Üçüncü Basamak Bir Rehabilitasyon Merkezinden 3 Yıllık Düşme Verilerinin Kök Neden Analizi

Yıl 2026, Cilt: 48 Sayı: 2, 182 - 188, 11.02.2026

Özge Tezen , Zeynep Yakişir , Ayşe Merve Ata

https://doi.org/10.20515/otd.1781993

https://izlik.org/JA62XE89LZ

Öz

Düşmeler, yaşlı bireyler, aileleri ve sağlık sistemleri üzerinde ciddi sonuçlara yol açan, giderek büyüyen bir halk sağlığı sorunudur. Bu çalışmanın amacı, üçüncü basamak bir rehabilitasyon merkezinde meydana gelen düşmelerin köken nedenlerini ve risk faktörlerini belirlemek ve düşmeye bağlı hastane yatış sürelerini azaltmaya yönelik stratejiler önermektir. Bu retrospektif, kesitsel araştırmaya, üçüncü basamak bir rehabilitasyon merkezinde yatarak tedavi görmekte iken düşme olayı bildirilen 248 hasta dahil edilmiştir. Hastaların demografik ve klinik özellikleri; cinsiyet, yaş, tanı, hastanede yatış sürecinde düşmenin meydana geldiği gün, kronik hastalık öyküsü, polifarmasi durumu, düşmenin gerçekleştiği yer ve zaman ile başvuru anındaki vitamin D, total (25 OH) ve albümin düzeyleri kaydedilerek analiz edilmiştir. Çalışmada düşme insidansı %1,8 olup, hastaların medyan yaşı 56’dır. Düşmeler en sık inme (%23), omurilik yaralanması (%18,5) ve pediatrik rehabilitasyon (%17,7) kliniklerinde gözlenmiştir. Olayların çoğunluğu hasta odalarında (%47,6), banyolarda (%25) ve klinik koridorlarında (%14,9) meydana gelmiş; en sık 08:00–16:00 saatleri arasında (%48) gerçekleşmiştir. Erişkin hastalarda düşme riski yaş ile anlamlı pozitif korelasyon göstermiştir (r=0,338, p<0,001). Ayrıca komorbid hastalığı bulunan (p=0,011) veya polifarmasi öyküsü olan (p<0,011) bireylerde düşme riskinin anlamlı düzeyde yüksek olduğu saptanmıştır. Pediatrik grupta düşme risk skoru albumin düzeyi ile negatif (r=-0,472, p=0,048) korelasyon gösterdi. Düşmelerin, özellikle kompleks tıbbi duruma sahip orta yaşlı hemiplejik ve paraplejik hastalarda daha sık görüldüğü belirlenmiştir. Yüksek riskli hastaların yatış sırasında erken dönemde tanımlanması ve düzenli aralıklarla risk değerlendirmesinin tekrarlanması, etkili düşme önleme programlarının uygulanması açısından kritik öneme sahiptir.

Anahtar Kelimeler

Itaki Düşme Riski Ölçeği , Düşmeler , Rehabilitasyon Merkezi , Kök Neden Analizi , Düşme Önleme

Etik Beyan

Ankara Bilkent City Hospital Medical Research Scientific and Ethical Evaluation Board with the decision number TABED 1/1249/2025 dated 07/05/2025

Destekleyen Kurum

yok

Proje Numarası

none

Teşekkür

yok

Root Cause Analysis of 3-year Falls Data From a Tertiary Rehabilitation Center

https://izlik.org/JA62XE89LZ

Öz

Falls are a growing public health issue with severe impacts on older adults, their families, and healthcare systems. This study aims to identify the root causes and risk factors of falls in a tertiary rehabilitation center and suggest measures to reduce fall-related hospital stays. This retrospective, cross-sectional study included 248 patients who were reported to have fallen among the patients receiving inpatient rehabilitation at a tertiary rehabilitation center. Demographic and clinical characteristics such as gender, age, diagnosis, day of fall in the rehabilitation hospital, history of chronic disease, polypharmacy, place of fall, time of fall, vitamin D, total (25 OH) levels and albumin levels at the time of admission were recorded. The fall rate was 1.8%, with a median patient age of 56. Falls were most common in stroke (23%), spinal cord injury (18.5%), and pediatric rehabilitation (17.7%) clinics, mainly occurring in patient rooms (47.6%), bathrooms (25%), and clinic corridors (14.9%), typically between 8:00 and 16:00 (48%). In adults, fall risk increased with age (r=0.338, p<0.001) and was higher in those with comorbidities (p=0.011) or polypharmacy (p<0.011). In pediatric group, fall risk score was negatively correlated with albumin level (r=-0.472, p=0.048). Falls were most common among middle-aged hemiplegia and paraplegia patients with complex medical conditions. Identifying high srisk patients at admission and conducting regular assessments are key to effective fall prevention.

