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Predicting Falls With the Morse Fall Scale: A Retrospective Assessment at the Veterans Health Administration
Peter J Hoover1, Terri L Blumke1, Anna D Ware1
1VA Palo Alto Healthcare System, CA, USA.
Clinical Nursing Research
|April 7, 2026
Summary
The Morse Fall Scale (MFS) poorly predicts patient falls in Veterans Health Administration (VHA) hospitals. While higher MFS scores correlate with falls, the tool lacks accuracy, necessitating improved fall risk assessment models.
Area of Science:
- Healthcare quality and patient safety
- Clinical informatics
- Geriatric medicine
Background:
- Accidental falls are a major cause of injury and prolonged recovery in hospitals, particularly within the Veterans Health Administration (VHA).
- The Morse Fall Scale (MFS) is a widely adopted tool for assessing patient fall risk, despite known limitations.
- Effective fall risk assessment is crucial for implementing appropriate preventative measures and improving patient outcomes.
Purpose of the Study:
- To evaluate the predictive performance of the Morse Fall Scale (MFS) for inpatient falls among Veterans.
- To determine if incorporating additional clinical data (Care Assessment Need [CAN] and Charlson Comorbidity Index [CCI]) improves fall risk prediction.
- To highlight the need for enhanced fall risk assessment tools in healthcare settings.
Main Methods:
- Retrospective analysis of electronic health records for Veterans admitted to VHA hospitals between July 1, 2020, and June 30, 2022.
- Inclusion criteria: completed MFS, CAN, and CCI; documented inpatient falls identified through clinical notes.
- Logistic regression models were used to assess the MFS's predictive accuracy for falls, with and without additional demographic and clinical variables.
Main Results:
- Out of 440,771 Veterans, 14,458 (3.3%) experienced a documented fall during their hospital stay.
- Veterans who fell generally had higher MFS scores, but the MFS demonstrated poor discrimination in predicting fall likelihood.
- While adding patient demographics, CAN, and CCI improved the model's performance, it remained suboptimal for accurate fall risk assessment.
Conclusions:
- The Morse Fall Scale (MFS), despite its widespread use in the VHA and other healthcare systems, exhibits suboptimal discrimination for predicting patient falls.
- The current MFS tool's limited accuracy undermines its practical utility in guiding fall prevention strategies.
- Development of more robust and accurate fall risk assessment models is essential for effective patient safety initiatives.
