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 When elderly patients are discharged, one of the major reasons they
end up back in the hospital is that they've suffered a fall,
researchers found.
"Hospitals spend a lot of time thinking about fall risk while the
patient is in the hospital, but there's much less attention to the
patient after discharge," said principal investigator Geoffrey
Hoffman of the University of Michigan School of Nursing.
Fall prevention efforts need to continue as the patient moves from
the hospital to home, or elsewhere, he said.
Hoffman and colleagues analyzed data on more than 8.3 million
patients, age 65 and above, who were hospitalized in 2013 and 2014.
About 14% of the patients were readmitted within 30 days of being
discharged.
Among these patients, about 5% were readmitted due to injuries
caused by falling, making it the third leading cause of readmissions
after blood poisoning due to bacteria and heart failure.
The prevalence of falls after discharge suggests there is a gap in
the quality of care provided before and after patients leave the
hospital, Hoffman said.
"Promoting mobility in and outside the hospital is critical,"
Hoffman told Reuters Health by phone.
Medicare, the government insurance program for older Americans,
penalizes hospitals when patients fall. To minimize these penalties,
hospitalized patients at high risk of falling may be discouraged
from getting up and moving around without assistance. This enforced
immobility could increase the risk of falls after discharge, the
researchers noted.
While hospitals already have programs in place to prevent
readmissions due to other post-discharge complications, the current
findings suggest these programs should also include fall prevention,
the researchers write in JAMA Network Open.
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Preventing falls requires multifaceted interventions, some of which
are beyond the hospital's control, said Tamara Konetzka, a
researcher at the University of Chicago who has studied patient
safety but who was not involved in the new study.
These interventions include physical and occupational therapy to
improve balance, medication review to avoid drugs that may
contribute to dizziness, and home modification efforts such as
installing handrails and removing rugs or slippery surfaces.
Patients who had fallen in the past, and those with impaired
cognition, had a higher risk of being readmitted for any reason, the
researchers found - particularly if they went home after discharge,
rather than to a skilled nursing facility.
"You essentially can't change someone's cognition or the fact that
they have fallen previously. What type of care they receive
following a hospital stay and where they receive it can be
modified," Matthew Titmuss, assistant vice president of value
management at the Hospital for Special Surgery in New York, told
Reuters Health by email.
"Falls are often the initial trigger for a trajectory of decline
among older adults - a trajectory including functional limitations,
multiple hospitalizations, and long-term nursing home use," Konetzka
told Reuters Health by email. "Reducing falls may thus have much
broader implications for health outcomes."
SOURCE: https://bit.ly/2M9qOPz JAMA Network Open, online May 24,
2019.
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