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Risk of falling among hospitalized patients with high modified Morse scores could be further Stratified
Irina Gringauz1,2, Yael Shemesh3,2, Amir Dagan1,2
1Internal Medicine T Department, Chaim Sheba Medical Center, 5265601, Tel-Hashomer, Israel.
Background:
Falls during hospitalization harbor both clinical and financial outcomes. The modified Morse fall scale [MMFS] is widely used for an in-hospital risk-of-fall assessment. Nevertheless, the majority of patients at risk of falling, i.e. with high MMFS, do not fall. The aim of this study was to ascertain our study hypothesis that certain patients' characteristics (e.g. serum electrolytes, usage of a walking device etc.) could further stratify the risk of falls among hospitalized patients with MMFS.
Methods:
This was a retrospective cohort analysis of adult patients hospitalized in Internal Medicine departments.
Results:
The final cohort included 428 patients aged 76.8±14.0 years. All patients had high (9 or more) MMFS upon admission, and their mean MMFS was 16.2±6.1. A group of 139 (32.5%) patients who fell during their hospitalization was compared with a control group of 289 (67.5%) patients who did not fall. The fallers had higher MMFS, a higher prevalence of mild dependence, and a greater use of a cane or no walking device. Regression analysis showed the following patients' characteristics to be independently associated with an increased risk of falling: mild dependence (OR=3.99, 95% CI 1.97-8.08; p<0.0001), treatment by anti-epileptics (OR=3.9, 95% CI 1.36-11.18; p=0.011), treatment by hypoglycemic agents (OR=2.64, 95% CI 1.08-6.45; p= 0.033), and hypothyroidism (OR=3.66, 05%CI 1.62-8.30; p=0.002). In contrast to their role in the MMFS, the use of a walker or a wheelchair was found to decrease the risk of falling (OR=0.3, 95% CI 0.13-0.69; p=0.005 and OR=0.25, 95% CI 0.11-0.59; p= 0.002).
Conclusions:
Further risk stratification of hospitalized patients, already known to have a high MMFS, which would take into account the characteristics pointed out in this study, should be attained.
Insights
Hospitalized patients with high fall risk scores (MMFS) can be further stratified using factors like mild dependence and specific medications. This helps identify individuals at higher risk of falls during their hospital stay.
Area of Science:
- Gerontology
- Internal Medicine
- Patient Safety
Background:
- Hospital falls have significant clinical and financial consequences.
- The Modified Morse Fall Scale (MMFS) is a common tool for assessing fall risk in hospitalized patients.
- Many patients with high MMFS scores do not fall, indicating a need for improved risk stratification.
Purpose of the Study:
- To identify patient characteristics that can further stratify fall risk in hospitalized individuals with high MMFS scores.
- To test the hypothesis that factors beyond MMFS can predict falls in high-risk patients.
Main Methods:
- Retrospective cohort analysis of adult patients admitted to Internal Medicine departments.
- Inclusion criteria: high MMFS score (≥9) upon admission.
- Comparison of patients who fell during hospitalization with a control group who did not fall.
Main Results:
- Patients who fell had higher MMFS, mild dependence, and used canes or no walking devices more frequently.
- Independent predictors of falls included mild dependence, anti-epileptic drugs, hypoglycemic agents, and hypothyroidism.
- Use of walkers or wheelchairs was associated with a decreased risk of falling.
Conclusions:
- Patient characteristics like mild dependence and specific medications can refine fall risk assessment in high-MMFS patients.
- Incorporating these factors into risk stratification models may improve prediction of falls in hospitalized individuals.
- Further research should focus on developing and validating enhanced fall risk assessment tools for hospitalized patients.
