Risk factors for falling in psychiatric inpatients: A prospective, matched case-control study

摘要

Falling is one the most common types of inpatient adverse events. Most fall-related research was conducted retrospectively and focused on elderly population in general hospital settings. This study aimed to timely identify all potential risk factors associated with falls and fall-related injury in a psychiatric inpatient setting. We recruited 145 fall events and 145 sex- and room-matched psychiatric control inpatients without fall in a 1002-bed psychiatric teaching hospital in northern Taiwan. In addition to medical records, the study variables included patient characteristics, circumstances and medications, which were collected from the patients and/or their families within 24h of receiving reports right after obtaining written informed consent. A psychiatrist and three head nurses conducted a comprehensive assessment of risk factors immediately after falls occurred. A conditional logistic regression model revealed four variables significantly associated with an increased risk of falling: the clinical global impression-severity (adjusted odds ratio (aOR)=2.19; 95% confidence interval, CI=1.13-4.24), the parkinsonism scores of the extrapyramidal syndrome rating scale (aOR=1.14; 95% CI=1.08-1.21), equivalent dosage of benzodiazepines use (aOR=1.15; 95% CI=1.03-1.30), and medication changes within 24h (aOR=10.3; 95% CI=1.37-76.8). Acute settings (aORs=2.06, 95% CI=1.01-4.18), a fall history in the past six months and a lack of history of medical problems (aORs=3.04; 95% CI=1.46-6.33) were associated with fall-related injury (aOR=2.70; 95% CI=1.29-5.69). Our study identified the severity of psychotic symptoms, extrapyramidal symptoms, medications usage and other several specific measures for prevention of falls in psychiatric inpatient settings.