Chapter 26. Prevention of Falls in Hospitalized and Institutionalized Older People

A fall is defined as unintentionally coming to rest on the ground, floor, or other lower level, but not as a result of syncope or overwhelming external force. Falling is a common cause of morbidity and the leading cause of nonfatal injuries and trauma-related hospitalizations in the United States. Complications include bone fractures, injury to the soft tissues, increased functional dependence, and fear of falling again, which itself can be debilitating. Each of these complications contributes to increased risk of future falls. Studies in community-dwelling older patients have identified age, gait or balance impairment, sensory or cognitive impairment, musculoskeletal diseases, environmental hazards, and many medications (such as sedativehypnotic drugs) as risk factors. One of the strongest predictors of future falls is having previously fallen. There are numerous other risk factors for falls in older persons, which are reviewed in detail elsewhere. The number of risk factors is correlated with the risk of falling. A study by Tinetti and colleagues found the risk of falling increased from 19% when one risk factor was present to 78% in the presence of 4 or more risk factors. Some of the factors associated with fall risk in the hospital setting, however, may differ from those in community-dwelling or institutional settings. The onset of an acute illness leading to hospitalization may increase fall risk due to immobility and deconditioning. Treatment for an acute condition, such as the addition of new medications or an altered medication regimen, may also increase fall risk. The hospital environment itself may either be a supportive environment (eg, the presence of handrails and no-slip bathing surfaces) or may contribute to fall risk (eg, unfamiliar rooms, improper bed height). This chapter reviews general evidence regarding multicomponent falls prevention protocols, and 5 specific interventions: identification bracelets, physical restraints, bed alarms, special flooring, and hip protectors.