Characteristics of early fallers on elderly patient rehabilitation wards

Background: falls are one of the most frequent complications on rehabilitation wards for elderly patients. Objective: to study the characteristics of early and late fallers. Design: prospective observational study with blinded end-point evaluation. Setting: a non-acute geriatric hospital. Subjects: 1025 consecutive patients admitted for rehabilitation following treatment for an acute illness. Main outcome measures: early/late fallers and time to first fall from admission. Results: we identified 824 non-fallers and 201 fallers. Seventy seven (38.3%) fell during the first week. The incidence decreased progressively in subsequent weeks. Early fallers were more likely to have a past history of falls (P=0.0009), an unsafe gait (P=0.001), confusion (P<0.0001) and be admitted from medical wards (P=0.03). Patients admitted from orthopaedic wards having sustained a lower limb fracture were significantly less likely to have an early fall compared to all other patients (P=0.027). When compared to later fallers, early fallers were more likely to have a past history of falls (P=0.045). They were less likely to be admitted from an orthopaedic ward (P=0.01) or to have sustained a fracture of the lower limbs (P=0.002). Logistic regression analysis showed that a past history of falls, confusion and an unsafe gait were independent risk factors predisposing to early falls. The Kaplan-Meier survival analysis showed a significantly higher cumulative risk of falling associated with these characteristics. Conclusion: the initial week of patients' rehabilitation is associated with the greatest risk of falling. Early fallers can be predicted by easily identifiable characteristics. This highlights the need for early fall risk assessment.