.6 years and 94% were admitted through the emergency department. During a median length of stay (LOS) of 11 days, 257 (8.7%) patients had a fall. Of these, 66 (25.7%) sustained an injury and 53 (20.6%) had two or more falls. Compared with nonfallers, fallers were more likely to be placed in a nursing home (odds ratio [OR]: 2.03, 95% confidence interval [CI]: 1.37-3.00), after adjustment for age, sex, frailty, and selected medical variables (including dementia and delirium). Patients without injury (OR: 1.83, 95% CI: 1.17-2.85) and those with injury (OR: 2.35, 95% CI: 1.15-4.77) were also more likely to be placed. Patients who fell had a longer LOS (median 19 days vs 10 days; P<0.001).


CONCLUSIONS
This study of older people in acute care shows that falls in the hospital are significantly associated with new placement in a nursing home. Given the predominantly negative experiences and the financial costs associated with placement in a nursing home, fall prevention should be a high priority in older people hospitalized with acute illness.
Department of Geriatric Medicine, Liverpool Hospital, Sydney, NSW, Australia.
David
D
Basic
Department of Geriatric Medicine and Rehabilitation, Shoalhaven District Memorial Hospital, Nowra, NSW, Australia.
Tabitha J
TJ
Hartwell
D000058:Accidental Falls / Q000706:statistics & numerical data*; D000208:Acute Disease; D000369:Aged, 80 and over; D003710:Demography; D005260:Female; D016330:Frail Elderly; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009735:Nursing Homes; D010360:Patient Transfer; D011446:Prospective Studies; D012307:Risk Factors
aged; falls; inpatients; nursing homes