Follow us on :


Take a look at the Recent articles

Cognitive deterioration upon admission is an important risk indicator of falls in the respiratory ward

Masafumi Nojiri

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Tatsuya Watanabe

Division of Rehabilitation, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Koichi Yamamura

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Saki Matsuura

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Takashi Sakuma

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Kazuaki Nishiki

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Keisuke Nakase

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Ryo Kato

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Shohei Shinomiya

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Yutaka Takahara

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Yuki Fujimoto

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Taku Oikawa

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

Shiro Mizuno

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

DOI: 10.15761/PMRR.1000215

Article
Article Info
Author Info
Figures & Data

Abstract

Objective: Falls have become a major problem in hospitalized elderly patients. During the hospitalization, a nurse evaluates the risk of falls using a fall assessment sheet. However, this assessment sheet does not reflect the characteristics of each ward or disease. Therefore, this study aimed to clarify the characteristics of falls in respiratory wards.

Methods: Medical records of patients admitted to our respiratory ward from April 1, 2018, to March 31, 2019, were reviewed. Patients were divided into fall (N=18) and non-fall (N=343) groups, and their clinical test results, A fall assessment sheets, and Functional Independence Measure (FIM) scores were examined.

Results: Scores on the admission a fall assessment sheets were poorer, and the item of cognitive ability was lower in the fall than that in the non-fall group (p=0.008). With regard to FIM, no significant difference was found in the FIM motor score, but the FIM cognitive score was significantly lower in the fall group. The FIM motor score was significantly improved after hospitalization, but the FIM cognitive score did not improve. The difference in disease, Alb, Hb, and body mass index (BMI) was not significant.

Conclusion: The risk of falls in respiratory wards is high. In particular, cognitive deterioration upon admission was the most common cause of falls in respiratory wards.

Key words

Respiratory disease, falls, functional independence measure (FIM), dementia, rehabilitation

Introduction

Japan has become a super-aging society, and the proportion of elderly inpatients is continuously increasing. As a result, falls are the most common type of medical accident, and its incidence is increasing each year [1]. Prevention of falls is an important issue for medical safety because falls not only require new treatment but also lengthen hospital stays and increase medical expenses [2].

Effective intervention to prevent falls involves screening for falls and preselecting high-risk patients upon admission. The usefulness of a fall risk assessment tool has been suggested and is used in several facilities in japan.

However, this tool has not been adapted according to the specific characteristics of each ward, although many studies have been made on falls in chronic disease wards and in patients with cerebral infarction. In addition, no fall risk assessment tool to predict falls in hospitalized patients from each department has been statistically verified to predict the accuracy, suggesting that patients at risk of falls may not be accurately grasped. As the cause of falls differs in each ward, dealing with each department is desirable. The fall rate in respiratory wards is known to be high [3,4], but the cause remains unclear. Therefore, this study aimed to analyze the risk of falls in respiratory wards.

Patients and Methods

This study examined 361 patients (including multiple hospitalizations) who were admitted to our hospital’s respiratory ward for at least one week from April 1, 2018, to March 31, 2019. Patients in other departments and with insufficient data were excluded.

The survey items were as follows: falls, age at admission, gender, main illness, complications, devices (oxygen administration, infusion, thoracic drain tube, tracheal cannula), body mass index (BMI), hemoglobin (Hb), Alb, fall assessment sheet score upon admission, presence of rehabilitation, discharge destination, and Functional Independence Measure (FIM). However, FIM was measured only in rehabilitation patients (N=216).

FIM was performed using a 7-point scale, with 13 items on motor subscale and 5 items on cognition subscale for daily life activity independence. The FIM is one of the most commonly used in rehabilitation programmes in japan. The FIM total score (T-FIM), the FIM motor score (M-FIM), and FIM cognitive score (C-FIM) were compared a fall group to a non-fall group. This measurement was performed by a physiotherapist/occupational therapist after admission and immediately before discharge. Patients were divided into a fall group (N=18) who fell and a non-fall group (N=343) who did not fall. Pearson’s X2 test and Mann–Whitney U-test were performed to determine the occurrence of falls.

The study was approved by the Research Ethics Committee of Kanazawa Medical University (Protocol: No. I511).

Results

Total fall rates in our wards were 1.80 falls per 1,000 patient days. In the fall group, the length of hospital stay the number of rehabilitation introductions, and the fall assessment sheet score were significantly high, but the difference in BMI, Alb, and Hb was not significant (Table 1).

