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Method and Instrumented Fixture for Femoral Fracture Testing in a Sideways Fall-on-the-Hip Position
Published on: August 17, 2017
Fall risk and falls count by functional status in patients with hip fracture
Seigo Inoue1, Yohei Otaka2,3, Michiyuki Kawakami1,4
1Department of Rehabilitation Medicine, Tokyo Bay Rehabilitation Hospital, Narashino, Chiba, Japan.
Background:
Patients with hip fractures are at high risk of falling. In hospitals, identifying high-risk patients based on their capabilities and implementing targeted prevention strategies is essential. Because fall risk changes with functional recovery, it should be assessed longitudinally rather than at a single time point. This study aimed to determine whether the risk of falls (falls per 1,000 person-days) was stratified by motor and cognitive functional status and to examine the relationship between fall incidence rates and the actual number of falls in each functional status.
Methods:
This retrospective observational study included 824 consecutive patients with hip fractures admitted to a rehabilitation hospital. Data on falls during hospitalization and Functional Independence Measure (FIM) scores were retrieved from medical records. Average FIM scores for the motor and cognitive items were obtained and categorized into complete dependence, modified dependence, and independence. Fall rates and number of observed falls in each combined condition were investigated.
Results:
The highest fall rate was observed when patients were in states of modified motor dependence and complete cognitive dependence (11.4 falls/1,000 person-days; 17 falls; 9.3% of all falls). In contrast, patients in independent motor and cognitive states had a lower fall rate (2.0 falls/1,000 person-days) but accounted for a larger proportion of total falls (32 falls; 17.6% of all falls), representing 1.9 times the total number of falls observed in the highest fall-rate group.
Conclusion:
This study successfully demonstrated that fall risk in patients with hip fractures varies according to functional status, peaking during phases of modified motor dependence and complete cognitive dependence. However, owing to longer observation periods, a greater number of falls occurred among those in low-risk states than among those in high-risk states, demonstrating the "prevention paradox." Effective management requires a dual strategy: intensive interventions targeting high-risk phases and standardized preventive measures for all patients to address cumulative risk during the recovery process.
