J Nutr Health Aging

Volume 19, Number 10, 2015

PRO-ACTIVE FALL-RISK MANAGEMENT IS MANDATORY TO SUSTAIN

IN HOSPITAL-FALL PREVENTION IN OLDER PATIENTS - VALIDATION
OF THE LUCAS FALL-RISK SCREENING IN 2,337 PATIENTS
V.S. HOFFMANN1,3, L. NEUMANN2,3, S. GOLGERT2, W. VON RENTELN-KRUSE2
1. Institute of Medical Information Sciences, Biometry and Epidemiology (IBE), Ludwig-Maximilians-University Munich, Marchionistrasse 15, Munich, Germany; 2. Albertinen-Haus,
Geriatrics Centre, University of Hamburg, Sellhopsweg 18-22, Hamburg, Germany; 3. Verena Hoffmann and Lilli Neumann contributed equally to this work. Corresponding author:
Lilli Neumann, Albertinen-Haus, Geriatrics Centre, Scientific Department at the University of Hamburg, Sellhopsweg 18-22, D-22459 Hamburg, Germany, Tel.: ++49-40-5581-1692;
Fax: ++49-40-5581-1874; E-Mail: lilli.neumann@albertinen.de

Abstract: Objectives: Prevention of in-hospital falls contributes to improvement of patient safety. However, the
identification of high-risk patients remains a challenge despite knowledge of fall-risk factors. Hence, objective
was to prospectively validate the performance of the LUCAS (Longitudinal Urban Cohort Ageing Study)
fall-risk screening, based on routine data (fall history, mobility, mental status) and applied by nurses. Design:
Observational study comparing two groups of patients who underwent different fall-risk screenings; the LUCAS
screening (2010 - 2011) and the STRATIFY (St Thomas’s Risk Assessment Tool In Falling Elderly Inpatients)
(2004 - 2006). Setting: Urban teaching hospital. Participants: Consecutively hospitalized patients (≥ 65 years
old) were screened on admission; LUCAS n = 2,337, STRATIFY n = 4,735. Measurements: The proportions of
fallers were compared between the STRATIFY and the LUCAS time periods. The number of fallers expected
was compared to that observed in the LUCAS time period. Standardized fall-incidence recording included
case-note checks for unreported falls. Plausibility checks of fall-risk factors and logistic regression analysis
for variable fall-risk factors were performed. Results: The proportions of fallers during the two time periods
were LUCAS n = 291/2,337 (12.5 %) vs. STRATIFY n = 508/4,735 (10.7 %). After adjustment for risk-factor
prevalence, the proportion of fallers expected was 14.5 % (334/2,337), the proportion observed was 12.5 %
(291/2,337) (p = 0.038). Conclusions: In-hospital fall prevention including systematic use of the LUCAS fall-
risk screening reduced the proportion of fallers compared to that expected from the patients’ fall-risk profile.
Raw proportions of fallers are not suitable to evaluate fall prevention in hospital because of variable prevalence
of patients’ fall-risk factors over time. Continuous communication, education and training is needed to sustain
in-hospital falls prevention.

Key words: Geriatric medicine, risk management, in-hospital falls, fall-risk screening, patient safety.