Table 1. A Fall assessment sheet checklist at our hospital: If any one of the items from A to G is applicable, enter the reference point. The risk of falling is assessed on a 16-point scale. 0–5 points are considered as low risk, 6–10 points are intermediate risk, and 11–16 points are high risk.

Item

Checklist

Reference point

A

Age

¨ 70 years old or older

¨ 9 years old or younger

2

B

Medical history

¨ History of falls

¨ History of loss of consciousness

1

C

Sensation

¨ Has a hearing impairment

¨ Has vision impairment

¨ Has visual field damage

1

D

Range of activity

¨ Has paralysis or numbness

¨ Has contractures/deformities in their extremities

¨ Has missing extremities

¨ Has poor balance

¨ Has weak feet/lower back

¨ Has abnormal gait

¨ Uses a wheelchair/walker/cane

¨ Requires assistance when moving around

4

E

Cognitive ability

¨ Has delirium and shows menacing behavior

¨ Shows menacing behavior

¨ Has impaired memory

¨ Shows impaired judgment

¨ Shows a decline in the ability to understand

3

F

Pharmacotherapies

¨ Sleep stabilizers

¨Narcotics

¨Antihypertensive diuretics

¨ Anti-Parkinson agents

¨ Sedatives

¨ Chemotherapy

¨ Enema/laxatives

¨ Anti-dementia agents

2

G

Excretion

¨ Has urinary incontinence

¨ Has fecal incontinence

¨ Always has an urge to urinate

¨ Always has an urge to defecate

¨ Requires assistance to go to the bathroom

¨ Goes to the bathroom at night

¨ Uses a portable toilet

3

Table 1A. Distribution table for the fall and non-fall groups at the time of admission. *:χ2 test; †:Mann-Whitney U test; ‡: Fall score: Total score of the fall assessment sheet.

Fall group

Non-fall group

p value

Number of times

18 number (Fell twice: 2 number)

343 number

 

Age

75.06

71.92

0.1240

Male: female ratio, male (%)

12: 6

(66.7 %)

230: 113

(67.0 %)

0.9727

Duration of hospitalization

43.61

26.92

0.0005

Rehabilitation intervention

13件

(72.2 %)

203件

(59.2 %)

0.2714

Fall score 

10.72

7.97

0.0041

BMI (kg/)

21.79

21.80

0.6901

Alb (mg/L)

3.36

3.45

0.5212

Hb (g/dL)

11.12

12.21

0.1569

Table 2 shows the examination results of the main diseases and the environment. Lung cancer was the most common in-patient disease, followed by community-acquired pneumonia and aspiration pneumonia. No between-group differences were observed based on disease variability. Majority of lung cancers were advanced stage, and 42 patients had brain metastases. Best supportive care comprises 34% of treatment strategies. No significant differences were found in the following comorbidities: cerebrovascular disease, neurological disease, epilepsy, dementia, and mental illness. The turning point was that the hospital was frequently transferred in the fall group. As regards the environmental factors, 94% of patients received intravenous infusions, and all patients who fell down received infusions. The fall group had no thoracic drain tube and tracheal cannula inserted.

Table 2. Characteristics of hospitalization. A: Table of primary underlying diseases at the time of admission. Other includes mycobacterium avium complex (MAC), pulmonary arteriovenous fistulas, pneumocystis pneumonia, IgG-related disease (IgG-RD), and sarcoidosis. B: Lung cancer stage and treatment strategy. C: Evaluation of the presence/absence of patient devices such as oxygen during hospitalization, comorbidities at the time of admission, and discharge destination. §: One patient with Parkinson’s disease, one patient with spinocerebellar degeneration and one patient with hydrocephalus. Evaluated using Pearson's χ2 test. *: p<0.01.

