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Beyond the score: Reevaluating the Morse Fall Scale for fall risk assessment among hospitalized veterans
Kate R Oppegaard1,2, Jennifer Kime3, Khalilah Seid4
1Department of Nursing Professional Services & National Center for Rehabilitative Auditory Research, VA Portland Health Care System, Portland, Oregon, USA.
Background:
Inpatient falls cause substantial harm and cost. The Morse Fall Scale (MFS) is widely used for fall risk assessment. Yet, the scale's ability to differentiate patients who are at high risk for falling remains unclear.
Objectives:
This study evaluated whether the admission MFS total score or individual categories differentiated between patients who did and did not fall in an inpatient setting.
Methods:
A retrospective cohort design was used. Inpatients who had a complete MFS assessment on admission, from June 2022 to May 2024, were included. Fall occurrence was identified using post-fall documentation. Group differences were analyzed, and a logistic regression analysis identified predictors of falls.
Results:
Among 5004 patients, 3.5% fell. Compared to patients who did not fall, those who fell had significantly higher MFS total scores. Mean scores for both groups were above the cutoff for high fall risk (i.e., ≥45). A prior fall history, impaired mental status, assistive device use, and weak/impaired gait were associated with the occurrence of a fall.
Conclusions:
While several risk factors were associated with the occurrence of a fall, the majority of the patients were assessed to be at high risk for a fall using the MFS. These findings suggest that the total score may not be useful for differentiating those who may fall and that future research should prioritize individualized interventions targeting high-risk characteristics. Tailoring interventions to address specific risk factors may enhance fall prevention effectiveness and optimize resource allocation in acute care settings.
Insights
The Morse Fall Scale (MFS) may not effectively differentiate high-risk inpatients for falls, as most patients scored high. Individual risk factors, not the total score, better predict falls, suggesting tailored interventions are needed.
Area of Science:
- Healthcare research
- Patient safety
- Clinical assessment tools
Background:
- Inpatient falls lead to significant patient harm and healthcare costs.
- The Morse Fall Scale (MFS) is a common tool for assessing fall risk in hospitals.
- The MFS's effectiveness in distinguishing between high-risk and low-risk fallers is uncertain.
Purpose of the Study:
- To determine if the admission Morse Fall Scale (MFS) total score or its individual components can differentiate between inpatients who fall and those who do not.
- To identify specific MFS categories or patient characteristics associated with inpatient falls.
Main Methods:
- Retrospective cohort study including 5004 inpatients with MFS assessments upon admission (June 2022 - May 2024).
- Fall occurrence was documented through post-fall records.
- Statistical analyses included group comparisons and logistic regression to identify fall predictors.
Main Results:
- 3.5% of patients experienced falls.
- Patients who fell had significantly higher MFS total scores than non-fallers, with both groups exceeding the high-risk threshold (≥45).
- Predictors of falls included prior fall history, impaired mental status, use of assistive devices, and gait abnormalities.
Conclusions:
- The MFS total score may lack utility in differentiating fall risk among inpatients.
- Specific risk factors like fall history, mental status, assistive device use, and gait impairment are strongly associated with falls.
- Individualized interventions targeting specific high-risk characteristics are recommended for effective fall prevention in acute care settings.