Background patients remains challenging, but the value of formal screening

In-hospital falls (IHF) of elderly patients are frequent
adverse events that may have substantial impact on health
outcomes, quality of care, patient safety and costs (1-4).
Due to multimorbidity and presence of acute illness geriatric
in-patients are at particular risk of falling in an unknown
surrounding (5). Falls may cause pain, injuries, post-fall
syndrome, anxiety, poor functional outcome and increasing
length of stay (1, 2, 6). There is evidence that, in particular, the
level of functional status is of high relevance to the occurrence
of IHF and older patients’ outcome of hospital care (7).
Addressing this context, the LUCAS (Longitudinal Urban
Cohort Ageing Study) research consortium is investigating
functional competence in older persons in different settings of
healthcare-service delivery in order to improve preventive and
healthcare measures (8). One LUCAS subproject’s aim is to
improve IHF prevention.
Reasons for falls have been extensively studied and the
identification of high-risk patients is regarded as a key
component in falls prevention. However, despite available
evidence from controlled trials prevention of IHF is not an easy
task in daily practice in hospitals (9). Identification of high-risk
Received November 7, 2014
Accepted for publication December 17, 2014
1012
is a matter of debate (10).
Study question
For years, the use of the St Thomas’s Risk Assessment
Tool In Falling Elderly Inpatients (STRATIFY) (11) was part
of the fall-prevention intervention process in our clinic (12).
This screening tool was chosen because a similar clinic with
comparable patients had tested and prospectively validated it
(10, 13). The implementation of interdisciplinary team-based
multifactorial fall-prevention was followed by a significant
reduction in relative risk of falling and incident falls, but
not injurious falls (12). However, the results left room for
improvement in detecting high-risk patients (14).
Therefore, the LUCAS fall-risk screening was developed
using the data of 2,594 patients admitted 2004 - 2005, and
retrospectively validated on 2,141 patients admitted in 2006
(15). Adopted to our setting, this screening to identify patients
at high risk (9) is based on three risk factors: the Barthel Index
(BI) (16) mobility items ‘transfer’ and ‘walking’ with the
sum scores of 5 - 15 indicating mobility is insecure, the fall-
history two months before hospitalization, and mental alteration
(confused, agitated, demented). A high-risk patient is defined
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JNHA: CLINICAL NEUROSCIENCES

by ≥ 2 factors. Operational definitions of mental alteration are lecture of one hour was performed by a member of the research
explained on the LUCAS fall-risk screening documentation team in cooperation with the head of the nursing services
sheet (confused: patients with disturbed orientation, memory, to train nurses on the use of the LUCAS fall-risk screening
confused ideas or inconclusive and incoherent speech; agitated: and to show documentation of screening result in the paper
patient inadequately excited, nervous or restless psycho- patient record, including evaluation of single fall-risk factors
motoric activity; demented: patients with defined clinical and classification of patients being at high or low risk.
diagnosis of dementia irrespective of the type of dementia, Subsequently, pre-tests were performed for two weeks. As not
symptomatology suspicious of dementive disease, cognitive, all nurses were able to participate individual trainings were
emotional or social deficits). While collecting these data, given additionally on the wards during this pre-test phase. The
patients were screened by STRATIFY (11) and, consequently, pre-test analysis did not indicate the need of further training.
targeted preventive measures were undertaken according to the High-risk patients received the same fall-prevention
fall risk as rated by STRATIFY. Starting in 2010, the LUCAS measures as were previously provided to high-risk patients
screening was then used by nurses to categorize patients into a according to STRATIFY (2004 - 2006), i.e. labeling of the
high-risk and a low-risk group. patient’s bed, additional supervision and assistance with
The primary aim of this study was to evaluate the patient transfer and toilet use, individual patient and caregiver
screening’s performance by comparing the proportion of fallers counseling including provision of an information leaflet, staff
using STRATIFY (2004 - 2006) and LUCAS (2010 - 2011) as education and encouragement to use eyeglasses, hearing aids,
screening, respectively (17). footwear, and mobility devices appropriately, in addition to
routine geriatric care (12).
Participants and methods
Sources and collection of data
Setting
As part of an academic teaching hospital in the northwest
STRATIFY (2004 - 2006)
corner of Hamburg, Germany (250,000/1.8 million inhabitants
Data collection contained socio-demographic information,
in this urban area), the geriatric clinic provides 131 beds and
Barthel-Index, ICD-diagnoses, and the STRATIFY fall-risk
serves about 2,500 inpatients annually, with around 68 %
factors, electronically provided by the hospital controlling
referred from the emergency room, the admission ward or
department. There were 4,735 observations of patients admitted
other departments, 23 % from other hospitals in and around
from 1st September 2004 - 31st December 2006 when the
Hamburg, and 9 % referred from general practitioners, all for
STRATIFY screening was used (STRATIFY time period).
geriatric acute and complex therapy according to the German
DRG system. There are five wards, with one dedicated to
LUCAS (2010 - 2011)
acutely ill patients with mental impairment (AICI) (18).
Eligible patients were all patients consecutively admitted
Patients are admitted to wards with beds available, except
during 1st March 2010 - 28th February 2011, 65 years and
admission to the AICI ward. There are early-morning meetings
older, and with LOS ≥ 48 hours. Patients admitted twice due to
on each ward (10 - 15 min.) and weekly sessions of the total
the same medical reasons were included once, including only
ward staff (60 min.). The patient rooms have more space than
the first admission. Further data were collected that included
in conventional hospital buildings, facilitating nurses’ and
information on functional health status (e.g. BI, Mini Mental
therapists’ access to the patients’ beds, and the handling and
State Examination) and the items of the LUCAS fall-risk
parking of mobility devices. Handrails, night-lights, nonslip
screening, as STRATIFY was not used any longer in the clinic.
bathroom flooring, electric beds, and appropriate height chairs
Socio-demographic data and ICD-diagnoses were provided by
and toilet seats are standard.
the hospital controlling department. A data manager collected
the information on functional health status and the LUCAS fall-
Definitions and fall-prevention measures
risk screening from the paper patient records.
A fall was defined as ‘an unexpected event in which the
Additional predefined plausibility checks of fall-risk factors
patient came to rest on the ground, floor or lower level’ (19).
were performed in order to check whether nurses had used the
Fall incidences were recorded using the standardized reporting
LUCAS screening properly. The ICD-10-GM Versions 2010
system (12). The patients’ case notes were checked by the
and 2011 and primary and secondary diagnostic codes were
research team to detect unreported falls (20). Occupied bed
used to check the fall-risk factors ‘mental alteration’ and ‘fall-
days (OBDs) were defined as the difference between the dates
history’. The BI mobility items ‘transfer’ and ‘walking’ were
of admission and discharge.
recalculated in every patient to verify ‘insecure mobility’.
Before implementation of the LUCAS fall-risk screening
a one hour interdisciplinary updating training session for all
Statistical analyses
members of the interdisciplinary geriatric team was performed
Percentages, medians, ranges and interquartile ranges
by the leading geriatrician and members of the research team
(IQR) were calculated as appropriate to describe patient
(power-point presentation incl. examples). Furthermore, a

