Risk factors for falls during inpatient rehabilitation

Abstract

Objective: To determine risk factors for falls during inpatient rehabilitation on the basis of admission data, and to assess the predictive value of the FIM instrument.

Design: One thousand four hundred seventy-two patients consecutively admitted to a large tertiary care rehabilitation center during 18 mos were included in this retrospective study. Events surrounding falls were reported by clinical staff. Demographic data, prehospital socioeconomic status, medical condition at admission, and admission FIM scores were analyzed using log-logistic regression model for their association with falls.

Results: One hundred forty (9.5%) patients fell at least once. Most falls occurred during daytime (85%), in a patient room (90%), and were unobserved (74%). About a half of all falls occurred during the first week of rehabilitation stay. Multivariate model revealed that diagnosis of stroke and amputation, age between 41 and 50 yrs, lower cognitive FIM scores, and a large number of medical comorbidities (> or =9) were associated with a high risk for fall. The respective prevalence ratios were 1.79, 3.80, 2.01, 0.98, and 1.50.

Conclusions: The rate of falls varies considerably among different diagnostic groups admitted to inpatient rehabilitation. Mid-aged people with stroke and amputation, worse cognitive functions, and greater medical complexity are at a higher risk for falling. Admission FIM score may be of value for predicting falls in rehabilitation setting, which warrants further investigation.