Fall Risk in Patients with Acute Psychosis

Patient Falls in Seclusion Rooms in Psychiatric Inpatient Care: A Sociotechnical Probabilistic Risk Modeling Study

BACKGROUND

Patient falls are a major adverse event in psychiatric inpatient care.

PURPOSE

To model the risk for patient falls in seclusion rooms in psychiatric inpatient care.

METHODS

Sociotechnical probabilistic risk assessment (ST-PRA) was used to model the risk for falls. Data sources were the research team, literature review, and exploration groups of psychiatric nurses. Data were analyzed with fault tree analysis.

RESULTS

The risk for a patient fall in a seclusion room was 1.8%. Critical paths included diagnosis of a psychiatric disorder, the mechanism of falls, failure to assess and prevent falls, and psychological or physical reason. The most significant individual risk factor for falls was diagnosis of schizophrenia.

CONCLUSIONS

Falls that occur in seclusion events are associated with physical and psychological risk factors. Therefore, risk assessment methods and fall prevention interventions considering patient behavioral disturbance and physiological risk factors in seclusion are warranted.

Fall-risk-increasing drugs and falls requiring health care among older people with intellectual disability in comparison with the general population: A register study

Background

Falls are the most common cause of injury for older people in the general population as well as among those with intellectual disability. There are many risk factors for falls, including a range of drugs which are considered to be fall-risk-increasing (FRIDs). The aim of the present study was to describe prescription patterns of FRIDs in itself as well as in relation to falls requiring health care among older people with intellectual disability and their age-peers in the general population. Moreover, to investigate possible differences between the two groups.

Methods

A cohort of people with intellectual disability and a referent cohort, one-to-one-matched by sex and year of birth, were established. Each cohort comprised 7936 people aged 55+ years at the end of 2012. Register data were collected for 2006–2012 on prescription of antidepressants, anxiolytics, hypnotics and sedatives, opioids, and antipsychotics, as well as for fall-related health care contacts. Analyses were performed on yearly data, using repeated measures models.

Results

People with intellectual disability were more likely to be prescribed at least one FRID (Relative Risk [RR] 2.31). The increase was highest for antipsychotics (RR 25.0), followed by anxiolytics (RR 4.18), antidepressants (RR 2.72), and hypnotics and sedatives (RR 1.42). For opioids, however, a lower prevalence (RR 0.74) was found. In both cohorts, those with prescription of at least one FRID were more likely to have a fall-related injury that required health care. The increased risk was higher in the referent cohort (RR 3.98) than among people with intellectual disability (RR 2.27), although people with intellectual disability and prescription still had a higher risk of falls than those with prescription in the referent cohort (RR 1.27). A similar pattern was found for all drug groups, except for opioids, where prescription carried the same risk of having a fall-related injury that required health care in both cohorts.

Conclusions

With or without prescription of FRIDs, older people with ID have a higher risk of falls requiring health care than their age-peers in the general population. It is important to be aware of this when prescribing drugs that further increase the risk of falls.

Managing Patient Falls in Psychiatric Inpatient Units: Part 1

The problem addressed in the current quantitative, descriptive study was the significantly higher number of patient falls in hospital inpatient psychiatric units than in medical-surgical areas, resulting in patient-safety issues. The purpose of this study was to explore psychiatric unit directors' perceptions of the factors that contribute to patient falls in the State of Michigan. Two research questions guided the study: (a) What are psychiatric unit directors' perceptions of the possible intrinsic factors that contribute to patient falls in the psychiatric inpatient units, and (b) what are psychiatric unit directors' perceptions of the possible extrinsic factors that contribute to patient falls in the psychiatric inpatient units? An online survey was the tool used to gather data from the State of Michigan psychiatric unit directors. The analyses for the 2 questions indicated the participants believed that intrinsic factors were more strongly related to the likelihood of patient falls than were extrinsic factors.

Managing Patient Falls in Psychiatric Inpatient Units: Part 2

Patient falls in the hospital psychiatric inpatient units are more frequent than in the medical-surgical units. The purpose of this study was to explore psychiatric unit directors' perceptions of the factors that contribute to patient falls in the State of Michigan. A quantitative online questionnaire was sent to the directors of psychiatric units in Michigan. Two research questions (RQs) guided the study: (a) What are psychiatric unit directors' perceptions of the possible intrinsic factors that contribute to patient falls in the psychiatric inpatient units, and (b) what are psychiatric unit directors' perceptions of the possible extrinsic factors that contribute to patient falls in the psychiatric inpatient units? In comparing the results, 6 of the 7 factors with the highest mean levels of agreement were intrinsic factors. In the current study, patient gait (mean, 4.65) ranked first, history of falls (mean, 4.52) second, and multiple medications (mean, 4.50) third as fall-risk factors. The need for the involvement of the team members (mean, 4.55) in preventing falls was the most highly rated factor among the extrinsic factors. Educating unit team members in assisting with fall prevention is a critical consideration for leaders.

Falls in elderly people: a multifactorial analysis of risk markers using data from the Swedish general population study 'Good ageing in Skåne'

BACKGROUND AND AIMS

The aim of this study was to describe the prevalence of falls in a general older population, especially among the most elderly, and the risk markers associated with falls.

METHODS

This is a cross-sectional study in which 38 fall risk markers were analysed in non-, occasional- and frequent-fallers. The population was 2,865 individuals (aged 60-93), randomly selected from the general population register. The risk of falling was calculated as age-adjusted odds ratios. The relation between the number of risk markers for an individual and falls was also analysed.