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PRO-ACTIVE FALL-RISK MANAGEMENT IS MANDATORY TO SUSTAIN IN HOSPITAL-FALL PREVENTION

characteristics. The Mann-Whitney test and χ2 test were used
to assess differences between patients.
We compared the proportions of fallers between the two
time periods (LUCAS and STRATIFY time period) in order
to assess effects associated with the implementation of the
LUCAS fall-risk screening. We also conducted a logistic
regression analysis to estimate the regression coefficients for
the first dataset in order to account for variable distribution
of fall-risk factors in the two time periods. These coefficients
were then used to calculate the number of fallers expected
taking into account risk-factor distribution. We then compared
the number of fallers expected and the number of fallers
observed, determining significance by using the χ2 test.
The aim of the logistic regression analysis was thus not
to evaluate the screening tools’ ability to predict fallers, but
rather to estimate the proportion of fallers and the probability
to fall considering variability in the prevalence of fall-risk
factors. It is clear that the incidence of falls is influenced by fall
prevention measures.
All confidence intervals (CI) were calculated at 95 % level.
Table 1
Patient characteristics and distribution of fall-risk factors
Two sided p-values ≤ 0.05 were considered to be significant.
Data management applied SPSS 12.0.1 (SPSS Inc., 1989 -
2003), and the analyses were performed using SAS 9.2 (SAS
Institute Inc. 2008). Ethical approval was obtained from the
Hamburg General Medical Council Ethics Committee (No.
PV-2980).
Results
Recruitment and patient characteristics
During 2010 - 2011, there were 2,402 eligible out of 2,559
patients admitted. There remained 2,337/2,402 (97.3 %) who
were screened using the LUCAS fall-risk screening (Figure
1). According to the screening documented, 27.3 % of patients
were mentally impaired, 41.9 % had falls before admission and
54.3 % presented with insecure mobility. Using this screening,
40.4 % of patients were assigned to the high-risk group and
received fall-prevention intervention measures accordingly
(Table 1).

