The incidence of falls in intensive care survivors

Abstract

Background: Falling among adults in acute care is an important problem with falls rates in tertiary hospitals ranging from 2% to 5%. Factors that increase the risk of falling, such as advanced age, altered mental status, medications that act on the central nervous system and poor mobility, often characterise individuals who survive a prolonged intensive care unit (ICU) admission. Purpose: To measure the incidence of falls and describe the characteristics of fallers among intensive care survivors. Methods: A comprehensive retrospective chart review was undertaken of 190 adults who were intubated and ventilated for ≥168 h and survived their acute care stay. Using a standardised form, several variables were extracted including falls during hospitalisation and risk factors such as age, severity of illness, and length of stay in intensive care and hospital. Findings: Thirty-two (17%, 95% confidence interval 11.5–22.2%) patients fell at least once on the in-patient wards following their ICU stay. Compared with non-fallers, fallers were younger (53.2 ± 17.9 vs. 44.1 ± 18.3 years; p = 0.009) and had a shorter duration of inotropic support in ICU (84 ± 112 vs. 56 ± 100 h; p = 0.040). The majority of fallers were aged less than 65 years (84%). Both fallers and non-fallers had similar APACHE II scores (20 ± 8 vs. 21 ± 7; p = 0.673), length of stay in intensive care (14.2 ± 8.7 vs. 14.0 ± 9.7 days; p = 0.667) and hospital length of stay (43.9 ± 33.1 vs. 41.0 ± 38.8 days; p = 0.533). Conclusion: Falling during hospitalisation is common in intensive care survivors. Compared with non-fallers, fallers were younger and required inotropes for a shorter duration. Those who survive a prolonged admission to an ICU may benefit from specific assessment of balance and falls risk by the multidisciplinary team.