Combined Assessment of Cognitive and Balance Abilities to Predict Falls in Patients in the Convalescent Rehabilitation Ward

Abstract

Objective

This study aimed to investigate the relationship between falls and cognitive and balance problems in patients.

Methods

This retrospective observational study analyzed the medical records of 1010 older patients admitted to a convalescent rehabilitation ward. The primary endpoint was fall occurrence during ward stays. The main outcomes were the Mini-Mental State Examination (MMSE) and Standing Test for Imbalance and Disequilibrium (SIDE), with patients divided into groups of MMSE ≥28 and <28 and SIDE ≥2b and <2b.

Results

During ward stays, 220 patients (22%) fell. Estimating the fall risk of the MMSE ≥28 + SIDE ≥2b group compared to that of other groups revealed that only the MMSE <28 + SIDE <2b group had a significantly higher fall risk, with a hazard ratio [95% confidence interval] of 3.13 [1.51–6.46].

Conclusion

Combined MMSE and SIDE assessment at ward admission facilitated the easy identification of individuals at high fall risk.

Keywords

fall risk convalescent rehabilitation ward mini-mental state examination standing test for imbalance and disequilibrium older patients

Get full access to this article

View all access options for this article.

References

Allan

L. M.

Ballard

C. G.

Rowan

E. N.

Kenny

R. A.

(2009). Incidence and prediction of falls in dementia: A prospective study in older people. PLoS One, 4(5), Article e5521. https://doi.org/10.1371/journal.pone.0005521

American Geriatrics Society . (2001). Guideline for the prevention of falls in older persons. American Geriatrics society, British Geriatrics society, and American academy of orthopaedic surgeons panel on falls prevention. Journal of the American Geriatrics Society, 49(5), 664–672. https://doi.org/10.1046/j.1532-5415.2001.49115.x

Bliuc

Nguyen

N. D.

Milch

V. E.

Nguyen

T. V.

Eisman

J. A.

Center

J. R.

(2009). Mortality risk associated with low-trauma osteoporotic fracture and subsequent fracture in men and women. JAMA, 301(5), 513–521. https://doi.org/10.1001/jama.2009.50

Blum

Korner-Bitensky

(2008). Usefulness of the Berg balance scale in stroke rehabilitation: A systematic review. Physical Therapy, 88(5), 559–566. https://doi.org/10.2522/ptj.20070205

Cabinet Office . (2021). Annual Report on the Ageing Society. Cabinet Office White Paper on the Aging Society. Available at: https://www8.cao.go.jp/kourei/english/annualreport/index-wh.html

de Waroquier-Leroy

Bleuse

Serafi

Watelain

Pardessus

Tiffreau

A. V.

Thevenon

(2014). The functional Reach test: Strategies, performance and the influence of age. Annals of Physical and Rehabilitation Medicine, 57(6-7), 452–464. https://doi.org/10.1016/j.rehab.2014.03.003

Dupont

W. D.

Plummer

W. D.

(1990). Power and sample size calculations. A review and computer program. Controlled Clinical Trials, 11(2), 116–128. https://doi.org/10.1016/0197-2456(90)90005-m

Folstein

M. F.

Folstein

S. E.

McHugh

P. R.

(1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189–198. https://doi.org/10.1016/0022-3956(75)90026-6

Ganz

D. A.

Bao

Shekelle

P. G.

Rubenstein

L. Z.

(2007). Will my patient fall. JAMA, 297(1), 77–86. https://doi.org/10.1001/jama.297.1.77

10.

Hagino

Nakamura

Fujiwara

Oeki

Okano

Teshima

(2009). Sequential change in quality of life for patients with incident clinical fractures: A prospective study. Osteoporosis International, 20(5), 695–702. https://doi.org/10.1007/s00198-008-0761-5

11.

Kaufer

D. I.

Williams

C. S.

Braaten

A. J.

Gill

Zimmerman

Sloane

P. D.

(2008). Cognitive screening for dementia and mild cognitive impairment in assisted living: Comparison of 3 tests. Journal of the American Medical Directors Association, 9(8), 586–593. https://doi.org/10.1016/j.jamda.2008.05.006

12.

Mets

M. A.

Volkerts

E. R.

Olivier

Verster

J. C.

(2010). Effect of hypnotic drugs on body balance and standing steadiness. Sleep Medicine Reviews, 14(4), 259–267. https://doi.org/10.1016/j.smrv.2009.10.008

13.

Miyai

Sonoda

Nagai

Takayama

Inoue

Kakehi

Kurihara

Ishikawa

(2011). Results of new policies for inpatient rehabilitation coverage in Japan. Neurorehabilitation and Neural Repair, 25(6), 540–547. https://doi.org/10.1177/1545968311402696

14.