2004 - 2006* 2010 - 2011** p-value p-value 2004

patient sample patient sample 2004 - 2006 - 2006 vs.
vs. 2010 - 2010 - 2011
2011 (patients on
total patients AICI ward
excluded)
Total Patients Patients on AICI ward
excluded
Patients screened 4,735 2,337 1,963 -- --
Age (y) Median (range) 82 (65 - 101) 82 (65 - 104) 82 (65 - 104) 0.3215 0.4844
Female (%) 69.9 66.8 68.3 0.0079 0.1843
Fallers (%) 508 (10.7) 291 (12.5) 195 (9.9) 0.0313 0.3340
Number of falls 742 450 260 -- --
Falls per 1000 OBDs 8.2 11.4 7.9 -- --
Patients screened as high risk (%) 41.4 40.4 35.1 0.4410 0.0581
Total Barthel-Index*** score, 45 [25 - 65] 45 [30 - 65] 50 [30 - 65] 0.6321 0.0221
Admission Median [IQR]
MMSE score, admission Median 24 [20 - 27] 25 [20 - 28] 26 [22 - 28] 0.0006 < 0.0001
[IQR]
LUCAS screening items As docu- According As docu- According to
mented by to plausibi- mented by plausibility
nurses lity checks nurses checks
Falls history (%) 35.3 41.9 48.0 40.3 46.5 < 0.0001 < 0.0001
Mental alteration (%) 21.2 27.3 44.8 17.0 35.1 < 0.0001 < 0.0001
Insecure mobility‡ (%) 35.4 54.3 55.8 52.9 56.6 < 0.0001 < 0.0001
Notes: * fall-risk screening by STRATIFY, ** fall-risk screening by LUCAS fall-risk screening, *** Barthel-Index (29), ‡ defined by the Barthel-Index mobility items ‘transfer’ and
‘walking’ scores of 5 - 15, MMSE = Mini Mental State Examination, IQR = interquartile range, y = years, AICI ward = specialized ward for acutely ill patients with mental impairment,
OBDs = occupied bed days