A

Primary underlying disease

Total N=361

Fall group N=18

Non-fall group N=343

Lung cancer

152

6

146

Community-acquired pneumonia

50

0

50

Aspiration pneumonia

48

7

41

Interstitial pneumonia

43

3

40

Empyema

5

0

5

Pneumothorax

4

0

4

chronic obstructive pulmonary disorder (COPD) acute exacerbation

18

0

18

Asthmatic attack

10

0

10

Other

31

2

29

B

Total N=361

Fall group N=18

Non-fall group N=343

Stage Ⅰ‐Ⅱ

8

0

8

Stage Ⅲ

42

1

41

Stage Ⅳ

103

5

97

Brain metastases present

42

2

40

Treatment strategy

 

 

 

Treatment/testing

101

3

98

Palliative care

51

3

48

C

Total N=361

Fall group N=18

Non-fall group N=343

Comorbidities (multiple conditions in the same patient present)

 

 

 

Cerebral infarction/cerebral hemorrhage

27

4

23

Neurological disorder §

3

0

3

Dementia

16

3

13

Epilepsy

8

2

6

Mental illness

17

0

17

Discharge destination

 

 

 

Discharged home

276

8

268

Transfer to a different institution/Hospice care

64

9

55

Transfer to a different department

3

0

3

Death

36

1

35

Environment

 

 

 

Oxygenation

139

9

130

Drain placement

14

0

14

Presence or absence of tracheostomy

6

0

6

Infusion

340

18

322

None of the above

16

0

16

The fall assessment sheet score is divided into a low-risk group, (0–5 points), medium-risk group (6–10 points), and high-risk group (11–16 points), with fall rates of 1.9%, 3.4%, and 9.4%, respectively. The fall score was significantly higher in the fall group than that in the non-fall group (Table1), and the difference in the distribution according to the risk level was found. In the examination according to each item, only the cognitive ability was significantly lower in the fall that that in the non-fall group (Table1), whereas other items showed no significant differences (Table 3).

Table 3. Comparison of a fall assessment sheet scores at the time of admission. *: χ2 test; †:Mann–Whitney U test.

Fall group N=18

Non-fall group N=343

p value

Overall score

10.72 ± 3.84

7.97 ± 3.75

0.0041

A

Age

14

229

0.1949*

B

Prior medical history

8

97

0.0844*

C

Sensation

9

121

0.1286*

D

Range of activity

14

214

0.1013*

E

Cognitive ability

7

47

0.0008*

F

Pharmacotherapies

10

163

0.3629*

G

Excretion

17

311

0.2959*

Except for patients who underwent rehabilitation intervention, FIM-based studies showed that no difference was found M-FIM upon admission. Only C-FIM was significantly lower in the fall group with a significant difference (Table 4). On discharge, exercise improvement was observed. When comparing before and after hospitalization results, improvement in C-FIM was poor. M-FIM improvement was also poor in the fall group (Table 5).

Table 4. 4A: Comparison of M-FIM score at the time of admission. Low M-FIM score at admission: 13–39 points, intermediate score: 40–78 points, high score: 79–91 points. 4B: Comparison of C-FIM score at the time of admission. Low C-FIM score at admission: 5–25 points, high score: 26–35 points. Evaluations were performed using Pearson's χ2 test. 4C: Comparison of FIM scores at the time of admission and discharge. Evaluated using Mann-Whitney U test.

4A

M-FIM score at admission

Fall group

Non-fall group

Low score

4

52

Intermediate score

7

91

High score

2

57

p=0.592

4B

C-FIM score at admission

Fall group

Non-fall group

Low score

6

22

High score

7

179

p=0.0003

4C

Fall group

(Mean)

Non-fall group

(Mean)

p value

M-FIM score at admission

48.15

57.85

0.0618

C-FIM score at admission

27.08

32.29

0.0124

M-FIM score at discharge

62.50

74.21

0.0254

C-FIM score at discharge

25.17

32.58

0.0005

Table 5. Changes in FIM score after hospitalization and before discharge in rehabilitated patients. Evaluated using Paired T test.

After hospitalization (Mean)

Before discharge (Mean)

p value

T-FIM

 

 

 

 Total

79.32

100.25

< 0.0001

 Fall group

75.23

87.58

0.1561

 Non-fall group

82.73

102.74

< 0.0001

M-FIM

 

 

 

 Total

57.26

68.98

< 0.0001

 Fall group

48.15

62.50

0.1172

 Non-fall group

57.85

74.21

< 0.0001

C-FIM

 

 

 

 Total

31.98

32.03

0.8967

 Fall group

27.08

25.17

0.1752

 Non-fall group

32.29

32.58

0.6361

 Non-fall group

79.32

100.25

< 0.0001

Discussion

In recent years, inpatients have become increasingly aging in Japan. In this study, 85% of inpatients are elderly people aged ≥65 years, and the number of inpatients highly at high for falling is increasing [4].

