Fall Risk Factors

Systems theory

General systems theory originated from the work of biologist Ludwig von Bertalanffy. Any organization can be viewed as a system. The emphasis with systems theory is to see an organization as a whole rather than focusing on individual components. In its simplified version a system can be viewed as input, throughput and outputs with a feedback loop. The entire system is designed to meet goals (Mele et al., 2010).

A systems view is necessary to effectively prevent patient falls. This section of the course describes the patient (input) and hospital environmental factors (throughput) that influence and increase the incidence of falls (Anderson et al., 2013).

Later sections will describe how throughput can affect the incidence of falls.


Patient characteristics that indicate high risk for falls

Patients 65 and older are considered at increased risk of falls even in their own environments.  According to the Center for Disease Control (CDC), every year one out of three older adults, 65 and older, experiences a fall.  The older the person is, the greater is the risk for falls.  The fall rate for adults 85 and older has been reported to be almost four times that for adults 65 to 74. For this age group, falls are also the most common causes of hospital admission due to trauma (CDC, 2015).

In this age group, falls are the leading cause of injury death.  The older a person is when they fall, the more likely they are to have serious injuries.  The highest rates of deaths from falls, 82%, occur among people 65 and older.

We know according to several research studies the following characteristics contribute to the possibility of a patient falling while in a hospital or other medical facility:

Specific conditions

Common uses of Anticholinergic Drugs
Indication Drugs
Parkinson's disease
  • Trihexyphenidyl (Artane)
  • Benztropine mesylate (Cogentin)
  • Biperiden
  • Procyclidine
  • Scopolamine
Skeletal muscle relaxant and irritable bowel
  • 2,5 antihistamines (orphenadrine)
  • Scopolamine
  • Hyoscyamine (Levsinex)
  • Belladonna alkaloids
  • Propantheline (Pro-Banthine)
Reduce secretions
  • Atropine
  • Hyoscyamine (Levsinex)
Urinary incontinence and overactive bladder
  • Flavoxate (Urispas)
  • Oxybutynin (Ditropan, Oxytrol)
  • Tolterodine Fesoterodine (Toviaz)
  • Solifenacin (VESIcare)
  • Darifenacin (Enablex) (Mayo Clinic, 2016)

Throughput – environmental factors

In a study done in a 1300 bed urban hospital found the majority of the falls were unassisted (79%), occurred in the patient’s room (85%) and during the evening/overnight hours (59%).  Common in the over 65 year old patients were elimination related falls (50%) with most falls occurring on the way to use bathrooms or in bathrooms. Units with the highest fall rates (6.12 falls per 1,000 patient days) had the highest patient to nurse ratios (5.9 to 1) (Hitcho et al., 2004). Another study reported a decrease in fall rates with units whose nurses had national nursing specialty certification (Boyle, et al., 2015).

Ambulation was also found to increase a time during which falls occurred. This could account for the increase number of falls documented in rehabilitation units (Zhao & Kim, 2015). The number of beds in a room also was a factor in the incidence of falls. In a study of fall rates in single bed rooms versus multiple bed rooms, researchers found an increase in fall rates in the single bed rooms. They have recommendations for not placing elderly patients in single bed rooms (Singh et al., 2015).

Instant feedback

Which of the following have been shown to increase the probability of patient falls occurring?
High patient to nurse ratios
Use of laxatives
Use of Benzodiazepines
All of the above