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Figure 1
Patient flowchart for the two observation periods
Notes: LOS = length of hospital stay, h = hours, excl. = exclusive, AICI ward = specialized
ward for acutely ill patients with mental impairment, OBDs = occupied bed days
The LUCAS screening was not always used properly. The
plausibility checks revealed that all three risk factors had
been under-recorded (mental impairment 27.3 % vs. 44.8 %,
fall history 41.9 % vs. 48.0 %, insecure mobility 54.3 % vs.
55.8 %). Therefore, the fall-risk classification of the patients
had to be corrected in a total of 254 (10.9 %) patients. Two
hundred and thirty patients rated at low were actually at high
risk. Only one patient was rated at high but should have been
rated at low risk. The screening result could not be calculated
in 23 patients although a risk group was assigned in the
documentation.
Between 2004 - 2006, there were 4,735 patients who
had been screened by STRATIFY. The median age of these
patients was 82 years (65 - 101 y), and 69.9 % were females.
Mental impairment was recorded in 21.2 %, 35.3 % fell
before admission, and mobility was insecure in 35.4 % of
these patients. The obvious differences between risk-factors’
prevalence in the two time periods, 2004 - 2006 and 2010 -
2011, do imply that the distribution of fall-risk factors had
changed.
Fallers and multivariate analysis
During 2010 - 2011, there were 291 (12.5 %) fallers, 450
total falls and 11.4 falls per 1,000 OBDs resulting in a total of
103 (22.9 %) injuries including 7 fractures, 69 abrasions and
27 lacerations, compared to 508 (10.7 %) fallers, 742 total falls
and 8.2 falls per 1,000 OBDs resulting in 142 (19.1 %) injuries
including 13 fractures, 83 abrasions, 46 lacerations during 2004
- 2006.
The proportion of fallers expected was 14.5 % after
adjustment for the risk factors. However, the proportion of
fallers observed was lower than expected (p = 0.038); 291
fallers observed vs. 334 expected (Figure 2). There were more
men both with single and recurrent falls (≥ 2 falls) than women;
1015
i.e. 78/776 (10.1 %) and 51/776 (6.6 %) vs. 125/1,561 (8.0 %)
and 37/1,561 (2.4 %).
Figure 2
Proportion of fallers observed using STRATIFY and LUCAS
Subgroup analyses
The different prevalence of fall-risk factors may be related
to the opening of the specialized AICI ward in November 2009,
dedicated to acutely ill patients with cognitive impairment. This
could have attracted more patients with mental impairment, in
general.
After exclusion of the 374 patients admitted to the AICI
ward, there were 1,963 patients left, median age of 82 years
(65 - 104 y) and 68.3 % females. According to documentation
17.0 % of these patients were mentally impaired, 52.9 % had
insecure mobility and 40.3 % had previous falls. Compared
to the time period 2004 - 2006 the percentage of mentally
impaired patients was significantly lower while both the other
risk factors were recorded significantly more often (Table 1).
After plausibility checks even, the percentage of patients with
mental impairment was 35.1 %, insecure mobility 56.6 %, and
fall history 46.5 %.
There were 195 (9.9 %) out of these 1,963 patients who
had 260 total falls, 7.9 falls per 1,000 OBDs resulting in 68
(26.2 %) injuries; 2 fractures, 46 abrasions, 20 lacerations.
After adjustment for risk-factors’ prevalence, the number of
fallers expected was 260 (13.3 %), but the 195 (9.9 %) fallers
observed was lower (p < 0.0001).
Rather more falls were recorded on the AICI ward. There,
the percentage of fallers (96/374) was 25.7 %; the fall-rate was
28.9 falls per 1,000 OBDs. Forty-four percent of those patients
who fell had recurrent falls on this AICI ward while frequent
fallers contributed to a quarter of the total fallers on the other
wards. The percentage of frequent fallers on the AICI ward was
nearly five times as high as compared to that on all other wards;
42/374 (11.2 %) vs. 46/1,963 (2.3 %). In the patients from the
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PRO-ACTIVE FALL-RISK MANAGEMENT IS MANDATORY TO SUSTAIN IN HOSPITAL-FALL PREVENTION
AICI ward, there were five out of the total 7 fall events with
fractures (5/190 vs. 2/260; 2.6 vs. 0.8 % of all falls recorded).
The proportion of fallers decreased slightly over the
complete period observed (2004 - 2011). Yet, stabilization
seems to appear. The reduction in fallers after implementation
of systematic prevention seems being moderately sustained
(Figure 3). In retrospect, the proportion of fallers decreased
from 16 and 20 % in both female and male patients, as had
been recorded in the period 2000 – 2002 (21).
Figure 3
Proportion of fallers and rate of falls per 1,000 OBDs over time
%
Notes: incl. = inclusive, excl. = exclusive, AICI ward = specialized ward for acutely ill
patients with mental impairment, OBDs = occupied bed days
Discussion
Key Findings
The LUCAS fall-risk screening was validated in a
temporally independent sample of 2,337 patients and defined
a reasonable high-risk group. The proportion of fallers was
reduced although adjustment for fall-risk factors showed an
increased prevalence. Functional and cognitive status were