As measures to prevent falls at our hospital, nurses evaluate the fall risk of patients using a fall assessment sheet in Japan, whereas the fall risk assessment of patients under rehabilitation intervention is performed in the rehabilitation department using FIM. If the risk of falling is over the intermediate risk, information is shared at the conference and measures are taken to improve the breathing state and device arrangement. When falls occur, medical professionals submit an incident report and future countermeasures should be considered. The fall rate in acute care hospitals varies among different reports but been reported from 1.38 to 4.3 % falls per 1,000 patient days [3,5,6].

Sato et al. reported that the fall rate in respiratory medicine and rheumatology wards was higher than the overall fall rate [6]. However, in our ward, the fall rate was 1.80 % falls per 1,000 patient days, and our measures were considered effective.

In this study, a difference was found only in the length of hospital stay and the place of discharge according to the patient background. Dunne et al. reported that falls in acute care hospitals make discharges 2.4 times more difficult [7]. In this study, no differences were found in terminal patients, background disease/blood data, comorbidities, and motor function. Patients were considered difficult to discharge to their respective homes and had prolonged hospital stay because of the fall. Motor function improvement in the fall group is poor even under rehabilitation intervention and is important to prevent falls (Table 5).

In japan, the fall assessment sheet is commonly used, and results of this study also showed a significant difference between the fall and non-fall groups. With this, the risk for falls can be sufficiently evaluated even in the respiratory ward. However, when comparing the items in detail, only the difference in cognitive dysfunction was significant based on the results in the fall group, which was the same as in FIM. The cognitive function deterioration could lead to falls due to misjudgement [8].

In addition, environmental characteristics in the respiratory ward include several devices connected to the oxygen tube, the infusion line, and the patient. In this study, 94% of inpatients were treated with intravenous therapy, and approximately half of them received nasal or mask oxygen. Patients receiving oxygen are reported to be at increased risk of falling [9]. In an environment where the risk of falls is high, lack of cognitive ability to grasp changes in the surrounding environment and physical changes seem to have been the most important factors that cause falls.

In addition, as shown in Table 5, improvement of exercise items can be expected by improving the general condition and rehabilitation accompanying disease remission; however, cognitive function improvement is poor. This suggests that cognition function evaluation upon admission is important to assess the risk for falls in the future.

Limitations

The limitations of this study are as follows: the analysis period is only 1 year and further accumulation of the number of falls is necessary. In this study, the evaluation was limited to simple items such as assessment sheets, and therefore, examinations using cognitive function tests such as Hasegawa’s formula should have also been used. In addition, FIM was measured only for rehabilitation-introduced patients. However, a bias often occurs in patients undergoing rehabilitation because they are often introduced in patients with reduced ADL. In addition, fall assessment and FIM tend to be similar, and we analyzed them to be reliable in this study. All cases should be investigated in the future. A fall assessment sheet specifically made for respiratory wards should also be considered with emphasis on cognitive skills.

Conclusion

During respiratory hospitalization, patients used many devices, making them highly at risk of falling. As the value of the fall assessment sheet (FIM) decreases, the fall rate increases. In addition, cognitive deterioration during hospitalization is the most important cause of falls, and therefore, these patients need further measures to prevent falls.

Acknowledgements

I am grateful to Clinical support room member for carefully proofreading the manuscript. The authors would also like to thank the Kanazawa Medical University Hospital rehabilitation staff and patients.

References

  1. Ministry of Health, Labor and Welfare (H29) Overview of patient survey in Japan.
  2. Quigley P, White S (2012) Hospital-based fall program measurement and improvement in high reliability organizations. Online J Issues Nurs 18: 5. [Crossref]
  3. Trinh LTT, Assareh H, Wood M, Addison-Wilson C, Sathiyaseelan Y (2020) Falls in Hospital Causing Injury. J Healthc Qual 42: 1-11. [Crossref]
  4. Schwendimann R, Bühler H, De Geest S, Milisen K (2008) Characteristics of hospital inpatient falls across clinical departments. Gerontology 54: 342-348. [Crossref]
  5. F Healey, S Scobie, D Oliver, A Pryce, R Thomson, et al. (2008) Falls in English and Welsh hospitals: a national observational study based on retrospective analysis of 12 months of patient safety incident reports. Qual Saf Health Care 17: 424-430. [Crossref]
  6. Sato N, Hase N, Osaka A, Sairyo K, Katoh S (2018) Falls among Hospitalized Patients in an Acute Care Hospital: Analyses of Incident Reports. J Med Invest 65: 81-84. [Crossref]
  7. Dunne TJ, Gaboury I, Ashe MC (2014) Falls in hospital increase length of stay regardless of degree of harm. J Eval Clin Pract 20: 396-400. [Crossref]
  8. Allali G, Launay CP, Blumen HM, Callisaya ML, De Cock AM, et al. (2017) Falls, Cognitive Impairment, and Gait Performance: Results from the GOOD Initiative. J Am Med Dir Assoc 18: 335-340. [Crossref]
  9. MK Beauchamp, K Hill, RS Goldstein, T Janaudis-Ferreira, D Brooks (2009) Impairments in Balance Discriminate Fallers from Non-Fallers in COPD. Respir Med 103: 1885-1891. [Crossref]

