Page 12 - FALL GUIDELINES MOH 2019

1.0 INTRODUCTION

FALLS

Definition

A fall is defined as an unplanned descent to a lower level, with or without injury.

Demographics

Falls are common

Falls are the most frequently reported incident in hospital wards, with rates ranging from
1.7-25 falls per 1,000 patient bed days, depending on the unit. Geriatric psychiatry patients
have the highest risk of falls.

Falls are dangerous and expensive

30-51% of falls in hospitals result in some form of injury, ranging from minor bruises to
severe wounds and fractures. Falls are associated with a longer length of stay in hospital,
greater utilization of healthcare and higher rates of discharge to nursing homes.

Falls may be prevented
Close to one-third of falls in hospitals and nursing care facilities can be prevented.

Local Data

A prevalence study done in a large tertiary hospital in Malaysia in 2011 showed that the
majority of falls occurred in the period between midnight and noon. This may have been
associated with toileting at night and higher activity in the mornings. Out of the 132 falls in
the study, 21.5% occurred in the toilet while 51.6% occurred by the bedside. 47.5% of
fallers had a previous history of falls. 41% occurred in the general medical wards. The
psychiatry, radiotherapy and oncology, and orthopedic wards together contributed to 25%
of the falls.

The most significant intrinsic risk factors were:
1. Functional status: the ‘middle group’ ie. those who were not bedbound nor fully
independent were at highest risk of falls (OR 2.3)
2. History of falls (OR 2.47)
3. Disorders of the circulatory system (OR 2.28)

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