Moncada

L. V.

(2011). Management of falls in older persons: A prescription for prevention. American Family Physician, 84(11), 1267–1276.

15.

Montero-Odasso

M. M.

Kamkar

Pieruccini-Faria

Osman

Sarquis-Adamson

Hogan

D. B.

Hunter

S. W.

Kenny

R. A.

Lipsitz

L. A.

Lord

S. R.

Madden

K. M.

Petrovic

Ryg

Speechley

Sultana

Tan

M. P.

van der Velde

Verghese

Masud

(2021). Evaluation of clinical practice guidelines on fall prevention and management for older adults: A systematic review. JAMA Network Open, 4(12), Article e2138911. https://doi.org/10.1001/jamanetworkopen.2021.38911

16.

Morris

M. E.

Webster

Jones

Hill

A. M.

Haines

McPhail

Kiegaldie

Slade

Jazayeri

Heng

Shorr

Carey

Barker

Cameron

(2022). Interventions to reduce falls in hospitals: A systematic review and meta-analysis. Age and Ageing, 51(5), afac077. https://doi.org/10.1093/ageing/afac077

17.

Richardson

Bennett

Kenny

R. A.

(2015). Polypharmacy including falls risk-increasing medications and subsequent falls in community-dwelling middle-aged and older adults. Age and Ageing, 44(1), 90–96. https://doi.org/10.1093/ageing/afu141

18.

Saxton

Morrow

Eschman

Archer

Luther

Zuccolotto

(2009). Computer assessment of mild cognitive impairment. Postgraduate Medicine, 121(2), 177–185. https://doi.org/10.3810/pgm.2009.03.1990

19.

Shah

Bell

R. J.

Davis

S. R.

(2006). Homocysteine, estrogen and cognitive decline. Climacteric, 9(2), 77–87. https://doi.org/10.1080/13697130600641282

20.

Suzuki

Kurata

Yamamoto

Makino

Kanamori

(2012). Impact of fall-related behaviors as risk factors for falls among the elderly patients with dementia in a geriatric facility in Japan. American Journal of Alzheimer's Disease and Other Dementias, 27(6), 439–446. https://doi.org/10.1177/1533317512454706

21.

Suzuki

Sonoda

Misawa

Saitoh

Shimizu

Kotake

(2005). Incidence and consequence of falls in inpatient rehabilitation of stroke patients. Experimental Aging Research, 31(4), 457–469. https://doi.org/10.1080/03610730500206881

22.

Tariq

S. H.

Tumosa

Chibnall

J. T.

Perry

M. H.

Morley

J. E.

(2006). Comparison of the Saint Louis University mental status examination and the mini-mental state examination for detecting dementia and mild neurocognitive disorder--a pilot study. American Journal of Geriatric Psychiatry, 14(11), 900–910. https://doi.org/10.1097/01.JGP.0000221510.33817.86

23.

Teranishi

Kondo

Okuyama

Tanino

(2017). Investigation of factors involved in patient falls during the early stage of hospitalization in a Kaifukuki rehabilitation ward. Japanese Journal of Comprehensive Rehabilitation Science, 8(4), 10–15. https://doi.org/10.11336/jjcrs.8.10

24.

Teranishi

Kondo

Sonoda

(2010). A discriminative measure for static postural control ability to prevent in-hospital falls: Reliability and validity of the standing test for imbalance and Disequilibrium (SIDE). Japanese Journal of Comprehensive Rehabilitation Science, 1(1), 11–16. https://doi.org/10.11336/jjcrs.1.11

25.

Teranishi

Kondo

Tanino

Miyasaka

Sakurai

Kaga

Suzuki

Matsushima

Kawakita

Sonoda

(2013). An analysis of falls occurring in a convalescence rehabilitation ward – a decision tree classification of fall cases for the management of basic movements. Japanese Journal of Comprehensive Rehabilitation Science, 4(1), 7–13.

26.

Tinetti

M. E.

Kumar

(2010). The patient who falls: “It's always a trade-off. JAMA, 303(3), 258–266. https://doi.org/10.1001/jama.2009.2024

27.

Tsoi

K. K.

Chan

J. Y.

Hirai

H. W.

Wong

S. Y.

Kwok

T. C.

(2015). Cognitive tests to detect dementia: A systematic review and meta-analysis. JAMA Internal Medicine, 175(9), 1450–1458. https://doi.org/10.1001/jamainternmed.2015.2152

28.

World Health Organization . (2008). WHO global report on falls prevention in older age. WHO. Available at: https://www.who.int/publications/i/item/9789241563536