Factors associated with falls in elderly inpatients: an integrative review

Authors

DOI:

https://doi.org/10.33448/rsd-v11i9.31719

Keywords:

Aged; Accidental Falls; Hospitalization; Patient Safety; Review.

Abstract

Objective: To identify the main factors associated with falls in elderly inpatients in the scientific literature. Method: We conducted an integrative literature review with searches in the following databases: MedLine via VHL, PubMed, SciELO, Web of Science, Scopus, and LILACS. We identified 2,969 publications, of which 11 were selected for the final sample of this study. We built a theoretical model for the critical analysis and data presentation. The factors that presented association or risk for falls in elderly inpatients were considered as evidence. Results: The factors associated with falls in elderly inpatients were categorized into intrinsic and extrinsic. The main intrinsic factors identified were: 1) functional decline, delirium, history of falls, and advanced age; and the extrinsic factors: admission to a surgical ward and the use of central nervous system depressants, more precisely sedatives and antipsychotics. We observed that these factors are associated in the studied population. Conclusion: The studies showed that intrinsic factors are the main risk factors for falls in hospitalized elderly. However, we observed their association with extrinsic factors and the complexity of falls. Thus, these findings highlight the importance of multidimensional assessment of hospitalized elderly, the adoption of fall prevention strategies and timely intervention on modifiable factors, providing more safety to the elderly patient in the hospital environment.

References

Abreu, H. C. de A., Reiners, A. A. O., Azevedo, R. C. de S., da Silva, A. M. C., Abreu, D. R. de O. M., & de Oliveira, A. D. (2015). Incidence and predicting factors of falls of older inpatients. Revista de Saude Publica, 49. https://doi.org/10.1590/S0034-8910.2015049005549

Albuquerque, N. L. S. de, Sisnando, M. J. de A., Sampaio Filho, S. P. C., Morais, H. C. C., Lopes, M. V. de O., & Araújo, T. L. de. (2013). Fatores de risco para quedas em pacientes hospitalizados com cardiopatia isquêmica. Revista Da Rede de Enfermagem Do Nordeste, 14(1), 158–168.

Anand, A., & MacLullich, A. M. J. (2021). Delirium in older adults. Medicine, 49(1), 26–31. https://doi.org/10.1016/j.mpmed.2020.10.002

Aryee, E., James, S. L., Hunt, G. M., & Ryder, H. F. (2017). Identifying protective and risk factors for injurious falls in patients hospitalized for acute care: a retrospective case-control study. BMC Geriatrics, 17(1), 260. https://doi.org/10.1186/s12877-017-0627-9

Babine, R. L., Hyrkäs, K. E., Bachand, D. A., Chapman, J. L., Fuller, V. J., Honess, C. A., & Wierman, H. R. (2016). Falls in A Tertiary Care Hospital-Association With Delirium: A Replication Study. Psychosomatics, 57(3), 273–282. https://doi.org/10.1016/j.psym.2016.01.003

Bai, J., Liang, Y., Zhang, P., Liang, X., He, J., Wang, J., & Wang, Y. (2020). Association between postoperative delirium and mortality in elderly patients undergoing hip fractures surgery: a meta-analysis. Osteoporosis International, 31(2), 317–326. https://doi.org/10.1007/s00198-019-05172-7

Billett, M. C., Campanharo, C. R. V., Lopes, M. C. B. T., Batista, R. E. A., Belasco, A. G. S., & Okuno, M. F. P. (2019). Functional capacity and quality of life of hospitalized octogenarians. Revista Brasileira de Enfermagem, 72(Suppl 2), 43–48. https://doi.org/10.1590/0034-7167-2017-0781

Brasil. Ministério da Saúde. (2013). Portaria no 529, de 1o de abril de 2013. Institui o Programa Nacional de Segurança do Paciente (PNSP). Diário Oficial da União.

