Risk factors for falling in psychiatric inpatients: a prospective, matched case-control study

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.