Selected risk factors of patients’ falls in hospitals: low BMI, hypotension, increased heart rate, hypoglycaemia, anaemia

Czech version

Authors: I. Brabcová ¹; H. Hajduchová ¹; V. Tóthová ¹; S. Bártlová ¹; J. Holý ¹; M. Doseděl ²; J. Malý ²; J. Vlček ²; K. Papp ³
Authors‘ workplace: Jihočeská univerzita v Českých Budějovicích, Zdravotně sociální fakulta, Ústav ošetřovatelství, porodní asistence a neodkladné péče, Ředitelka: prof. PhDr. Valérie Tóthová, Ph. D. ¹; Univerzita Karlova v Praze, Farmaceutická fakulta v Hradci Králové, Katedra sociální a klinické farmacie, Vedoucí: doc. PharmDr. Josef Malý, Ph. D. ²; University of Debrecen, Faculty of Health in Nyíregyháza, Dean: Imre Semsei, Ph. D., DSc. ³
Published in: Prakt. Lék. 2020; 100(1): 23-28
Category: Of different specialties

Overview

Introduction: The risk of patients’ falls in hospitals is affected by a number of risk factors. The risk factors include low BMI values, hypotension or pathological haematological and biochemical blood values, respectively.

The goal of the research study consisted in evaluating the effect of selected physical and laboratory indicators on the incidence of patients’ falls in hospitals.

Methods: The case-and-control study was chosen for the research. The case group included 222 patients with fall during hospitalization, and the control group included 1076 patients with similar characteristics within fall during hospitalization. The study included 1298 patients in total. The data collection lasted from 1. 1. to 31. 12. 2017.

Results: The group of patients with fall showed a statistically significantly lower average BMI index (25.9 kg/m²) than the control group of patients without fall (27.3 kg/m²), p = 0.001. The risk estimate (RE) at BMI under 18.5 kg/m² is 1.641 [95%: CI 0.686–3.927]. RE at systolic pressure value under 110 mm Hg is 1.109 [95%: CI 0.674–1.825]. The group of patients with fall showed, on average, a statistically higher heart rate (79.8 min) than the control group of patients without fall (77.9 min), p = 0.015. The group of patients with fall showed a statistically significantly higher glycaemia level (7.1 mmol/l) than the control group of patients without fall (6.2 mmol/l), p = 0.001. The patients with fall had a lower average value of haemoglobin (120.8 g/l) than the patients without fall (122.3 g/l).  The patients with fall had statistically significantly lower values of K (4.2 mmol/l) and Cl (102.1 mmol/l) than the control group of patients without fall (K 4.7 mmol/l, p = 0.002) and (Cl 103.1 mmol/l, p = 0.026).

Conclusion: The results show that the monitoring of BMI, blood pressure, haematological and biochemical blood examinations constitutes an integral part of the program of prevention of falls of hospitalized patients.

Sources

1. Joint Commission International. Prevence pádů ve zdravotnickém zařízení. Cesta k dokonalosti a zvyšování kvality. Praha: Grada Publishing 2007.

2. Jarošová D, Majkusová K, Zeleníková R, a kol. Prevence pádů a zranění způsobených pády u starších dospělých – Klinický doporučený postup adaptovaný [online]. Dostupné z: https:dokumenty.osu.cz/lf/uom/uom-publikace/kdp-pady-plna-verze.pdf [cit. 2019-11-19].

3. Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am 2006; 90(5): 807–824.

4. Brabcová I, Hajduchová H, Tóthová V, Bártlová S. Souvislosti mezi pády pacientů a vybranými rizikovými faktory. Prakt. Lék. 2017; 97(4): 163–167.

5. Kaňovský P. Poruchy chůze a pády ve stáří. Neurol. praxi 2003; 1: 21–25.

6. Manlapaz DG, Sole G, Jayakaran P, Chapple CM. Risk factors for falls in adults with knee osteoarthritis: a systematic review. PMR 2019; 11(7): 745–757.

7. Greco EA, Pietschmann P, Migliaccio S. Osteoporosis and sarcopenia increase frailty syndrome in the elderly. Front Endocrinol. 2019; 10: 255 [online]. Dostupné z: https://doi.org/10.3389/fendo.2019.00255 [cit. 2019-11-19].