Brock, F., Bettinelli, L. A., Dobner, T., Stobbe, J. C., Pomatti, G., & Telles, C. T. (2016). Prevalence of hypoalbuminemia and nutritional issues in hospitalized elders. Revista Latino-Americana de Enfermagem, 24. https://doi.org/10.1590/1518-8345.0260.2736

Cabral, J. F., Silva, A. M. C. da, Andrade, A. C. de S., Lopes, E. G., & Mattos, I. E. (2021). Vulnerabilidade e Declínio Funcional em pessoas idosas da Atenção Primária à Saúde: estudo longitudinal. Revista Brasileira de Geriatria e Gerontologia, 24(1). https://doi.org/10.1590/1981-22562021024.200302

Canuto, C. P. de A. S., Oliveira, L. P. B. A. de, Medeiros, M. R. de S., & Barros, W. C. T. dos S. (2020). Segurança do paciente idoso hospitalizado: uma análise do risco de quedas. Revista Da Escola de Enfermagem Da USP, 54, 1–9. https://doi.org/10.1590/s1980-220x2018054003613

Clemson, L., Mackenzie, L., Ballinger, C., Close, J. C. T., & Cumming, R. G. (2008). Environmental interventions to prevent falls in community-dwelling older people: a meta-analysis of randomized trials. Journal of Aging and Health, 20(8), 954–971. https://doi.org/https://doi.org/10.1177/0898264308324672

Gringauz, I., Shemesh, Y., Dagan, A., Israelov, I., Feldman, D., Pelz-Sinvani, N., Justo, D., & Segal, G. (2017). Risk of falling among hospitalized patients with high modified Morse scores could be further Stratified. BMC Health Services Research, 17(1). https://doi.org/10.1186/s12913-017-2685-2

Groot, G. C. L. de, Al-Fattal, A., & Sandven, I. (2020). Falls in hospital: a case-control study. Scandinavian Journal of Caring Sciences, 34(2), 332–339. https://doi.org/10.1111/scs.12733

Hou, W.-H., Kang, C.-M., Ho, M.-H., Kuo, J. M.-C., Chen, H.-L., & Chang, W.-Y. (2017). Evaluation of an inpatient fall risk screening tool to identify the most critical fall risk factors in inpatients. Journal of Clinical Nursing, 26(5–6), 698–706. https://doi.org/10.1111/jocn.13510

Ishida, Y., Maeda, K., Nonogaki, T., Shimizu, A., Yamanaka, Y., Matsuyama, R., Kato, R., & Mori, N. (2020). Malnutrition at Admission Predicts In-Hospital Falls in Hospitalized Older Adults. NUTRIENTS, 12(2). https://doi.org/10.3390/nu12020541

Kasuga, T., Aruga, F., Ono, K., Hiratsuka, Y., & Murakami, A. (2017). Visual impairment as an independent risk factor for falls in hospitalized patients. Canadian Journal of Ophthalmology, 52(6), 559–563. https://doi.org/10.1016/j.jcjo.2017.04.010

Lackoff, A. S., Hickling, D., Collins, P. F., Stevenson, K. J., Nowicki, T. A., & Bell, J. J. (2020). The association of malnutrition with falls and harm from falls in hospital inpatients: Findings from a 5-year observational study. Journal of Clinical Nursing, 29(3–4), 429–436. https://doi.org/10.1111/jocn.15098

Lee, J., Negm, A., Peters, R., Wong, E. K. C., & Holbrook, A. (2021). Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis. BMJ Open, 11(2), e035978. https://doi.org/10.1136/bmjopen-2019-035978

Levinoff, E., Try, A., Chabot, J., Lee, L., Zukor, D., & Beauchet, O. (2017). Precipitants of delirium in older inpatients admitted in surgery for post-fall hip fracture: an observational study. The Journal of Frailty & Aging, 1–6. https://doi.org/10.14283/jfa.2017.37

Lopes, A. A., do Carmo Jayme, D. H., de Abreu, I. L. V., Silva, I. E., Lobo, M. H. S., Oliveira, M. C., & de Freitas Pinheiro, I. (2020). Evaluation of visual functions and their relationship to functional vision and falls in active elderly of the community. Revista Brasileira de Oftalmologia, 79(4), 236–241. https://doi.org/10.5935/0034-7280.20200051

Maresova, P., Javanmardi, E., Barakovic, S., Barakovic Husic, J., Tomsone, S., Krejcar, O., & Kuca, K. (2019). Consequences of chronic diseases and other limitations associated with old age – a scoping review. BMC Public Health, 19(1), 1431. https://doi.org/10.1186/s12889-019-7762-5

