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    • br Methods br Results From a study population

    2024-04-18


    Methods
    Results From a study population of 7069 patients, a total of 149 falls were reported during the study MHY1485 for an incidence rate (IR) of 5.2 falls per 1000 patient-days (PD), 95% confidence interval (CI) 4.4/1000 PD–6.1/1000 PD. The incidence rate ratio (IRR) for patients in the ACE unit compared to those in non-ACE units was 0.96 (95% CI: 0.56, 1.63). Table 1 shows characteristics of patients in the ACE and non-ACE units. The mean age of the study population was 76.4 years (SD ± 8.3) with females composing 60.6% of the patients. Given the high proportion of zeros and the count nature of the response variable, the zero-inflated Poisson (ZIP) model was used to control for potential confounders in the multivariate analysis. The Vuong test confirmed that this decision was the appropriate one. The unadjusted ZIP model estimated an IRR of 0.18 (95% CI 0.09, 0.37; P < 0.001) for falling among patients in the ACE unit compared to those in the non-ACE units, a significant 82% reduction in the incidence of falls in the ACE unit. The final, adjusted ZIP model estimated a somewhat lower but significant 73% reduction in the incidence of falls for patients in the ACE unit when compared to patients in the non-ACE units; the IRR was 0.23 (95% CI 0.13, 0.54; P < 0.001) after adjusting for age, sex, medications, and MFS (see Table 2). There was a significant increase in the incidence of falls in patients who received one dose or more of any psychotropic or hypnotic to those who did not receive any doses of these medications during their hospitalization (adjusted IRR: 1.67; 95% CI, 1.17–2.37; P = 0.004). Male sex was also associated with decreased risk of falls (adjusted IRR: 0.54; 95% CI, 0.38–0.76; P < 0.001). Table 2 shows factors associated with the incidence of falls, namely the type of unit, medications, sex, age, and MFS.
    Discussion Assessing the efficacy of fall preventive strategies in hospitalized elderly patients is essential in improving healthcare for this age group. With an aging population, patients 65 years and older accounted for 78% of the total Medicare expenditure in 2011 and 33% of it was for inpatient hospital care. To tackle this challenging age group, healthcare providers raised the issue of needing dedicated units to provide better care and decrease unwanted events such as patient falls. Additionally, the literature describes many interventions that have been implemented, such as hip protectors, fall alarm devices and removal of physical restraints, and these interventions had variable results in reducing the risk of falls in acute care settings. Introduced earlier, a meta-analysis done by Fox et al., in 2012 showed ACE units decrease the risk of falls in the hospital for older adults by 49% without increasing the cost of hospitalizations. To measure the relative risk reduction of falls of ACE unit compared to usual care, they included two trials with a total sample size of 749. They reported a relative risk of 0.51; 95% CI, 0.29–0.88; P = 0.02. There was also a quasi-randomized controlled study done in 2011 by Wald et al. that compared an ACE unit to a general medical unit. Although they found the ACE unit had improved recognition of abnormal functional and cognitive status, it did not show any improvement in decreasing the risk of falls in patients admitted to the ACE unit. However, their study had several limitations which affected the generalizability of the results. It was a single-center, non-blinded retrospective study with a small sample size, as it included only 217 patients. Additionally, the study was started 3 months after the unit being established with a follow up duration of 6 months only. A 2015 study that examined the two-year fall rate differences between non-subspecialty units as well as hospital characteristics found that 87% of the variation in fall rates could be attributed to between-unit differences. High fall rates were linked to higher patient volume, which may indicate that variables such as patient turnover could predict an increased risk of falls thus representing a potential area for future study.