8. Tinetti ME, Kumar C. The patient who falls: It’s always a trade-off. JAMA 2010; 303(3): 258–266.

9. Idiaquez J, Roman GC. Autonomic dysfunction in neurodegenerative dementias. J Neurol Sci 2011; 305: 22–27.

10. Mazur, K., Wilczyński, K., Szewieczek, J. Geriatric falls in the context of a hospital fall prevention program: delirium, low body mass index, and other risk factors. Clin Interv Aging 2016; 11: 1253–1261 [online]. Dostupné z: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5027952/ [cit. 2019-11-19].

11. Finucane C, Kenny RA. Falls risk, orthostatic hypotension, and optimum blood pressure management: is it all in our heads? Am J Hypertens 2016; 30(2): 115–117 [online]. Dostupné z: https://doi.org/10.1093/ajh/hpw129 [cit. 2019-11-19].

12. McDonald C, Pearce M, Kerr SR, Newton J. A prospective study of the association between orthostatic hypotension and falls: definition matters. Age Ageing 2016; 46(3): 439–445.

13. Jansen S, Bhangu J, de Rooij S, et al. The association of cardiovascular disorders and falls: a systematic review. J Am Med Dir Assoc 2016; 17(3): 193–199.

14. Mol A, Bui Hoang PTS, Sharmin S, et al. Orthostatic hypotension and falls in older adults: a systematic review and meta-analysis. J Am Med Dir Assoc 2018; 25(5): 589–597.

15. Dharmarajan TS, Avula S, Norkus EP. Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients. J Am Med Dir Assoc 2006; 7(5): 287–293.

16. Tachi T, Yokoi T, Goto C, et al. Hyponatremia and hypokalemia as risk factors for falls. Eur J Clin Nutr 2015; 69(2): 205–210.

17. Yau RK, Strotmeyer ES, Resnick HE, et al. Diabetes and risk of hospitalized fall injury among older adults. Diabetes Care 2013; 36(12): 3985–3991.

18. Doseděl M, Malý J, Vosátka J, a kol. Zapojení klinického farmaceuta do managementu pádů u polymorbidního geriatrického pacienta s opakovanými pády v anamnéze. Čes. slov. Farm. 2018; 67: 205–211.

19. de Groot MH, van Campen JP, Moek MA, et al. The effects of fall risk increasing drugs on postural control. a literature review. Drugs Aging 2013; 30(11): 901–920.

20. Seppala LJ, Wermelink AMAT, de Vries M, et al. Fall-risk-increasing drugs: a systematic review and meta-analysis: II. Psychotropics. J Am Med Dir Assoc 2018; 19(4): 371.e11–371.e17 [online]. Dostupné z: https://www.jamda.com/article/S1525-8610(17)30784-3/fulltext [cit. 2019-11-19].

21. Papakonstantinopoulou K, Sofianos I. Risk of falls in chronic kidney disease. JFSF 2017; 2(2): 33–38.

22. Kalvach Z, Holmerová I. Geriatrická křehkost – významný klinický fenomén. Med. praxi 2008; 5(2): 66–69.

23. Topinková E. Geriatrie pro praxi. Praha: Galén 2005.

24. Šeblová J, Škulec R. Diferenciální diagnostika kolapsových stavů a přechodných poruch vědomí. Med. praxi 2011; 8(6): 265–267.

25. O’Neil CA, Krauss MJ, Bettale J, et al. Medications and patient characteristics associated with falling in the hospital. J Patient Saf 2018; 14(1): 27–33.

26. Bieniek J, Wilczyński K, Szewieczek J. Fried frailty phenotype assessment components as applied to geriatric inpatients. Clin Interv Aging 2016; 11: 453–459.

27. Kojima G, Kendrick D, Skelton DA, et al. Frailty predicts short-term incidence of future falls among British community-dwelling older people: a prospective cohort study nested within a randomised controlled trial. BMC Geriatr 2015; 15: 155 [online]. Dostupné z: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4667521/ [cit. 2019-11-19].

28. Hubbard RE, Lang IA, Llewellyn DJ, Rockwood K. Frailty, body mass index, and abdominal obesity in older people. J Gerontol A Biol Sci Med Sci 2010; 65(4): 377–381.

29. Sheehan KJ, O’Connell MD, Cunningham C, et al. The relationship between increased body mass index and frailty on falls in community dwelling older adults. BMC Geriatr 2013; 13: 132 [online]. Dostupné z: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4029500/ [cit. 2019-11-19].

30. Dukas LC, Schacht E, Mazor Z, Stahelin HB. A new significant and independent risk factor for falls in elderly men and women: a low creatinine clearance of less than 65 ml/min. Osteoporosis Int 2005; 16(3): 332–338.