major risk factors for in-hospital falls. Unfortunately, in
routine clinical practice, even a three-item fall-risk screening
to identify patients at high risk of falling may not always be
applied appropriately.
Prospective fall-risk screening validation
The LUCAS fall-risk screening is based on clinical
information as recorded in routine geriatric practice in hospital.
Comprehensive geriatric assessment facilitates awareness
of older patients’ risk constellations (22). The strengths of
this study are the high numbers of patients screened using
STRATIFY and LUCAS and the long observation periods (23).
The prospective validation showed efficiency in defining a
high-risk group, and subsequent fall-prevention measures were
associated with a reduction in the risk-adjusted proportion of
fallers. After exclusion of the patients on the AICI ward, this
1016
result became even more apparent.
It has to be stressed that common values of predictability
were not suitable here because of the provision of fall
prevention to patients at high risk as identified by the LUCAS
screening. Consequently, we used the proportion of fallers and
the fall-rate as outcome measures. Furthermore, the change in
patient risk-factors’ prevalence detected did prohibit the direct
comparison of raw proportions of fallers. Therefore, a logistic
regression model was used to adjust for variable risk-factor
prevalence.
Clinical implications
Importance of reduced functional competence
As reported earlier (12, 21) more falls were recorded in men,
probably due to their lower functional-status levels compared
to the female patients. In general, the patients’ lower functional
competence corresponded to high fall-risk factor prevalence.
Therefore, more high-risk patients had to be expected. There
were 40.4 % screened high risk by LUCAS vs. 41.4 % by
STRATIFY. Despite higher risk-factor prevalence the LUCAS
screening defined a reasonable high-risk group. This is of
practical relevance as staff resources are limited, and adherence
to regular screening and its acceptance may be strengthened
(24). In fact, adherence to screen every patient admitted was
very high.
Screening performance
Although the LUCAS screening is supposed being easily
performed it had not always been applied appropriately by
the nurses. The risk factor “mental alteration” showed the
highest discrepancy between the nurses’ documentation and
the plausibility checks indicating the potential need of further
clarification. With respect to the efforts on improving the
IHF-prevention process this finding is somewhat concerning
as group session and additional training on the wards were
offered. Continuous staff training seems mandatory in order
to sustain the prevention process. Advanced training will be
organized to make nurses more sensitive of problems how to
use the screening. Also, the introduction of leadership support
by one nurse on each ward responsible for fall-prevention
(25) and the evaluation of the fall-risk prevention intervention
process will be considered (26, 27).
Nevertheless, this finding was somewhat unexpected in
an academic geriatric clinic (22). One may speculate whether
general reluctance to documentation or daily habitual pro-
active ‘risk-watching’ and management by the nursing staff
may be potential reasons (28). Frequent fluctuation in staff
corresponding to lower level of experience has also to be
considered. However, it also might be caused by too low an
awareness of mental impairment as has been reported from
general hospitals (29), and addressed as a matter of urgent
subject to improvement (30). In retrospect, some patients had
a diagnosis of delirium, and it is well known that delirium may
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be quite difficult to recognize as early as possible. This is the
case, in particular, if symptomatology is not that of an agitated
delirium (31).
Reduced mental function
The high occurrence of falls on the AICI ward is comparable
with that reported from another study (32). Although the
number of patients from the AICI ward was small in this
study our findings do also compare with those from a large
patient sample (33). Interdependencies between mental function
and mobility (34, 35) appear to have an impact on location
and type of IHF (36). Five out of seven falls with fractures
were recorded on the AICI ward. Also in hospitals mental
disturbances may particularly be associated with injurious falls
(33, 37). The risk of falling in older hospitalized patients with
mental impairments does add to other risks in this particular
patient segment (38). Therefore, one may well assume that
prevention of functional decline, and of delirium (39) and,
thereby, of prevalent fall-risk factors may considerably
contribute to improvement in IHF reduction.
Usefulness of formal screening
Mental impairment as relevant co-morbidity is a prerequisite
for admittance to the AICI ward. One of the three LUCAS
screening items is thus fulfilled in these patients. Therefore,
it may well be argued if fall-risk screening will contribute to
improved identification of high-risk patients on this ward at all.
Rather, fall-risk prevention measures are mandatory for every
