BACKGROUND Unassisted falls are more likely to result in injury than assisted falls. However, little is known about risk factors for falling unassisted. Furthermore, rural hospitals, which care for a high proportion of older adults, are underrepresented in research on hospital falls. This study identified risk factors for unassisted and injurious falls in rural hospitals. METHODS Seventeen hospitals reported 353 falls over 2 years. We categorized falls by type (assisted vs. unassisted) and outcome (injurious vs. non-injurious). We used multivariate logistic regression to determine factors that predicted fall type and outcome. RESULTS With all other factors being equal, the odds of falling unassisted were 2.55 times greater for a patient aged ≥65 than < 65 (95% confidence interval [CI] = 1.30-5.03), 3.70 times greater for a patient with cognitive impairment than without (95% CI = 2.06-6.63), and 6.97 times greater if a gait belt was not identified as an intervention for a patient than if it was identified (95% CI = 3.75-12.94). With all other factors being equal, the odds of an injurious fall were 2.55 times greater for a patient aged ≥65 than < 65 (95% CI = 1.32-4.94), 2.48 times greater if a fall occurred in the bathroom vs. other locations (95% CI = 1.41-4.36), and 3.65 times greater if the fall occurred when hands-on assistance was provided without a gait belt, compared to hands-on assistance with a gait belt (95% CI = 1.34-9.97). CONCLUSIONS Many factors associated with unassisted or injurious falls in rural hospitals were consistent with research conducted in larger facilities. A novel finding is that identifying a gait belt as an intervention decreased the odds of patients falling unassisted. Additionally, using a gait belt during an assisted fall decreased the odds of injury. We expanded upon other research that found an association between assistance during falls and injury by discovering that the manner in which a fall is assisted is an important consideration for risk mitigation.

中文翻译：

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与医院无助跌落相关的患者和系统因素：一项观察性研究。

背景技术与无助跌倒相比，无助跌倒更容易造成伤害。但是，人们对无助跌倒的危险因素知之甚少。此外，在医院跌倒的研究中，乡村医院对老年人的照顾比例很高，但这些医院的代表性不足。这项研究确定了农村医院无助跌倒伤害的危险因素。方法17家医院报告在2年中有353例跌倒。我们根据类型（辅助与非辅助）和结果（伤害与非伤害）对跌倒进行了分类。我们使用多元逻辑回归来确定预测跌倒类型和结果的因素。结果在所有其他因素相同的情况下，年龄≥65岁的患者比<65岁的患者无助跌倒的几率是2.55倍（95％置信区间[CI] = 1.30-5.03），3。有认知障碍的患者比没有认知障碍的患者高70倍（95％CI = 2.06-6.63），如果没有将步态带识别为患者干预，则比没有被识别的患者高（6.9％CI）（95％CI = 3.75- 12.94）。在所有其他因素相同的情况下，年龄≥65岁的患者跌倒的几率比<65岁的患者高出2.55倍（95％CI = 1.32-4.94），如果浴室跌倒的发生率是其他位置的2.48倍。 （95％CI = 1.41-4.36），与不带步态安全带的动手辅助相比（95％CI = 1.34-9.97），如果跌倒发生在不带步态安全带的动手辅助下，则跌幅要大3.65倍。结论农村医院无意摔倒或伤害倒下的许多因素与在大型医院进行的研究一致。一个新颖的发现是，将步态带识别为干预措施可以降低患者不自觉地摔倒的几率。另外，在辅助跌倒期间使用步态腰带可以降低受伤的几率。我们扩展了其他研究，通过发现跌倒的辅助方式是减轻风险的重要考虑因素，该研究发现了跌倒期间的辅助功能与伤害之间的关联。