Etiology of falls among cognitively intact hospice patients

Falls can pose a serious threat to hospice patients receiving palliative care. Interventions to reduce falls have yielded minimal results among older patients. Falls among hospice patients provide a unique population from which a new approach to fall prevention may need to be established.

The aim is to devise a forecasting model with which to predict the probability of a patient fall and evaluate whether the model predicts patient falls better than existing measures.

Two hundred patients were randomly selected from one of the largest hospices in the United States. After patient admission, patient falls were followed-up via weekly calls until a fall, patient death, or hospice discharge occurred. Independent factors included demographic, functional status, environmental measures, symptoms, medications, attitudinal dispositions, and the use of an ambulatory aid.

Cognitively intact hospice patients who have a higher risk of falls are those who had a past history of a fall (p = 0.022), patients that are physically more functional as demonstrated by higher score on the Palliative Performance Scale (p = .039), patients with a greater "fear-of-losing-independence (p = 0.023)," those who try to "avoid asking for help (p = 0.005)," and those who "feel uneasy about asking for help (p = 0.05)." Patients who depend on ambulatory aids were less likely to fall (p=0.06). The forecasting model predicted patient falls correctly in 78% of the patients observed.

The current model predicted fall occurrence far better than the Morse Falls Scale and other functional status measures and may lead to a shift in fall prevention approaches among hospice patients.