Risk Factors for Falls Among Hospitalized Medical Patients - A Systematic Review and Meta-analysis

To identify and quantify risk factors for in-hospital falls in medical patients.

Six databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and Google Scholar) were systematically screened until April 11, 2023, to identify relevant articles.

All titles and abstracts of the retrieved articles were independently screened by 2 researchers who also read the full texts of the remaining articles. Quantitative studies that assessed risk factors for falls among adult patients acutely hospitalized were included in the review. Publications that did not capture internal medicine patients or focused on other specific populations were excluded.

Information on study characteristics and potential risk factors were systematically extracted. Risk of bias was assessed using the Quality in Prognosis Studies tool. Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Meta-analyses of Observational Studies in Epidemiology guidelines were followed for reporting.

The main outcome was any in-hospital falls. Using a random-effects meta-analysis model, association measures for each risk factor reported in 5 or more studies were pooled. Separate analyses according to effect measure and studies adjusted for sex and age at least were performed. Of 5067 records retrieved, 119 original publications from 25 countries were included. In conclusion, 23 potential risk factors were meta-analyzed. Strong evidence with large effect sizes was found for a history of falls (odds ratio [OR], 2.54; 95% confidence interval [CI], 1.63-3.96; I², 91%), antidepressants (pooled OR, 2.25; 95% CI, 1.92-2.65; I², 0%), benzodiazepines (OR, 1.97; 95% CI, 1.68-2.31; I², 0%), hypnotics-sedatives (OR, 1.90; 95% CI, 1.53-2.36; I², 46%), and antipsychotics (OR, 1.61; 95% CI, 1.33-1.95; I², 0%). Furthermore, evidence of associations with male sex (OR, 1.22, 95% CI, 0.99-1.50; I², 65%) and age (OR, 1.17, 95% CI, 1.02-1.35; I², 72%) were found, but effect sizes were small.

The comprehensive list of risk factors, which specifies the strength of evidence and effect sizes, could assist in the prioritization of preventive measures and interventions.