Functional Outcomes Graded With Normative Data Can Predict Postdischarge Falls and 30-Day Readmissions in Hospitalized Older Adults

Abstract

Purpose: Acute care physical therapists are asked to determine safe discharge plans for older patients who may be at risk for falls. Quantifying risk based on functional tests may be an effective way to educate patients on their risk and reduce falls after discharge. Methods: A total of 110 ambulatory patients 65 years and older on the medicine service of an acute care hospital were tested for the American Geriatric Society's top 5 fall risk factors. Results on functional tests of leg strength (5 times sit-to-stand), balance (functional reach test), gait deviation (gait speed), use of assistive device (yes or no), and history of falls (yes or no) were compared to normative data and entered into an algorithm that calculated a “fall risk score.” Participants were followed up via phone at 1, 3, 6, 9, and 12 months postdischarge. Results: Our tool predicted repeated falls (P = .05) but not whether or not a participant would fall. Individual factors including history of falls (odds ratio [OR] 2.4 entire cohort, OR 8.7 females) and balance impairment (OR 13.14 females) did predict falls. An incidental finding linked history of falls with 30-day readmissions for the entire cohort (OR 4.6) and in particular for females (OR 14.8). Conclusion: Testing functional measures prior to discharge can predict fall rate and 30-day readmission rate in older patients.