Mechanical restraints, rehabilitation therapies, and staffing adequacy as risk factors for falls in an elderly hospitalized population.

This case-control study of fall-related risk factors for elderly hospitalized patients hypothesized that the use of mechanical restraints, participation in a rehabilitation program, and staffing inadequacy increase the risk of falls. The study included 252 patients, also known as "cases," aged 60 to 85 years, who fell during the period between March 1 and December 31, 1993, in a large metropolitan hospital; and 250 "controls," randomly selected patients aged 60 to 85 years, who were matched with the cases in terms of length of stay to the day of the fall. Analysis using conditional logistic regression revealed that individuals who had been placed in a mechanical restraint at any point during their hospital stay prior to the fall (for the cases) or the selected day (for the controls) had approximately twice the risk of falling as did patients who had not been placed in restraints. Cases and controls showed no significant differences in terms of their participation in occupational therapy, physical therapy, or cardiac rehabilitation, and staffing adequacy was similar for both groups. While the finding of 2 to 4.7 times the risk for falls for those placed in a mechanical restraint only approached statistical significance, the results indicate that the risk of falling is highest soon after a patient has had to be placed in a mechanical restraint.