Hospital-Acquired Delirium Linked to Inpatient Falls
An inter-regional data review demonstrated a relationship between hospital-related falls and delirium at Kaiser Permanente Southern California (KPSC) hospitals. Hospitalized older adults are vulnerable to developing geriatric syndromes, including delirium, which occurs in 1 in 6 older adults hospitalized for medical reasons. Once acquired, only 18% of patients experience resolution of all symptoms of delirium after hospital discharge. Falls have a similar and dramatic impact on older patients; the risk of a fall resulting in nursing home placement is 10%. Falls may lead to a major injury, a change in medical and psychological status, and a loss of independence.
Falls and incident delirium shared risk factors that can be addressed in quality metrics to improve age-specific medical care for older adults. Risk factors common to falls and delirium include polypharmacy, high-risk medications, cognitive impairment, and acute illness. Lack of mobility in the hospital further contributes to both falls and delirium. Hospitalized patients spend more than 80% of the time in bed and only 4% of the time standing or walking. Early and progressive mobilization shortens length of stay and is associated with better clinical outcome.
The KPSC Falls Preventions Team therefore added prevention of delirium and education about delirium prevention into multidisciplinary falls prevention programs. Specific actions included screening for delirium using the Confusion Assessment Method tool, reduced prescribing of anticholinergic agents in older adults, reduced use of benzodiazepines and Z class non-benzodiazepines, and implementation of pedometer use to increase early and cumulative ambulation during hospitalization. In conclusion, geriatric inpatients are at greater risk of both delirium and falling and may benefit from age-specific interventions that maximize clinical outcome and retain functional independence.
Lee EA, Gibbs NE, Fahey L, Whiffen TL. Making hospitals safer for older adults: updating quality metrics by understanding hospital-acquired delirium and its link to falls. Perm J. 2013;17(4):32-36.
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