RESULTS

About one in ten reported falling during the past 6 months, 35% of which were over 90 years old. Twenty-one risk markers were significantly related to falls confirming falling as a multifactorial problem. These included a variety of diseases, symptoms, medical and physical functions, life-style factors and the taking of certain drugs. The five risk markers with the highest odds ratio in frequent fallers were 'tendency to fall' (37.9), 'low walking speed' (12.8), consumption of 'neuroleptics' (10.9), 'impaired mobility' (10.0) and 'dementia' (5.4). Subjects with more than four and seven risk markers showed a 9- respectively 28-fold increase in the risk of falling, especially among frequent fallers and those aged over 90 years.

CONCLUSION

Falls are common in the elderly population and the risk is multifactorial. The results imply that there is an overrepresentation of fallers in a distinct subgroup of the very elderly and those with multiple risk markers. The self-perceived clinical sign 'tendency to fall' seems highly sensitive as indicator of individuals at risk. Several risk markers may be treatable. Fall risk seems to increase in a non-linear, almost exponential way with increasing number of risk markers.

Assessing falls risk in older adult mental health patients: a Western Australian review

Falls are a common and costly complication of hospitalization, particularly in older adult populations. This paper presents the results of a review of 139 falls at two older adult mental health services in Western Australia, Australia, over a 12-month period. Data were collected from the hospital incident report management system and from case file reviews of patients who sustained a fall during hospitalization. The results demonstrated that the use of different risk assessment and falls management tools led to variations in practice, policies, and management strategies. The review identified mental health-specific falls risk factors that place older people with a mental illness at risk when admitted to the acute mental health setting. With the expansion of community mental health care, many older people with a mental illness are now cared for in a variety of health-care settings. In assessing falls risk and implementing falls-prevention strategies, it is important for clinicians to recognize this group as an ambulant population with a fluctuating course of illness. They have related risks that require specialized falls assessment and management.

Psychiatric patients are at increased risk of falling and choking

Acutely ill psychiatric patients experience symptoms and take medications that increase their risk of both falling and choking; however, nurses and other caregivers may not be keenly aware of these risks. This article will provide a brief review of the literature related to risk factors for falls and choking and interventions to prevent falls and choking. Increased education for nursing students and staff employed at inpatient psychiatric units has the potential to reduce both incidence and injuries related to falls and choking.

Effectiveness of interventions for the assessment and prevention of falls in adult psychiatric patients: A systematic review

BACKGROUND

Patient fall is among the top five sentinel events in hospitals due to the resultant functional loss and injury sustained. Precise fall risk assessment and prevention strategies are important components of a fall prevention program. Due to psychiatric conditions and medications, these patients may require a different fall management program compared to other patient populations.

OBJECTIVE

The objective of this review was to identify the best available evidence for the effectiveness of nursing fall risk assessment tools, interventions to reduce incidence of falls, and common risk factors of adult psychiatric patients who fall.

INCLUSION CRITERIA

Adults (19 to 64 years) diagnosed with mental illnessEvaluation of nursing fall risk assessment tools in adult psychiatric settings, and interventions, which minimised fall risk or fall rates.Number of patient falls during hospitalisation was the main outcome.Primary quantitative studies published in English language.

SEARCH STRATEGY

The literature search sought published studies, and was limited to English language reports. There were no date restrictions applied to the search. Electronic databases searched included:CINAHLPubMedCochrane Central Register of Controlled TrialsPsycINFOScienceDirectScopusWeb of ScienceWiley-InterScienceProQuestMedNar METHODOLOGICAL QUALITY: Studies retrieved were assessed by two independent reviewers for methodological validity prior to inclusion in the review using standardised critical appraisal instruments from the Joanna Briggs Institute System for the Unified Management, Assessment and Review of Information (JBI-SUMARI).

DATA EXTRACTION

Data including specific details about the methods, settings, purposes, populations, interventions, and outcomes significant to the review's objectives were extracted by two independent reviewers using standardised data extraction tools from JBI-SUMARI.

RESULTS

Eleven studies were included in this review: three before-and-after studies, four descriptive studies, two case control studies and two cohort studies. Evidence with regards to the effectiveness of fall risk assessment tools and prevention strategies was inconclusive. Certain risk factors which were more frequently associated with falls included diagnoses of depression, bipolar disorder, and dementia / Alzheimer's disease, altered mental status, physiological symptoms, past history of falls, mobility and gait problems, concurrent medical conditions, polypharmacy, and taking of certain medications such as sedatives, antidepressants and mood stabilisers, particularly lithium.

CONCLUSION

Evidence on the effectiveness of fall risk assessment tools and prevention strategies in psychiatric setting was inconclusive due to a paucity of studies. However, certain risk factors were found to be more commonly associated with falls in adult psychiatric patients (Level III Evidence).Constant observation of the side effects of medications, particularly orthostatic hypotension, and review of patients' medical profile by doctors or pharmacists may be helpful in preventing falls in psychiatric patients. Findings on common risk factors can better aid healthcare professionals in identifying psychiatric patients who are at risk for falls.More research is needed on the evaluation of fall risk assessment tools and fall prevention strategies, specifically for the adult psychiatric patients. More prospective and better quality studies examining fall risk factors in psychiatric patients are needed.