Association of Fall Risk Scores With 30-Day Return to Hospital Rates in Older Adults Following a Hip Fracture: A Retrospective Single-Center Analysis of a Quality Improvement Database.

introductionHigher fall risk scores have been associated with increased morbidity among older adults. Older adults, particularly after a hip fracture, are vulnerable to hospital returns within 30 days post discharge. The objective of this quality improvement project was to examine whether higher fall risk scores, as measured by the Johns Hopkins Fall Risk Assessment Tool (JHFRAT), are associated with 30-day hospital return rates in adults aged 75 and older hospitalized with a hip fracture. Additionally, an exploratory analysis compared return rates between high fall risk admissions with and without hip fractures to contextualize findings.

methodsThis secondary analysis of a quality improvement database included 61,193 admissions of people aged 75 years and older to a 400-bed community teaching hospital between 2017 and 2020. Admissions were excluded if they died during hospitalization or were discharged to hospice care. Fall risk scores were calculated by hospital nursing staff using the JHFRAT and categorized into low (≤16.0) vs. high (>16.0) risk groups based on previous research. The outcome measure included hospital readmissions, observation stays, and emergency department (ED) visits without hospital admission within 30 days of initial discharge. Chi-square tests were used for statistical analysis, with a significance level set at a two-sided p-value < .05.

resultsAmong the 2,539 eligible admissions with a diagnosis of hip fracture, 2,077 (81.8%) were categorized as low fall risk and 462 (18.2%) as high fall risk. There was no significant difference in 30-day return rates between these groups (21% vs. 18%, p = .128). Similarly, among admissions without a hip fracture, return rates did not differ significantly by fall risk category (21% for low-risk vs. 22% for high-risk, p = .107). However, when examining only admissions with high fall risk scores, those without a hip fracture had a significantly higher return rate than those with a hip fracture (22% vs. 18%, p = .02).

conclusionHigh fall risk scores on the JHFRAT were not significantly associated with 30-day returns to the hospital among admissions aged 75 and older with a diagnosis of hip fracture in the hospital we studied. Limitations include the single-center design, potential variability in fall risk scoring due to nurse training differences, and a lack of information on social and post-discharge factors. Additional analyses in larger, multicenter, and more diverse populations are needed to explore additional factors that are associated with hospital returns in this population.