Maria Nathalia Silva , Yanne da Silva Camargo , Tathiane Ribeiro da Silva , Andrea M. Bernardes da Silva , Diogo Fernandes dos Santos , Douglas Eulálio Antunes
{"title":"Prognostic factors of falls in hospitalized adults and elderly: An epidemiological and clinical analysis","authors":"Maria Nathalia Silva , Yanne da Silva Camargo , Tathiane Ribeiro da Silva , Andrea M. Bernardes da Silva , Diogo Fernandes dos Santos , Douglas Eulálio Antunes","doi":"10.1016/j.injury.2024.111966","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>Falls are known to cause injuries ranging from minor to severe, resulting in local or systemic lesions. Addressing prognostic factors associated with falls is crucial for preventing this adverse event through the implementation of patient care protocols. This study aimed to explore the epidemiological, clinical, and pharmacological prognostic factors influencing falls in adult and elderly patients, assessing the timing and impact of these factors using survival curve analysis.</div></div><div><h3>Methods</h3><div>A retrospective observational cohort study included 176 hospitalized patients experiencing falls, categorized into adults (<60 years) and elderly (≥60 years). Binomial tests and logistic regression assessed variable associations, while Kaplan-Meier curves and Cox proportional hazards models analyzed survival.</div></div><div><h3>Results</h3><div>Overall, 25.9 % of adults and 33.3 % of the elderly experienced some form of injury (minor or moderate). Patients were alone during the fall in 77.6 % of cases for those under 60, compared to 50 % for those 60 and older (<em>p</em> < 0.001). Falls from own height were the most common, occurring in 46.6 % of patients under 60 years and 66.7 % of elderly patients (<em>p</em> = 0.011). Among adults under 60, factors such as past alcohol history (<em>p</em> = 0.0276), falling alone (<em>p</em> = 0.0002), benzodiazepine use (<em>p</em> = 0.0001), antiarrhythmic/antihypertensive medication (<em>p</em> = 0.0005), and antipsychotics (<em>p</em> = 0.0001) were significantly associated with falls. In the elderly, significant factors included falling from one's own height (<em>p</em> = 0.0112), muscle weakness (<em>p</em> = 0.0183), gait disorders (<em>p</em> = 0.0443), vasodilators (<em>p</em> = 0.0107), antihistamines (<em>p</em> = 0.0003), and hypoglycemic agents (<em>p</em> = 0.0041). Survival curve analysis indicated women under 60 had a worse prognosis for falls compared to elderly women (<em>p</em> = 0.038). For the elderly, opioid use (<em>p</em> = 0.045) and muscle weakness (<em>p</em> = 0.037) represented poor prognostic factors compared to adults under 60. In Cox regression, only female sex in patients under 60 showed a higher risk (HR=1.47) compared to women over 60 (<em>p</em> = 0.0014). Although not significant in multivariate analysis, muscle weakness (<em>p</em> = 0.066) and opioid use (<em>p</em> = 0.0545) had proportional hazards of 1.37 and 1.12, respectively.</div></div><div><h3>Conclusion</h3><div>Female sex indicated poorer prognosis in <60 s, while opioids and muscle weakness were concerning for the elderly. These findings emphasize the need for tailored care protocols to stratify patient fall risk and prognosis during hospitalization and develop effective preventive strategies in healthcare<strong>.</strong></div></div>","PeriodicalId":54978,"journal":{"name":"Injury-International Journal of the Care of the Injured","volume":"55 12","pages":"Article 111966"},"PeriodicalIF":2.2000,"publicationDate":"2024-10-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Injury-International Journal of the Care of the Injured","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0020138324006958","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0
Abstract
Background
Falls are known to cause injuries ranging from minor to severe, resulting in local or systemic lesions. Addressing prognostic factors associated with falls is crucial for preventing this adverse event through the implementation of patient care protocols. This study aimed to explore the epidemiological, clinical, and pharmacological prognostic factors influencing falls in adult and elderly patients, assessing the timing and impact of these factors using survival curve analysis.
Methods
A retrospective observational cohort study included 176 hospitalized patients experiencing falls, categorized into adults (<60 years) and elderly (≥60 years). Binomial tests and logistic regression assessed variable associations, while Kaplan-Meier curves and Cox proportional hazards models analyzed survival.
Results
Overall, 25.9 % of adults and 33.3 % of the elderly experienced some form of injury (minor or moderate). Patients were alone during the fall in 77.6 % of cases for those under 60, compared to 50 % for those 60 and older (p < 0.001). Falls from own height were the most common, occurring in 46.6 % of patients under 60 years and 66.7 % of elderly patients (p = 0.011). Among adults under 60, factors such as past alcohol history (p = 0.0276), falling alone (p = 0.0002), benzodiazepine use (p = 0.0001), antiarrhythmic/antihypertensive medication (p = 0.0005), and antipsychotics (p = 0.0001) were significantly associated with falls. In the elderly, significant factors included falling from one's own height (p = 0.0112), muscle weakness (p = 0.0183), gait disorders (p = 0.0443), vasodilators (p = 0.0107), antihistamines (p = 0.0003), and hypoglycemic agents (p = 0.0041). Survival curve analysis indicated women under 60 had a worse prognosis for falls compared to elderly women (p = 0.038). For the elderly, opioid use (p = 0.045) and muscle weakness (p = 0.037) represented poor prognostic factors compared to adults under 60. In Cox regression, only female sex in patients under 60 showed a higher risk (HR=1.47) compared to women over 60 (p = 0.0014). Although not significant in multivariate analysis, muscle weakness (p = 0.066) and opioid use (p = 0.0545) had proportional hazards of 1.37 and 1.12, respectively.
Conclusion
Female sex indicated poorer prognosis in <60 s, while opioids and muscle weakness were concerning for the elderly. These findings emphasize the need for tailored care protocols to stratify patient fall risk and prognosis during hospitalization and develop effective preventive strategies in healthcare.
期刊介绍:
Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.