Machine Learning Prediction for Postdischarge Falls in Older Adults: A Multicenter Prospective Study

Abstract

Objectives: The study aimed to develop a machine learning (ML) model to predict early postdischarge falls in older adults using data that are easy to collect in acute care hospitals. This may reduce the burden imposed by complex measures on patients and health care staff.

Design: This prospective multicenter study included patients admitted to and discharged from geriatric wards at 3 university hospitals and 1 national medical center in Japan between October 2019 and July 2023.

Setting and participants: The participants were individuals aged ≥65 years. Of the 1307 individuals enrolled during the study period, 684 were excluded, leaving 706 for inclusion in the analysis.

Methods: We extracted 19 variables from admission and discharge data, including physical, mental, psychological, and social aspects and in-hospital events, to assess the main outcome measure: falls occurring within 3 months postdischarge. We developed a prediction model using 4 major classifiers, Extra Trees, Bernoulli Naive Bayes, AdaBoost, and Random Forest, which were evaluated using a 5-fold cross-validation. The area under the receiver operating characteristic curve (AUC) was used to evaluate predictive performance.

Results: Among the 706 patients, 114 (16.1%) reported a fall within 3 months postdischarge. The Extra Trees classifier demonstrated the best predictive performance, with an AUC of 0.73 on the test data. Important features included the Lawton Instrumental Activities of Daily Living scale, Clinical Frailty Scale (≥4 points), presence of urinary incontinence, 15-item Geriatric Depression Scale (≥5 points), and preadmission residence, all assessed at admission.

Conclusions and implications: To our knowledge, this is the first study to develop an ML model for predicting early postdischarge falls among older patients in acute care hospitals. The findings suggest that this model could assist in developing fall-prevention strategies to ensure seamless transition of care from hospitals to communities.

Keywords: Falls; hospitalization-associated disability; machine learning; older patients; predictive model.