老年学と老年医学の研究

概要

Impact of Cognitive Impairment on Inpatient Falls in Single Room Setting and its Adverse Outcomes

Singh I *,Edwards C ,Okeke J

Dementia is associated with increased risk of falls; furthermore single rooms are associated with a higher risk of inpatient falls (IF). Hospitals are facing an increasingly ageing population, of whom one third could have cognitive impairment (CI). The aim of this study is to determine the prevalence of cognitive impairment amongst patients who have fallen in the hospital and compare adverse outcomes between inpatient fallers with and without CI (NCI). Methods: This is a retrospective observational study. CI was defined on the basis of case notes recording of dementia, CI, chronic confusion, functional impairment due to memory problems or MMSE/MoCA< 25. Results: The mean age of patients with CI and NCI were 84.23 ± 7.44 and 80.21 ± 11.05 years (p<0.01), 57% and 48.2% were females respectively. The total number of inpatient falls incidents reported over the two years was 1611. The falls incidents in patients with CI were 814 (242 patients) and 797 falls incidents were reported from NCI (434 patients). The mean falls/inpatient faller in patients with CI and NCI were 3.36 ± 4.00 and 1.84 ± 1.46 respectively (p<0.001). There was a significant increase in the length of stay in patients with CI (50.68 ± 40.49) compared to NCI (37.92 ± 37.8, p<0.001). More patients (23.63%) with CI needed a new care home placement as compared to NCI group (11.1%, p<0.001). The hip fracture in CI and NCI were 2.9% and 1.4% respectively (p=NS). Conclusion: Older people with CI have significantly higher incidence of inpatient falls in single rooms and adverse outcomes including discharge to a new care home and prolonged length of stay when compared to inpatient fallers with NCI. We acknowledge the study's weakness that there are no outcome data for patients with CI who did not fall in the hospital. Prompt identification of dementia patients and falls risk assessment could prevent associated adverse outcomes.