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Jane E. Mahoney, MD; Mari Palta, PhD; Jill Johnson, MS, PT; Muhammad Jalaluddin, PhD; Shelly Gray, PharmD; Soomin Park, MS; Mark Sager, MD

Arch Intern Med. 2000;160:2788-2795.

Background  Evidence suggests that acute illness and hospitalization may increase the risk for falls.

Objective  To evaluate the rate of falls, and associated risk factors, for 90 days following hospital discharge.

Methods  We consecutively enrolled 311 patients, aged 65 years and older, discharged from the hospital after an acute medical illness and receiving home-nursing services. Patients were assessed within 5 days of discharge for prehospital and current functioning by self-report, and balance, vision, cognition, and delirium by objective measures. Patients were followed up weekly for 13 weeks for falls, injuries, and health care use.

Results  The rate of falls was significantly higher in the first 2 weeks after hospitalization (8.0 per 1000 person-days) compared with 3 months later (1.7 per 1000 person-days) (P = .002). Fall-related injuries accounted for 15% of all hospitalizations in the first month after discharge. Independent prehospital risk factors significantly associated with falls included dependency in activities of daily living, use of a standard walker, 2 or more falls, and more hospitalizations in the year prior. Posthospital risk factors included use of a tertiary amine tricyclic antidepressant, probable delirium, and poorer balance, while use of a cane was protective.

Conclusions  The rate of falls is substantially increased in the first month after medical hospitalization, and is an important cause of injury and morbidity. Posthospital risk factors may be potentially modifiable. Efforts to assess and modify risk factors should be integral to the hospital and posthospital care of older adults (those aged 65 years).

From the Departments of Medicine (Drs Mahoney and Sager) and Preventive Medicine (Drs Palta and Sager), University of Wisconsin Medical School, Madison; Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wis (Dr Mahoney); the Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison (Dr Palta and Ms Park); New England Center for Integrative Health, Lyme, NH (Ms Johnson); SmithKline Beecham Pharmaceuticals, Philadelphia, Pa (Dr Jalaluddin); and the School of Pharmacy, University of Washington, Seattle (Dr Gray).

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