Prevalence of falls in the last weeks of life and relationship between falls, independence and quality of dying in Japan: a large prospective cohort study

OBJECTIVE

This study aims to determine the frequency of falls and their serious complications in palliative care units (PCUs), as well as explore the complex interplay between falls, independence and quality of dying.

DESIGN

A prospective cohort study.

SETTING AND PARTICIPANTS

The dying process of patients with advanced cancer in 23 PCUs in Japan.

OUTCOME MEASURES

Palliative care specialist physicians recorded whether patients experienced falls, serious complications from falls, activities that led to falls, independence (workability in the last days and use of indwelling urinary catheter) and Good Death Scale as an indicator of quality of dying.

RESULTS

Of the 1633 patients evaluated, 150 patients (9.2%; 95% CI 7.8% to 11%) experienced falls within 30 days prior to death. The patients who fell were mostly men, had Eastern Cooperative Oncology Group performance status 3 on admission, a longer estimated prognosis on admission and delirium during hospitalisation. Serious falls causing fractures or intracranial haemorrhages were rare in five patients (0.3%; 95% CI 0.038% to 0.57%). The most common reason for falls was the need to use the toilet (64.7%). The Good Death Scale and indwelling urinary catheter use were not significantly associated with falls (p=0.34; p=0.34).

CONCLUSION

Falls occur in approximately 10% of patients in PCUs, but serious complications are rare. The relationship between falls, independence and quality of dying is complex, that is, a fall may not be necessarily bad, if it is the result of respect for the patient's independence. Healthcare providers need to consider fall prevention while supporting patients' desire to move on their own to maintain independence.

Incidence and outcomes of falls in an inpatient palliative care unit: a single-centre retrospective study

BACKGROUND

Falls are a significant concern in healthcare settings. While comprehensive strategies to prevent falls are employed in hospitals, there is a lack of information regarding falls within inpatient palliative care units.

METHOD

This retrospective cohort study analysed fall incidence, characteristics and outcomes in a metropolitan inpatient palliative care unit over a 1 year period. Falls were identified using the online incident reporting system and patient characteristics, fall risk assessment and prevention measures were obtained through the electronic patient records.

RESULTS

During the study period, there were 61 falls by 51 patients out of a total of 525 admitted patients. The incidence of falls was 9.7% and the rate of falls was 5.8 falls per 1000 bed days for all admitted patients. Though more than half of falls resulted in no injury, 41% of patients with falls died within a week post-fall. Fall risk assessment was completed for 97% of patients at the time of the fall.

CONCLUSION

This study contributes to the understanding of falls in inpatient palliative care units. Fall risk assessment and prevention measures did not appear to alter the rate of falls among patients who fell. Fall prevention strategies need to be tailored to meet patient autonomy, end of life goals and maintain healthcare standards.

Why patients in specialist palliative care in-patient settings are at high risk of falls and falls-related harm: A realist synthesis

BACKGROUND

Falls are the third highest reported safety incident in Specialist Palliative Care in-patient settings and yet specific risk factors connected with falling and associated outcomes in this setting are poorly understood.

AIM

To understand the key individualised risk factors leading to falls in specialist in-patient palliative care settings and understand the implications and outcomes for the patients who fall.

DESIGN

A realist synthesis of the literature, reported following the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) standards.

DATA SOURCES

An iterative literature search was conducted across three recognised health collections as well as grey literature from policy, practice and other relevant areas.

RESULTS

Falls taking place within in-patient specialist palliative care settings can cause significant harm to patients. The risk factors for these patients are multifaceted and often interlinked with underpinning complex realist mechanisms including a history of falls, the age of the person, impact of complex medications, improving functional status and the presence of delirium.

CONCLUSION

In-patients in specialist palliative care settings are at risk of falling and this is multifactorial with complex reasoning mechanisms underpinning the identified risks. There is a significant impact of a fall in this cohort of patients with many sustaining serious harm, delayed discharge and both physical and psychological impacts.

Fall Reduction Interventions for Hospice Patients

Despite efforts to decrease inpatient falls at a Midwestern Veterans Administration Medical Center, patients on the hospice unit continued to have higher rates of falls than patients on other units. The purpose of this article is to review the literature to determine if evidence-based, population-specific, fall prevention measures could be implemented to reduce the risk of falls for hospice patients. As a result of this literature review, an end-of-life care plan was developed and will be utilized to increase the frequency of assessment and rounding, and to encourage family involvement during this critical time frame.