The lack of fall risk assessment in discharged patients 

Falls are the most common adverse event occurring in care facilities and hospitals, particularly in rehabilitation wards. The period after discharge is a critical phase in which the risk of falls is highest: 40% of elderly people fall in the following six months and half of them suffer serious injuries. 

While the patient’s risk profile can be effectively assessed during the hospital stay by means of various scales, little is known about the possibility of these tools to identify at-risk individuals at the time of discharge at home. 

For this reason, after realizing a retrospective study in 2018, we conducted a preliminary prospective study on all patients discharged from the orthopaedic, respiratory and neurological rehabilitation wards of the Correggio Hospital (AUSL of Reggio Emilia) over a six-months period, to observe the association between Hendrich Fall Risk Model II (HIIFRM) scale score ≥ 5, which normally classifies in-patients as high risk, and any falls that occurred in the six months following return home. 

MBE contributed to the data analysis, the writing and the supervision of the project. 

Different performance for different patients 

We obtained data from 85 patients, 41% classified as high risk when discharged, although with different frequencies of risk for the three wards. 

19 individuals with an average HIIFRM score of 6 fell during the follow-up, with a fall rate of 22% (35% of neurological, 20% of orthopaedic and 8% of respiratory patients). 25% of these suffered a fracture. 

When analysing the three subgroups, the mean HIIFRM score for orthopaedic patients who fell was significantly higher than the score for non-fallers, demonstrating a good predictive ability of this assessment scale. In contrast, the scores of neurological non-fallers were perfectly overlapping with those of neurological fallers, making it clear that the HIIFRM does not have a good performance with this population. The small number of respiratory fallers did not allow comparisons and conclusions to be drawn for this sample. 

What to do after the screening 

The novelty of the study is to focus on the assessment of the risk of falls at the time of discharge in order to minimise second hospitalisations, also by planning preventive educational programmes implemented by occupational therapists or physiotherapists. 

The Hendrich Fall Risk Model II seems to be an effective tool to administer orthopaedic patients at the discharge, to assess their risk of fall in the following months. 

You can check the entire study free of charge here. 

Did you know that we also assessed the risk of fall in cognitive able elderly people through new parameters of posturography? 

The corresponding post can be read at this link.

Prevention