Intrinsic risk factors of falls in older patients

Abstract

Falls in older adults pose a major public health challenge, with intrinsic factors such as co-morbidities, polypharmacy and fall-risk-increasing drugs (FRIDs) contributing to increased risk and healthcare burden. The aim of this study is to identify key intrinsic risk factors for falls in older patients and to propose systems for healthcare professionals (HCP) to reduce falls risk and improve patient outcomes. In a retrospective analytical cross-sectional study, within a rehabilitation hospital, patient profiles compiled by clinical pharmacists were reviewed for patients 65 years and over and discharged between January and December 2023. Participants who met the inclusion criteria and were admitted with falls were classified as the faller group, while the remaining participants were assigned to the control group. Falls in the faller group were identified as non-mechanical (intrinsic). A data collection sheet was compiled to record data on demographic characteristics, co-morbidities, FRIDs and the number of chronic medications prescribed. For each category under investigation, statistical analysis was conducted to analyse associations between the faller group and the control group. From the findings of this study a fall risk assessment tool (SAFE-R), to identify intrinsic risk factors for falls, was developed. Of 782 participants meeting the inclusion criteria, 355 (45%) experienced a non-mechanical fall. The results of the study revealed that the risk of experiencing falls increases with increasing age (p < 0.05) and female gender (p < 0.001). Binary logistic regression analysis was used to relate risk of a fall to co-morbidities and FRIDs. Seven significant co-morbidity predictors for falls were identified, namely cognitive impairment, visual impairment, syncope, postural instability, history of falls, present fracture and osteoporosis (p < 0.05). The greater the number of co-morbidities present, the greater the risk of experiencing a fall (p < 0.001). The more chronic medications taken, the greater was the likelihood of experiencing a fall (p < 0.001). Benzodiazepine receptor agonists (p = 0.022) and opioids (p < 0.001) were identified as significant fall predictors. This study highlights the need to assess intrinsic fall risk factors and identifies strategies to enhance the intervention of clinical pharmacists in treatment optimisation. It further emphasizes that fall risk assessment tools support HCPs in identifying high-risk patients, thereby reducing fall risk and improving outcomes.