The association of malnutrition with falls and harm from falls in hospital inpatients: Findings from a 5-year observational study
The association of malnutrition with falls and harm from falls in hospital inpatients: Findings from a 5-year observational study
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DOI：
10.1111/jocn.15098
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发表时间：
2019-12-01
影响因子：
4.2
通讯作者：
Bell, Jack J.
中科院分区：
文献类型：
--
作者：
Lackoff, Ariel S.;Hickling, Donna;Bell, Jack J.
住院患者跌倒仍然是一个重要的临床问题，虽然营养不良是已知的跌倒风险因素，但很少有研究调查其与住院患者跌倒的关系。本研究旨在探讨营养不良与住院病人跌倒风险及跌倒伤害之间的独立关系。方法将年度营养不良审计中发现的营养不良与审计后12个月内通过电子患者事件报告系统获取的住院患者跌倒数据相结合。2011-2015年间1849名住院患者的审计数据，并分析了年龄、性别、BMI、营养不良、跌倒和有害跌倒之间的协变量关联。本文的报告符合加强流行病学观察性研究报告（STROBE）的建议（见附录S1）。结果营养不良发生率为32.4% (n = 543)， 171例（9.2%）住院患者出现下降，其中0.7% （n = 13）为不良。在双变量分析中，跌倒的患者更可能是老年人（中位79.0岁vs. 70.0岁；p < 0.0001）或营养不良（40.9% vs. 31.5%; p = 0.021）。营养不良（p < 0.0001）和较低的BMI （p = 0.026）是有害跌倒的显著预测因素。回归模型显示，只有年龄增加才会增加住院患者跌倒的可能性（OR 1.022 95% CI 1.021-1.046; p < 0.0001）。营养不良住院患者发生有害跌倒的可能性几乎是非营养不良住院患者的8倍（OR 7.94 95% CI 1.457-43.338; p = 0.017），与年龄和BMI无关。结论营养不良的患者更容易发生跌伤。应将营养不良评估纳入跌倒风险评估，以突出那些风险较大的患者，并将其与营养护理途径联系起来。
Background Inpatient falls continue to be a significant clinical issue, and while malnutrition is a known risk factors for falls, few studies have investigated its association with inpatient falls. This study aimed to explore the independent association between malnutrition and fall risk as well as harm from falls in hospital inpatients. Methods Malnutrition identified in annual malnutrition audits was combined with inpatient fall data captured through the electronic patient incident reporting system in the 12 months following audit days. Audit data were available for 1,849 inpatients across 2011-2015, and covariate associations between age, gender, BMI, malnutrition, falls and harmful falls were analysed. The reporting of this paper is in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) recommendations (see Appendix S1). Results The prevalence of malnutrition was 32.4% (n = 543), and 171 (9.2%) inpatients experienced a fall with 0.7% (n = 13) categorised as harmful. In bivariate analysis, patients who fell were more likely to be older (median 79.0 vs. 70.0 years; p < .0001) or malnourished (40.9% vs. 31.5%; p = .021). Malnutrition (p < .0001) and having a lower BMI (p = .026) were significant predictors of harmful falls. Regression modelling demonstrated that only increasing age increased the likelihood of having an inpatient fall (OR 1.022 95% CI 1.021-1.046; p < .0001). Malnourished inpatients were almost 8 times more likely to have a harmful fall than those not malnourished (OR 7.94 95% CI 1.457-43.338; p = .017), independent of age and BMI. Conclusions Malnourished patients are more likely to experience a harmful fall. Assessment of malnutrition should be incorporated into fall risk assessments as a way of highlighting those patients at greater risk and to link to nutritional care pathways.