Registered Nurses' Association of Ontario

Nursing Best Practice Guidelines

Risk Factors and Associated Odds of Falling

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Risk Factor:
History of a previous fall

Hospitalized:
OR, 2.76

Nursing Home:
OR, 3.41

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Risk Factor:
Age 

Hospitalized:
>75

Nursing Home:
> 87 (OR, 1.16)

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Risk Factor:
Gender 

Hospitalized:
insufficient data

Nursing Home:
Male (OR, 1.14)

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Risk Factor:
Medical conditions

Parkinson’s disease, diabetes mellitus, arthritis, cerebrovascular accidents, recent hospitalization and illness via their effect on strength, balance, and proprioception can contribute to fall risk. Although these diseases cannot be altered, other risk factors may be modifiable to lower the patient’s overall risk.

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Risk Factor:
Cognitive impairment

Hospitalized:
OR, 2.62-6.33

Nursing Home:
Wandering behaviour (OR, 1.84)

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Risk Factor:
Balance and gait

Hospitalized:
Current evidence suggests that this is a risk factor for hospitalized clients (Chen et al., 2009; Corsinovi et al., 2009; Kobayashi et al., 2009; Krauss et al., 2005)

Nursing Home:
Unsteady gait (OR, 1.13)
Transfer independence (OR, 1.49)
Wheelchair independence (OR, 1.39)

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Risk Factor:
Ambulatory  aids

Hospitalized:
Use of ambulatory aids (OR, 2.84)

Nursing Home:
Use of cane/walker (OR, 1.44)

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Risk Factor:
Environmental hazards

Hospitalized:
insufficient data

Nursing Home:
Falls attributed to environmental factors: 27.3% in this population. Restraint use (OR, 10.2)

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Risk Factor:
Drugs 

Hospitalized:
Psychotrophic drugs: OR, 1.93-7.95

Nursing Home:
Polypharmacy (4+ medications)
Benzodiazepines (adjusted RR, 1.44)
Psychotrophics: 2-fold increase rate of falls Diuretics (OR, 7.2)
Vasodilators (OR, 3.0)

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Risk Factor:
Vision (decreased)

Hospitalized:
OR, 2.46

Nursing Home:
OR, 1.6

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Risk Factor:
Systolic hypotension (<110 systolic)

Hospitalized:
insufficient data

Nursing Home:
OR, 2.0

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Risk Factor:
Hospital  ward

Hospitalized:
Geropsychiatry and rehabilitation wards with higher incidence of falls.

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Risk Factor:
Number  of risk factors

Hospitalized:
Five factors, including fall as a presenting complaint, a low transfer or mobility score of 3 or 4, or the primary nurses’ judgment that the patient was agitated, needed frequent toileting, or was visually impaired were found to predict falls in a hospital setting.

Having more than two of these risk factors was defined as high risk.

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