Anahtar Kelimeler

Itaki Fall Risk Scale , Falls , Rehabilitation Center , Root Cause Analysis , Fall Prevention

Etik Beyan

Ankara Bilkent City Hospital Medical Research Scientific and Ethical Evaluation Board with the decision number TABED 1/1249/2025 dated 07/05/2025

Destekleyen Kurum

none

Proje Numarası

none

Teşekkür

none

Kaynakça

• 1. Cameron ID, Kurrle SE, Sherrington C. Preventing falls and fall-related injuries in older people. Med J Aust. 2024; 221(3):140-44.
• 2. Osoba MY, Rao AK, Agrawal SK, Lalwani AK. Balance and gait in the elderly: A contemporary review. Laryngoscope Investig Otolaryngol. 2019; 4(1):143-53.
• 3. Heng H, Jazayeri D, Shaw L, Kiegaldie D, Hill AM, Morris ME. Hospital falls prevention with patient education: a scoping review. BMC Geriatr. 2020; 20(1):140.
• 4. Wilson A, Kurban D, Noonan VK, Krassioukov A. Falls during inpatient rehabilitation in spinal cord injury, acquired brain injury, and neurologmusculoskeletal disease programs. Spinal Cord. 2020; 58(3):334-40.
• 5. Choo YJ, Moon JS, Lee GW, Park WT, Chang MC. Falls in a single brain rehabilitation center: a 3- year retrospective chart review. Front. Neurol. 2025; 16(2):1-9.
• 6. Lin FF, Yang WY, Zhou JX, Cao LY, Huang LL. Retrospective Investigation and Research on Fall Events Among Hospitalized Patients in the Rehabilitation Department. Risk Manag Healthc Policy. 2024;17:1069-78.
• 7. Lee JE, Stokic DS. Risk factors for falls during inpatient rehabilitation. Am J Phys Med Rehabil. 2008; 87(5):341-50; quiz 351, 422.
• 8. Karan MA. Falls in Older People: Importance, and Risk Assessment. Aegean J Med Sci 2018;4:129-32.
• 9. Sönmez Düzkaya D, Özata Keskin N, Sönmez B, Polat S. The Evaluation of the Risk of Falling in Pediatric Patients. International Journal of Scientific Research. 2013;12: 384-87.
• 10. Çetin M, Solak N, Özdemir Çiflik B, Türk İ, Ermancik SS, Aydoğdu K. Thoracic trauma in the geriatric population and possible preventive measures: a retrospective analysis of 261 cases. Turk J Med Sci. 2024; 54(5):1013-20.
• 11. Suzuki T, Sonoda S, Misawa K, Saitoh E, Shimizu Y, Kotake T. Incidence and consequence of falls in inpatient rehabilitation of stroke patients. Exp Aging Res. 2005; 31:457-69.
• 12. Campanini I, Mastrangelo S, Bargellini A, Bassoli A, Bosi G, Lombardi F, et al. Feasibility and predictive performance of the Hendrich Fall Risk Model II in a rehabilitation department: a prospective study. BMC Health Serv Res. 2018;18(1):18.
• 13. Li Y, Hou L, Zhao H, Xie R, Yi Y, Ding X. Risk factors for falls among community-dwelling older adults: A systematic review and meta-analysis. Frontiers in Medicine.2023; 9:1019094.
• 14. Ambrose AF, Cruz, L, Paul G. Falls and Fractures: A Systematic Approach to Screening and Prevention. Mayo Clinic Proceeding.2015; 90(1), 94–108.
• 15. Tinetti ME, Kumar C. The patient who falls: "It's always a trade-off". JAMA. 2010; 303(3), 258–66.
• 16. Sullivan DH, Walls RC. Impact of nutritional status on morbidity in a population of geriatric rehabilitation patients. Journal of the American Geriatrics Society.1994; 42(5), 471–77.
• 17. Bischoff-Ferrari HA, Dawson-Hughes B, Willett WC, Staehelin HB, Bazemore MG, Zee RY, et al. Effect of Vitamin D on falls: a meta-analysis. JAMA. 2004; 291(16):1999-06.
• 18. Bolland MJ, Grey A, Avenell A. Effects of vitamin D supplementation on musculoskeletal health: a systematic review, meta-analysis, and trial sequential analysis. The Lancet Diabetes & Endocrinology. 2014; 6(11), 847-58.
• 19. Neo JJ, Kong KH. Prevalence of Vitamin D Deficiency in Elderly Patients Admitted to an Inpatient Rehabilitation Unit in Tropical Singapore. Rehabilitation Research and Practice. 2016; 2016:9689760.
• 20. Oliver D, Healey F, Haines TP. Preventing falls and fall-related injuries in hospitals. Clinics in Geriatric Medicine. 2010; 26(4), 645–92.
• 21. Vieira ER, Palmer RC, Chaves PH. Prevention of falls in older people living in the community. BMJ. 2016; 353:i1419.
• 22. Vlahov D, Myers AH, al-Ibrahim MS. Epidemiology of falls among patients in a rehabilitation hospital. Arch Phys Med Rehabil. 1990;71:8–12.
• 23. Ullah S, Finch CF, Day L. Incidence and characteristics of hospital falls: Findings from an Australian sentinel event reporting system. BMC Health Services Research. 2019; 19(1), 233.
• 24. Kojima G. Polypharmacy and falls: a systematic review and meta-analysis. Journal of the American Geriatrics Society. 2015; 63(3), 644–55.
• 25. Boyd CM, Fortin M. Future of multimorbidity research: how should understanding of multimorbidity inform health system design? Public Health Reviews. 2010; 32(2), 451–74.