• Melissa J Krauss, Bradley Evanoff, Eileen Hitcho, Kinyungu E Ngugi, William Claiborne Dunagan, Irene Fischer, Stanley Birge, Shirley Johnson, Eileen Costantinou, and Victoria J Fraser.
• Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA. mkrauss@im.wustl.edu
• J Gen Intern Med. 2005 Feb 1; 20 (2): 116122116-22.

ObjectiveTo comprehensively analyze potential risk factors for falling in the hospital and describe the circumstances surrounding falls.DesignCase-control study. Data on potential risk factors and circumstances of the falls were collected via interviews with patients and/or nurses and review of adverse event reports, medical records, and nurse staffing records.SettingLarge urban academic hospital.PatientsNinety-eight inpatients who fell and 318 controls matched on approximate length of stay until the index fall.Measurements And Main ResultsIn a multivariate model of patient-related, medication, and care-related variables, factors that were significantly associated with an increased risk of falling included: gait/balance deficit or lower extremity problem (adjusted odds ratio [aOR], 9.0; 95% confidence interval [CI], 2.0 to 41.0), confusion (aOR, 3.6; 95% CI, 1.6 to 8.4), use of sedatives/hypnotics (aOR, 4.3; 95% CI, 1.6 to 11.5), use of diabetes medications (aOR, 3.2; 95% CI, 1.3 to 7.9), increasing patient-to-nurse ratio (aOR, 1.6; 95% CI, 1.2 to 2.0), and activity level of "up with assistance" compared with "bathroom privileges" (aOR, 8.7; 95% CI, 2.3 to 32.7). Urinary or stool frequency or incontinence was of borderline significance (aOR, 2.3; 95% CI, 0.99 to 5.6). Having one or more side rails raised was associated with a decreased risk of falling (aOR, 0.006; 95% CI, 0.001 to 0.024).ConclusionsPatient health status, especially abnormal gait or lower extremity problems, medications, as well as care-related factors, increase the risk of falling. Fall prevention programs should target patients with these risk factors and consider using frequently scheduled mobilization and toileting, and minimizing use of medications related to falling.

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