RISK OF FALLS AFTER HOSPITAL DISCHARGE

Objectives: To determine the incidence of falls within the first month after hospitalization and risk factors associated with falling during this period. Design: Cohort study with 1-month follow-up after hospit al discharge. Setting: 370-bed community hospital. Patients: Consecuti ve sample of 214 patients, aged 70 years and over, hospitalized for me dical illness more than 48 hours and discharged to the community. Excl usion criteria: terminal illness, neurologic diagnosis, discharge to s killed nursing facility. Measurements: Information was obtained at hos pital admission, discharge, and 1 month after discharge. Initial asses sment included demographic data, vision, mood, pre-admission function, and use of assistive device. Discharge assessment included length of hospital stay, use of assistive device, need for professional help aft er discharge, medications, cognition, and functional status. Patients were assessed 1 month after discharge for history of confusion and fal ls. Main outcome measure was falls in the first month after discharge. Main Results: Twenty-nine patients (13.6%) fell during the month afte r discharge. Major risk factors for falls included, at discharge, decl ine in mobility (P = 0.005), use of assistive device (P = 0.002), and cognitive impairment (P = 0.05), and after hospital discharge, self-re port of confusion (P = 0.002). Patients who were functionally dependen t and needed professional help after discharge had the highest rate of falls (20.2%). In contrast, only 8.4% of independent patients not req uiring professional help fell (P = 0.01). Conclusions: There is a high incidence of falls after hospital discharge, particularly among patie nts who are functionally dependent. Further study is needed to determi ne to what extent acute illness and hospitalization may influence fall s risk.