Lackoff AS, Hickling D, Collins PF, Stevenson KJ, Nowicki TA, Bell JJ. J. Clin. Nurs. 2019; ePub(ePub): ePub.
Affiliation
Nutrition and Dietetics, School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, The University of Queensland, St Lucia, Queensland, Australia.
BACKGROUND: Inpatient falls continue to be a significant clinical issue and whilst malnutrition is a known risk factors for falls, few studies have investigated its association with inpatient falls. This study aimed to explore the independent association between malnutrition and falls risk as well as harm from falls in hospital inpatients.
METHODS: Malnutrition identified in annual malnutrition audits was combined with inpatient falls data captured through the electronic patient incident reporting system in the 12 months following audit days. Audit data was available for 1849 inpatients across 2011-2015 and covariate associations between age, gender, BMI, malnutrition, falls and harmful falls were analysed. The reporting of this paper is in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations (see Supplementary File 1).
RESULTS: The prevalence of malnutrition was 32.4% (n = 543) and 171 (9.2%) inpatients experienced a fall with 0.7% (n = 13) categorised as harmful. In bivariate analysis, patients who fell were more likely to be older (median 79.0 vs. 70.0 years; p < .0001) or malnourished (40.9% vs. 31.5%; p = .021). Malnutrition (p < .0001) and having a lower BMI (p = .026) were significant predictors of harmful falls. Regression modelling demonstrated that only increasing age increased the likelihood of having an inpatient fall (OR 1.022 95% CI1.021-1.046; p < .0001). Malnourished inpatients were almost 8 times more likely to have a harmful fall than those not malnourished (OR 7.94 95% CI 1.457- 43.338; p = .017), independent of age and BMI.
CONCLUSIONS: Malnourished patients are more likely to experience a harmful fall. Assessment of malnutrition should be incorporated into fall risk assessments as a way of highlighting those patients at greater risk and to link to nutritional care pathways.