patient admitted irrespective the screening’s result. Also, the
number of fall-related hospital admissions is increasing (40). A
priori, these patients do also fulfill one of the three risk factors
when admitted, creating a similar problem.
The use and impact of formal fall-risk screening vs.
nurses’ or physiotherapists’ judgment alone is still a matter of
ambiguity (41-43). An alternative to identify patients at high
risk of falling and, therefore, need of prevention is by using
higher age as risk indicator of falls (44). The British National
Institute for Health and Care Excellence (NICE) recommends
not using fall prediction tools. Instead, all patients aged 65
years or older should be regarded as being at risk of falling
(45).
However, analyses of fall-risk factors in geriatric in-patients
failed to show a strong relationship between age and IHF, as
also reported by Oliver and colleagues when developing the
STRATIFY screening. Rather, functional status level had
strong relationship (11, 15). Therefore, the decision on the
use of formal fall-risk screening, nurses’ or other professional
judgment or an age limit should probably depend on setting-
specific analyses, to reveal what does work best for reducing
IHF (13, 41).
The demand of formal fall-risk screening may depend on
staffs’ experience including risk management of geriatric
syndromes (15) and different compositions of interdisciplinary
teams as well. Irrespectively, validation of formal screening
1017
in a specific setting is mandatory. For example, informal
assessment of delirium was inadequate compared to formal
screening in the emergency department (46) supporting a
formal approach.
Limitations
For reasons of limited resources under routine care
conditions our study could not be designed to disentangle
single components of the falls prevention process. However,
an important element for interpretation of preventive effects
has been applied, that is the description of mental and physical
function (47).
Furthermore, there is yet no information available on the
LUCAS fall-risk screening performance in other hospitals’
geriatric wards and or other medical departments. This
screening might have its highest clinical impact in hospital
settings caring for a high number of older patients, but
where staff is not well familiar with pro-active geriatric risk-
management.
In general, information about effects of hospital-wide
interventions to improve the care for frail older inpatients
is scanty and still fragmented (48). Geriatric syndromes are
highly prevalent among older patients admitted to acute care
hospitals (49). Early identification of patients at risk seems
to be necessary to prevent geriatric syndromes’ exacerbation,
unwanted events, but also to improve therapeutic outcome. The
number of frail persons is supposed to rise, and elevated risk of
falling is highly prevalent in these patients (50).
Our fall-prevention program (screening and fall preventive
measures) focused on high-risk patients in particular, was
accompanied by a reduced proportion of fallers. Thereby,
nursing staff’s resources would be at disposal for intensified
patient care and for the provision of preventive measures.
Additionally, a full economic analysis in form of a cost-
effectiveness-analysis will be performed comparing the
LUCAS fall-risk screening and the STRATIFY screening.
Hence, estimates will be provided to what extent (monetary)
resources can be saved including monetary depiction of the
process for IHF prevention (9).
Conclusions
Older inpatients’ levels of functional competence are closely
related to fall-risk classification, with mental function being
of particular relevance. Raw proportions of fallers are not
suitable to evaluate IHF prevention. Adjustment for variable
prevalence of fall-risk factors over time is necessary. Also,
the findings do underscore the importance of continuous
information, communication and training of nursing staff and
interdisciplinary teams to sustain the process of IHF prevention.
Acknowledgements: We thank Joerg Hasford who served as scientific advisor and
critically reviewed the study design and Björn Klugmann for supporting data preparation.
Contributors: WvRK, VSH and LN were responsible for the study concept and design.
LN and SG recruited study participants, collected data and organized data management.
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PRO-ACTIVE FALL-RISK MANAGEMENT IS MANDATORY TO SUSTAIN IN HOSPITAL-FALL PREVENTION
VSH and LN performed the statistical analyses. VSH, LN and WvRK contributed to data
interpretation and preparation of the manuscript.
Conflict of interest disclosure statement: VSH, LN, SG and WvRK report no conflict
of interest.
Funding: This work was supported by the Federal Ministry for Education and
Research (BMBF), Berlin, Germany (grant no. 01ET0708, 01ET1002A). The funding
source had no role in the design and conduct of the study; in the collection, analyses, and
interpretation of the data, or in the preparation, review, or approval of the manuscript.
Ethical approval: Ethical approval was obtained from the Hamburg General Medical
Council Ethics Committee (No. PV-2980).
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