Evaluation of intrinsic and extrinsic fall risk factors in hospitals, long-term facilities, and homes: A narrative review

This review identifies and contrasts intrinsic and extrinsic risk factors associated with patient falls in long-term care facilities, home healthcare settings, and hospitals. Falls are the most common adverse events reported in healthcare settings. In 2016, 22% of residents in residential care communities experienced a fall in the past 90 days, representing 175,000 residents in the United States. The need for emergency care for the injuries caused by fall occurrences at home remains one of the most frequently occurring adverse events reported by patients receiving skilled home healthcare services. 30% of people aged 65 and older living in the community fall each year, and one in five incidents requires medical attention. The narrative review followed the procedures outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included in this systematic review if they met the following criteria: (1) written in English, (2) Peer-reviewed, (3) published between 1960 and 2024, and (4) investigated risk factors for patient falls in hospitals, long-term care facilities, and home healthcare. In all, a total of 64 articles were included in the review, of which nine studies assessed patient fall risk factors in home healthcare settings, 25 studies looked at patient fall risk factors in hospital settings, and 30 studies looked at the risk factors in long-term care facilities. There was limited research on risk factors for falls in home healthcare settings. Overall, long-term care facilities had more intrinsic risk factors for patient falls (e.g., medication use, chronic illness, and cognitive deficits) than other healthcare settings (hospitals and home healthcare). More extrinsic risk factors were reported in home healthcare settings (primarily inadequate assistive devices) than in other healthcare settings (Long-term care facilities and hospitals). The narrative review identified many contributing factors that may contribute to patient falls across health care settings (homes, long-term care facilities, and hospitals). Factors that may drive falls across different healthcare settings appear to differ, with intrinsic risk factors more prevalent in long-term care facilities and hospitals. On the other hand, extrinsic factors appear to play a larger role in home healthcare than in long-term care and hospitals, but more research is needed to investigate the person-environment in the home settings. The review reveals falls result from a mismatch between patient capabilities (intrinsic) and environmental/task demands (extrinsic), and that prevention of falls must target this interaction. Further, these differences may indicate that fall-prevention interventions need to vary across healthcare sectors.