The consequences of falls in acute and subacute hospitals in Australia that cause proximal femoral fractures

OBJECTIVES: To compare consequences for patients with proximal femoral fractures (PFFs) sustained in the hospital with patients who sustained PFFs in the community. DESIGN: Data were collected from inpatient notes and incident reports of patients admitted to hospitals over a 6-year period. All patients aged 75 and older sustaining a PFF in the hospital were identified and matched according to sex, age, and fracture date with patients who sustained a PFF in the community. SETTING: Illawarra region hospitals, New South Wales, Australia. PARTICIPANTS: Forty-three patients with a hospital-acquired PFF and 43 patients with a community-acquired PFF; mean age was 84.0 (range 75-92), and 67% were women. MEASUREMENTS: Outcomes at hospital discharge and circumstances of hospital-acquired PFF. RESULTS: Comparing outcomes of subjects with hospital versus community-acquired PFF revealed that 12 versus four died in the hospital (P = .03), 14 versus five were discharged to long-term nursing care facilities (P = .02), six versus 18 returned to preadmission ambulation (P = .004), and four versus 24 returned to preadmission activity of daily living status (P<.001). The median postfracture length of stay was 46 days for subjects with hospital-acquired PFF versus 32 days for those sustaining a PFF in the community (P < .01). Review of circumstances of the 43 hospital-acquired fractures revealed that 26 occurred in subacute wards, 25 occurred in bedrooms, 25 occurred at night, and 38 occurred while unsupervised. CONCLUSION: Patients with hospital-acquired PFF have poor outcomes. Adequate supervision, provision of hip protectors in the hospital, and strategies that address fracture circumstances may hold the keys to prevention.