Falls in Hospitals: Challenging Traditional Risk Assessments With New Insights Into Patient Mobility

Abstract

Aims and Objectives

To explore the association between different aspects of patient functional mobility, specifically, mobility capability (i.e., what the patients could do) versus mobility performance (i.e., what the patients actually did) and hospital falls.

Background

Fall risk assessments are important strategies to mitigate inpatient falls, and mobility is a crucial factor in determining a patient's risk. However, different fall assessment tools vary in how they attribute risk based on mobility difficulties. Understanding how various aspects of mobility uniquely influence fall risk is essential for accurately capturing and assessing a patient's true fall risk.

Design

A retrospective analysis was conducted using routine electronic medical record data at three hospitals, encompassing 498 patients who experienced falls and 53,708 patients who did not fall.

Methods

We examined patient mobility in three distinct ways and their relationship with in-hospital falls. Mobility was assessed within the first 48 h of admission using the mobility questions in the Johns Hopkins Fall Risk Assessment Tool (JHFRAT). Additionally, we evaluated other aspects of mobility using the AM-PAC scale, which measures mobility capability, and the JH-HLM scale, which assesses mobility performance.

Results

A negative linear/stepwise relationship was observed between both AM-PAC scores and JHFRAT mobility scores with fall incidence, indicating that lower mobility capability is consistently linked to a higher risk of falls. In contrast, the relationship between JH-HLM scores and falls followed an inverse U-shaped curve, with a lower fall incidence in patients with the lowest mobility performance.

Conclusions

This exploratory study highlights that a one-size-fits-all approach to assessing mobility may not accurately capture a patient's true fall risk, emphasising the importance of evaluating different aspects of patient mobility for a more precise assessment. By considering both functional mobility capacity and actual mobility performance, we can better understand and address the unique ways in which mobility impacts fall risk.