The study by Vassallo ef examined a much researched area, but is particularly useful to nurses and allied healthcare professionals who care for older adults in institutional rehabilitation settings. It adds to what is known by examining factors that can be used to identify patients who are likely to fall soon after transfer.The study has certain strengths. It is prospective, and falls were assessed by someone unaware of the risk factors. The tools used to assess patients' risk of falling are well recognised and used in many clinical areas. Their use enabled a large number of known fall risk factors to be considered. However, postural hypotension, which was probably a risk factor for some patients in this study, was not considered. The number of patients who had early fall was relatively low, which reduced the power of the study to identify risk factors.The authors found little to distinguish between the characteristics of patients who had early and late falls except a past history of falls (which increased the risk of an early fall) and lower limb fracture (which decreased the risk). Previous falls are a known risk factor among patients in hospital,' and this finding emphasises the particular vulnerability of this group after transfer to a rehabilitation facility. The psychological effect of "a fear of falling"2 may have contributed to the reduced risk of falls among those with lower limb fractures as these patients may have had serious injuries in previous falls.It would have been useful to know the time of day the falls occurred because this would have implications for appropriate staffing. However, the study stresses the importance of individualised and early multi-disciplinary fall risk assessment for all older adults on transfer to a rehabilitation ward, as well as continued regular reassessment.
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