Clinical characteristics and influencing factors of serious fall injuries among older inpatients: A secondary analysis of multicenter cross-sectional administrative data

Abstract

BackgroundInpatient falls are common adverse events in hospitals, particularly among older adults. However, current research on falls in the older population is limited by small sample sizes and reliance on single-center designs without distinguishing the different levels of fall injuries. ObjectiveTo examine the circumstances of falls in older inpatients and investigate the factors influencing serious fall injuries. DesignA secondary analysis of multicenter cross-sectional administrative data from the China National Database of Nursing Quality (CNDNQ). Setting(s)67 hospitals in Hunan, China. Participants5143 fall incidents from 5048 older inpatients were included from January 2019 to December 2022. MethodsDescriptive statistics (means, standard deviations, frequencies, and percentages) were used to describe fall characteristics. Given the multilevel data structure, a Generalized Linear Mixed Model (GLMM) with a Logistic link function was employed, treating hospitals and wards as random effects. Univariate and multivariate analyses were conducted. ResultsThe prevalences of fall-related injuries and serious fall injuries in this study were 63.3 % and 25.0 %, respectively. Nurse-to-patient ratio at the time of fall ≤0.04 (aOR = 1.522, 95 % CI: 1.297–1.785), female gender (aOR = 1.304, 95 % CI: 1.137–1.497), a lengthy hospital stay (aOR = 1.009, 95 % CI: 1.001–1.018) were associated with an increased risk of serious fall injuries. Surgical (aOR = 0.655, 95 % CI: 0.482–0.889) and orthopedic wards (aOR = 0.649, 95 % CI: 0.449–0.939) exhibited lower risks of serious fall injuries than internal medicine wards. The time period from 8:00 to 15:59 was associated with a higher risk of serious fall injuries compared to the period from 0:00 to 7:59 (aOR = 1.416, 95 % CI: 1.171–1.713). Compared to lying, standing (aOR = 2.594, 95 % CI: 1.733–3.883), getting in/out of bed (aOR = 1.403, 95 % CI: 1.009–1.951), walking or rehabilitating (aOR = 3.039, 95 % CI: 2.194–4.208), toileting (aOR = 1.411, 95 % CI: 1.038–1.917), and showering (aOR = 2.170, 95 % CI: 1.391–3.385) were associated with an increased risk of serious fall injuries. ConclusionsFall-related injuries and serious fall injuries are highly prevalent among older inpatients. The study provides insights for targeted fall prevention strategies, improving nursing management and patient safety. RegistrationNot registered.