Environmental factors associated with falls in hospitalised older people

INTRODUCTION: Older people are a vulnerable population for falls and the risk may be increased by unfamiliar hospital environments. Using a mixed method ergonomic approach to acknowledge the complexity of contemporary hospital environments, this thesis aims to explore the associations between patient characteristics and environmental causal factors of in-patient falls for older people. METHODS: A series of three exploratory pilot studies were carried out, followed by two large scale research projects using nationally collected data from patient incident reports and overnight bedrail audits. The mixed method approach included; secondary data analysis, interviews, surveys, and audits. MAIN FINDINGS: 1. Patients in care of older people wards have different characteristics compared to same age peers in other wards, with higher levels of frailty and confusion. 2. Bedrail use was found to rise with increasing level of confusion which is against general guidance. Staff rationales for bedrail use suggested an underlying intent to restrain confused patients. 3. Up to 92% of patients falls were reported to be un-witnessed. This may be explained by only 24% of patient beds being visible from nursing stations. 4. There were significant differences found in the fall locations between patients who were described as frail and those who were described as confused. CONCLUSION: Patients in care of older people wards have a different set of characteristics compared to same age peers in other wards. This suggests that they will have different requirements for fall prevention in terms of layout, visibility, equipment use and facilitating independence. Further research should focus on designing wards for care of older people patients which improve visibility, layout and way-finding to toilets and investigate whether these design improvements will facilitate independent movement and prevent patient falls.