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Falls in the General Hospital: Association With Delirium, Advanced Age, and Specific Surgical Procedures

Received September 14, 2008; revised November 7, 2008; accepted November 13, 2008. From the Dept. of Nursing, 75 Francis St, Tower 14, Brigham and Women’s Hospital, Boston MA. Send correspondence and reprint requests to Barbara E. Lakatos, R.N., Dept. of Nursing, Brigham and Women’s Hospital, 75 Francis St, Tower 14, Boston MA 02115. e-mail: blakatos{at}partners.org
© 2009 The Academy of Psychosomatic Medicine

BACKGROUND: Falls and delirium in general-hospital inpatients are related to increases in morbidity, mortality, and healthcare costs. Patients fall despite safeguards and programs to reduce falling. OBJECTIVE: The authors sought to determine the prevalence of diagnosed and undiagnosed delirium in patients who fell during their hospital stay. METHOD: The authors performed a retrospective electronic chart review of 252 patients who fell during their hospital stay. Falls were categorized by their severity (i.e., minor, moderate, and major). Demographic information, patient outcomes, and diagnostic criteria for delirium (per DSM–IV) were collected on the day of admission, the day of the fall, and the 2 days preceding the patient’s fall. RESULTS: Falls in the general hospital were associated with delirium (both diagnosed and undiagnosed), advanced age, and specific surgical procedures. CONCLUSION: Improving the recognition of undiagnosed delirium may lead to sustainable and successful fall prevention programs. Detection of impairments in mental status can assist staff to create individualized patient care plans. Knowledge about which patients are at risk for injury from delirium and falls can lead to improvements in patient safety, functioning, and quality of life.

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