Etiology of falls among cognitively intact hospice patients.

Background: Falls can pose a serious threat to hospice patients receiving palliative care. Interventions to reduce falls have yielded minimal results among older patients. Falls among hospice patients provide a unique population from which a new approach to fall prevention may need to be established.

Objective: The aim is to devise a forecasting model with which to predict the probability of a patient fall and evaluate whether the model predicts patient falls better than existing measures.

Methods: Two hundred patients were randomly selected from one of the largest hospices in the United States. After patient admission, patient falls were followed-up via weekly calls until a fall, patient death, or hospice discharge occurred. Independent factors included demographic, functional status, environmental measures, symptoms, medications, attitudinal dispositions, and the use of an ambulatory aid.

Results: Cognitively intact hospice patients who have a higher risk of falls are those who had a past history of a fall (p = 0.022), patients that are physically more functional as demonstrated by higher score on the Palliative Performance Scale (p = .039), patients with a greater "fear-of-losing-independence (p = 0.023)," those who try to "avoid asking for help (p = 0.005)," and those who "feel uneasy about asking for help (p = 0.05)." Patients who depend on ambulatory aids were less likely to fall (p=0.06). The forecasting model predicted patient falls correctly in 78% of the patients observed.

Conclusions: The current model predicted fall occurrence far better than the Morse Falls Scale and other functional status measures and may lead to a shift in fall prevention approaches among hospice patients.