Detrimental incidents, including falls, in an elderly institutional population

In a Canadian Geriatric hospital, the report forms on the 2,177 untoward incidents occurring during the 1976-78 period were analyzed. The incident and fall rates were respectively 51.1 and 42.7/10,000 patient-days. Falls were the most common incident (82.9 percent). Of the patients who fell, 40.4 percent were over the age of 80 and another 27.5 percent were in the 71-80 age group. The majority fell more than once. Most falls occurred during the waking activity hours, and many were associated with the changing of the position or posture, notably in the course of using a wheelchair. Alcohol was a factor in 4.2 percent of the incidents. Nevertheless, the rate for mortality and serious morbidity were low. Patients' rooms and toilets should receive extra surveillance, and the caretaker staff should exercise special care in the use of wheelchairs and assistive devices. More attention should be given to recording cases of postural hypotension, cardiac arrhythmias or drug side effects.