Editorial Information

Editor-in-Chief

Martin Grabois
Baylor College of Medicine

Article Type

Research Article

Publication history

Received: August 18, 2020
Accepted: August 24, 2020
Published: August 31, 2020

Copyright

©2020 Nojiri M. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Citation

Nojiri M, Watanabe T, Yamamura K, Matsuura S, Sakuma T, et al. (2020) Cognitive deterioration upon admission is an important risk indicator of falls in the respiratory ward. Phys Med Rehabil Res. 5. DOI: 10.15761/PMRR.1000215

Corresponding author

Masafumi Nojiri

Division of Respiratory Medicine, School of Medicine, Kanazawa Medical University, 1-1 Daigaku, Uchinada, Kahoku, Ishikawa, Japan 920-0293

E-mail : bhuvaneswari.bibleraaj@uhsm.nhs.uk

Table 1. A Fall assessment sheet checklist at our hospital: If any one of the items from A to G is applicable, enter the reference point. The risk of falling is assessed on a 16-point scale. 0–5 points are considered as low risk, 6–10 points are intermediate risk, and 11–16 points are high risk.

Item

Checklist

Reference point

A

Age

¨ 70 years old or older

¨ 9 years old or younger

2

B

Medical history

¨ History of falls

¨ History of loss of consciousness

1

C

Sensation

¨ Has a hearing impairment

¨ Has vision impairment

¨ Has visual field damage

1

D

Range of activity

¨ Has paralysis or numbness

¨ Has contractures/deformities in their extremities

¨ Has missing extremities

¨ Has poor balance

¨ Has weak feet/lower back

¨ Has abnormal gait

¨ Uses a wheelchair/walker/cane

¨ Requires assistance when moving around

4

E

Cognitive ability

¨ Has delirium and shows menacing behavior

¨ Shows menacing behavior

¨ Has impaired memory

¨ Shows impaired judgment

¨ Shows a decline in the ability to understand

3

F

Pharmacotherapies

¨ Sleep stabilizers

¨Narcotics

¨Antihypertensive diuretics

¨ Anti-Parkinson agents

¨ Sedatives

¨ Chemotherapy

¨ Enema/laxatives

¨ Anti-dementia agents

2

G

Excretion

¨ Has urinary incontinence

¨ Has fecal incontinence

¨ Always has an urge to urinate

¨ Always has an urge to defecate

¨ Requires assistance to go to the bathroom

¨ Goes to the bathroom at night

¨ Uses a portable toilet

3

Table 1A. Distribution table for the fall and non-fall groups at the time of admission. *:χ2 test; †:Mann-Whitney U test; ‡: Fall score: Total score of the fall assessment sheet.

Fall group

Non-fall group

p value

Number of times

18 number (Fell twice: 2 number)

343 number

 

Age

75.06

71.92

0.1240

Male: female ratio, male (%)

12: 6

(66.7 %)

230: 113

(67.0 %)

0.9727

Duration of hospitalization

43.61

26.92

0.0005

Rehabilitation intervention

13件

(72.2 %)

203件

(59.2 %)

0.2714

Fall score 

10.72

7.97

0.0041

BMI (kg/)

21.79

21.80

0.6901

Alb (mg/L)

3.36

3.45

0.5212

Hb (g/dL)

11.12

12.21

0.1569

Table 2. Characteristics of hospitalization. A: Table of primary underlying diseases at the time of admission. Other includes mycobacterium avium complex (MAC), pulmonary arteriovenous fistulas, pneumocystis pneumonia, IgG-related disease (IgG-RD), and sarcoidosis. B: Lung cancer stage and treatment strategy. C: Evaluation of the presence/absence of patient devices such as oxygen during hospitalization, comorbidities at the time of admission, and discharge destination. §: One patient with Parkinson’s disease, one patient with spinocerebellar degeneration and one patient with hydrocephalus. Evaluated using Pearson's χ2 test. *: p<0.01.

