Iatrogenic causes of falls in hospitalised elderly patients: A case-control study

Objective: To explore risk factors associated with falls and to evaluate a strategy used by nurses to predict and prevent falls in a hospitalised cohort of elderly patients. Design: A case-control study of risk factors for falls in hospital. Setting: A district general hospital in the UK. Subjects: Altogether 181 patients in an acute integrated medical unit who had fallen were matched for age with 181 patients in the next bed who had not fallen. Results: It was found that 46% (84 of 181) of the fallers were taking one or more benzodiazepines compared with 27% (48 of 181) of the control patients (p<0.001). More fallers 20% (34 of 181) had their benzodiazepines prescribed during their current admission compared with 7% (13 of 181) of the control patients (p<0.001). Temazepam was the main benzodiazepine used by over 95% of cases and controls. Overall 25% (45 of 181) of the fallers had fallen before during the current admission. The logistic regression analysis showed that only a previous fall, benzodiazepine intake, and the need for maximum assistance were significant predictors of falling in hospital, odds ratios were 5.6 (95% confidence interval (CI) 2.7 to 11.6), 2.3 (95% CI 1.4 to 3.7), and 3.1 (95% CI 1.9 to 5.2) respectively. Most fallers had been identified at risk of falling (125; 69%) by ward staff and in 113 (90%) of those preventive measures had been undertaken. Falls were least likely to occur during visiting hours with a peak incidence during night-time. Conclusion: There is a need for evidenced based successful fall prevention strategies but our study also reinforces an urgent public health message that an alternative to benzodiazepines should be sought for night sedation for older patients.