Marinho, G. S., De Azevedo Alves, G. A., De Oliveira, D. F., Fagundes Góes, Â. C., & Martinez, B. P. (2017). Risco De Quedas Em Pacientes Hospitalizados. Revista Pesquisa Em Fisioterapia, 7(1), 55. https://doi.org/10.17267/2238-2704rpf.v7i1.1218

Mazur, K., Wilczyński, K., & Szewieczek, J. (2016). Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors. Clinical Interventions in Aging, 11, 1253–1261. https://doi.org/10.2147/CIA.S115755

Mendes, K. D. S., Silveira, R. C. de C. P., & Galvão, C. M. (2008). Revisão integrativa: método de pesquisa para a incorporação de evidências na saúde e na enfermagem. Texto & Contexto - Enfermagem, 17(4), 758–764. https://doi.org/10.1590/S0104-07072008000400018

Morsch, P., Myskiw, M., & Myskiw, J. de C. (2016). Falls’ problematization and risk factors identification through older adults’ narrative. Ciencia e Saude Coletiva, 21(11), 3565–3574. https://doi.org/10.1590/1413-812320152111.06782016

Moura, L. A., Araújo, J. N. de M., Fernandes, A. P. N. de L., Carvalho, R. E. F. L. de, Silva, H. P. da, Viviane Euzébia Pereira Santos, Ferreira Júnior, M. A., & Vitor, A. F. (2017). Fatores de risco para cair em idosos no ambiente hospitalar. Revista Cubana de Enfermería, 33(3).

Najafpour, Z., Godarzi, Z., Arab, M., & Yaseri, M. (2019). Risk factors for falls in hospital in-patients: A prospective nested case control study. International Journal of Health Policy and Management, 8(5), 300–306. https://doi.org/10.15171/ijhpm.2019.11

Oliveira, A. S. de, Trevizan, P. F., Bestetti, M. L. T., & Melo, R. C. de. (2014). Fatores ambientais e risco de quedas em idosos: revisão sistemática. Revista Brasileira de Geriatria e Gerontologia, 17(3), 637–645. https://doi.org/10.1590/1809-9823.2014.13087

Oliveira, D. V. de, Pivetta, N. R. S., Yamashita, F. C., Nascimento, M. A. do, Santos, N. Q. dos, Nascimento Júnior, J. R. A. do, & Bertolini, S. M. M. G. (2021). Funcionalidade e força muscular estão associadas ao risco e medo de quedas em idosos? Revista Brasileira Em Promoção Da Saúde, 34, 1–9. https://doi.org/10.5020/18061230.2021.10903

Pasa, T. S., Magnago, T. S. B. D. S., Urbanetto, J. D. S., Baratto, M. A. M., Morais, B. X., & Carollo, J. B. (2017). Risk assessment and incidence of falls in adult hospitalized patients. Revista Latino-Americana de Enfermagem, 25. https://doi.org/10.1590/1518-8345.1551.2862

Pi, H.-Y., Gao, Y., Wang, J., Hu, M.-M., Nie, D., & Peng, P.-P. (2016). Risk Factors for In-Hospital Complications of Fall-Related Fractures among Older Chinese: A Retrospective Study. BioMed Research International, 2016. https://doi.org/10.1155/2016/8612143

Rashid, I., Tiwari, P., & Lehl, S. S. (2019). Prevalence and determinants of fall risk among elderly inpatients at a tertiary care public teaching hospital. Journal of Gerontology and Geriatrics, 2019(2), 96–102. https://www.scopus.com/inward/record.uri?eid=2-s2.0-

&partnerID=40&md5=f8fc46dcda3aa77ebf6a6a347e834fa7

Rubenstein, L. Z., Powers, C. M., & MacLean, C. H. (2001). Quality Indicators for the Management and Prevention of Falls and Mobility Problems in Vulnerable Elders. Annals of Internal Medicine, 135(8), 686–693. https://doi.org/10.7326/0003-4819-137-6-200209170-00020

Santos, J. da S., Valente, J. M., Carvalho, M. A. de, Galvão, K. de M., & Kasse, C. A. (2013). Identificação dos fatores de riscos de quedas em idosos e sua prevenção Identification of falls risks in elderly and its prevention. Revista Equilíbrio Corporal e Saúde, 5(2), 53–59.