A

Primary underlying disease

Total N=361

Fall group N=18

Non-fall group N=343

Lung cancer

152

6

146

Community-acquired pneumonia

50

0

50

Aspiration pneumonia

48

7

41

Interstitial pneumonia

43

3

40

Empyema

5

0

5

Pneumothorax

4

0

4

chronic obstructive pulmonary disorder (COPD) acute exacerbation

18

0

18

Asthmatic attack

10

0

10

Other

31

2

29

B

Total N=361

Fall group N=18

Non-fall group N=343

Stage Ⅰ‐Ⅱ

8

0

8

Stage Ⅲ

42

1

41

Stage Ⅳ

103

5

97

Brain metastases present

42

2

40

Treatment strategy

 

 

 

Treatment/testing

101

3

98

Palliative care

51

3

48

C

Total N=361

Fall group N=18

Non-fall group N=343

Comorbidities (multiple conditions in the same patient present)

 

 

 

Cerebral infarction/cerebral hemorrhage

27

4

23

Neurological disorder §

3

0

3

Dementia

16

3

13

Epilepsy

8

2

6

Mental illness

17

0

17

Discharge destination

 

 

 

Discharged home

276

8

268

Transfer to a different institution/Hospice care

64

9

55

Transfer to a different department

3

0

3

Death

36

1

35

Environment

 

 

 

Oxygenation

139

9

130

Drain placement

14

0

14

Presence or absence of tracheostomy

6

0

6

Infusion

340

18

322

None of the above

16

0

16

Table 3. Comparison of a fall assessment sheet scores at the time of admission. *: χ2 test; †:Mann–Whitney U test.

Fall group N=18

Non-fall group N=343

p value

Overall score

10.72 ± 3.84

7.97 ± 3.75

0.0041

A

Age

14

229

0.1949*

B

Prior medical history

8

97

0.0844*

C

Sensation

9

121

0.1286*

D

Range of activity

14

214

0.1013*

E

Cognitive ability

7

47

0.0008*

F

Pharmacotherapies

10

163

0.3629*

G

Excretion

17

311

0.2959*

Table 4. 4A: Comparison of M-FIM score at the time of admission. Low M-FIM score at admission: 13–39 points, intermediate score: 40–78 points, high score: 79–91 points. 4B: Comparison of C-FIM score at the time of admission. Low C-FIM score at admission: 5–25 points, high score: 26–35 points. Evaluations were performed using Pearson's χ2 test. 4C: Comparison of FIM scores at the time of admission and discharge. Evaluated using Mann-Whitney U test.

4A

M-FIM score at admission

Fall group

Non-fall group

Low score

4

52

Intermediate score

7

91

High score

2

57

p=0.592

4B

C-FIM score at admission

Fall group

Non-fall group

Low score

6

22

High score

7

179

p=0.0003

4C

Fall group

(Mean)

Non-fall group

(Mean)

p value

M-FIM score at admission

48.15

57.85

0.0618

C-FIM score at admission

27.08

32.29

0.0124

M-FIM score at discharge

62.50

74.21

0.0254

C-FIM score at discharge

25.17

32.58

0.0005

Table 5. Changes in FIM score after hospitalization and before discharge in rehabilitated patients. Evaluated using Paired T test.

After hospitalization (Mean)

Before discharge (Mean)

p value

T-FIM

 

 

 

 Total

79.32

100.25

< 0.0001

 Fall group

75.23

87.58

0.1561

 Non-fall group

82.73

102.74

< 0.0001

M-FIM

 

 

 

 Total

57.26

68.98

< 0.0001

 Fall group

48.15

62.50

0.1172

 Non-fall group

57.85

74.21

< 0.0001

C-FIM

 

 

 

 Total

31.98

32.03

0.8967

 Fall group

27.08

25.17

0.1752

 Non-fall group

32.29

32.58

0.6361

 Non-fall group

79.32

100.25

< 0.0001