Falls in older adults hospitalized in tertiary centers in Colombia. Clinical description and complications

Abstract

Objective The incidence of falls in elderly patients in the hospital environment is three times higher than that in the community. The aim was to determine the characteristics of patients who suffered in-hospital falls and their complications. Methods This was a cross-sectional study with patients older than 64 years of age, admitted between 2018 and 2020 to four clinics in Colombia who presented a fall during their stay. Clinical data, reasons for the fall, complications and use of drugs with a known risk for causing falls and with an anticholinergic load were reviewed. Results A total of 249 patients were included. The mean age was 77.5 ± 7.4 years, and there was a predominance of males (63.9%). The patients were hospitalized mainly for community-acquired pneumonia (12.4%) and heart failure (10.4%). Falls occurred most frequently in hospitalization wards (77.1%) and emergency departments (20.9%). Falls were related to standing alone (34.4%) and on the way to the bathroom (28.9%), with 40.6% (n = 102) of falls resulting in trauma, especially to the head (27.7%); the incidence of fractures was low (3.2%). Ninety-two percent of patients had polypharmacy (≥5 drugs), 88.0% received psychotropic drugs, and 37.3% received drugs with an anticholinergic load ≥3 points. Conclusions Hospitalized adults over 65 years of age suffered falls, mainly in hospitalization wards and emergency departments, especially during the process of solitary ambulation. Most had received psychotropic drugs and medications with a high anticholinergic load. These results suggest that it is necessary to improve risk prevention strategies for falls in this population.

Introducción La incidencia de caídas en pacientes ancianos dentro del ambiente hospitalario es tres veces superior a las que se presenta en la comunidad. Se planteó el objetivo de determinar las características de pacientes que sufrieron caídas intrahospitalarias y sus complicaciones en cuatro clínicas de Colombia. Métodos Estudio transversal con pacientes mayores de 65 años de edad, ingresados entre 2018 y 2020 en cuatro clínicas de Colombia, que presentaron una caída durante su estancia. Se revisaron datos clínicos, motivos de la caída, complicaciones y uso de medicamentos de riesgo conocido para generar caídas y con carga anticolinérgica. Resultados Se identificaron 249 pacientes, con edad media de 77,5 ± 7,4 años y predominio masculino (63,9%), internados principalmente por neumonía adquirida en comunidad (12,4%) y falla cardiaca (10,4%); las caídas ocurrieron más frecuentemente en los servicios de hospitalización (77,1%) y urgencias (20,9%). Se relacionaron con procesos de bipedestación en solitario (34,4%), y movilización al baño (28,9%), con traumatismo en 40,6% (n = 102), especialmente de cabeza (27,7%), y baja incidencia de fracturas (3,2%). El 92% de casos tenían polifarmacia ≥5 medicamentos, el 88% recibieron psicofármacos y 37,3% medicamentos con carga anticolinérgica ≥ 3 puntos. Conclusiones Los adultos mayores de 65 años internados sufrieron caídas, principalmente en los servicios de hospitalización y urgencias, en especial durante el proceso de deambulación en solitario. La mayoría habían recibido psicofármacos y medicamentos con alta carga anticolinérgica. Estos resultados sugieren que es necesario mejorar las estrategias de prevención de riesgo de este tipo de eventos.