Silva, E. N. da, Sakai, A. M., Trelha, C. S., Cabrera, M. A. S., & Dellaroza, M. S. G. (2021). Medidas de prevenção de queda em idosos hospitalizados. Revista Enfermagem Em Foco, 11(6). https://doi.org/10.21675/2357-707X.2020.v11.n6.3419

Souza, M. T. de, Silva, M. D. da, & Carvalho, R. de. (2010). Integrative review: what is it? How to do it? Einstein, 8(1), 102–108. https://www.scielo.br/pdf/eins/v8n1/pt_1679-4508-eins-8-1-0102

Staggs, V. S., Mion, L. C., & Shorr, R. I. (2014). Assisted and unassisted falls: Different events, different outcomes, different implications for quality of hospital care. Joint Commission Journal on Quality and Patient Safety, 40(8), 358–364. https://doi.org/10.1016/S1553-7250(14)40047-3

Vaccari, É., Lenardt, M. H., Willig, M. H., Betiolli, S. E., & Soares De Andrade, L. A. (2016). Segurança do paciente idoso e o evento queda no ambiente hospitalar. Cogitare Enfermagem, 21, 1–9. http://revistas.ufpr.br/cogitare/

Van Grootven, B., Jeuris, A., Jonckers, M., Devriendt, E., Dierckx de Casterlé, B., Dubois, C., Fagard, K., Herregods, M.-C., Hornikx, M., Meuris, B., Rex, S., Tournoy, J., Milisen, K., Flamaing, J., & Deschodt, M. (2020). Predicting hospitalisation-associated functional decline in older patients admitted to a cardiac care unit with cardiovascular disease: a prospective cohort study. BMC Geriatrics, 20(1), 112. https://doi.org/10.1186/s12877-020-01510-1

Venema, D. M., Skinner, A. M., Nailon, R., Conley, D., High, R., & Jones, K. J. (2019). Patient and system factors associated with unassisted and injurious falls in hospitals: an observational study. BMC Geriatrics, 19(1), 348. https://doi.org/10.1186/s12877-019-1368-8

Wedmann, F., Himmel, W., & Nau, R. (2019). Medication and medical diagnosis as risk factors for falls in older hospitalized patients. European Journal of Clinical Pharmacology, 75(8), 1117–1124. https://doi.org/10.1007/s00228-019-02668-3

World Health Organization. (2007). WHO Global Report on Falls Prevention in Older Age. WHO.

Zhao, M., Li, S., Xu, Y., Su, X., & Jiang, H. (2020). Developing a Scoring Model to Predict the Risk of Injurious Falls in Elderly Patients: A Retrospective Case–Control Study in Multicenter Acute Hospitals. Clinical Interventions in Aging, Volume 15, 1767–1778. https://doi.org/10.2147/CIA.S258171

Zhao, Y., Bott, M., He, J., Kim, H., Park, S. H., & Dunton, N. (2019). Evidence on Fall and Injurious Fall Prevention Interventions in Acute Care Hospitals. JONA: The Journal of Nursing Administration, 49(2), 86–92. https://doi.org/10.1097/NNA.0000000000000715

Downloads

Published

07/07/2022

How to Cite

ARAÚJO, M. P. D. .; NUNES, V. M. de A. .; ROSENDO, C. W. F. .; LIMA, F. A. S. de; SOARES, R. N. F. .; FERREIRA NETO, P. D. .; OKUNO, M. F. P. .; MENDES, F. R. P. .; TORRES, G. de V. Factors associated with falls in elderly inpatients: an integrative review . Research, Society and Development, [S. l.], v. 11, n. 9, p. e20711931719, 2022. DOI: 10.33448/rsd-v11i9.31719. Disponível em: https://rsdjournal.org/index.php/rsd/article/view/31719. Acesso em: 12 nov. 2024.

Issue

Vol. 11 No. 9

Section

Review Article

License

Copyright (c) 2022 Mayara Priscilla Dantas Araújo; Vilani Medeiros de Araújo Nunes; Clara Wilma Fernandes Rosendo; Flávio Anselmo Silva de Lima; Ruth Nayara Firmino Soares; Pedro Duarte Ferreira Neto; Meiry Fernanda Pinto Okuno; Felismina Rosa Parreira Mendes; Gilson de Vasconcelos Torres

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Authors who publish with this journal agree to the following terms:

1) Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

2) Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.

3) Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work.