Association between Cognitive Dysfunction and Falls by Behavioral Observation Assessment in Hospitalized Patients in the Recovery Phase Rehabilitation Wards

<p>【Objective】This study aimed to investigate whether the severity of cognitive impairment, as determined from the total score of Cognitive-related Behavioral Assessment（CBA）, which is based on behavioral observations, is associated with falls in patients admitted to rehabilitation wards.</p><p>【Methods】This retrospective cohort study included patients admitted to the recovery unit between April 2019 and March 2021. CBA was used to assess cognitive impairment, and falls were investigated using the records of the Falls and Falls Incident Report Form in the electronic medical record. To test the association between CBA on admission and falls early in hospitalization, falls within one month of admission were included in the tally, and those with falls within one month of admission were included in the fall group, while those without falls were included in the non-fall group. From the cross-tabulation of the two groups of falls and non-falls and CBA severity, a residual analysis was performed to identify the combination that deviated significantly from the expected values, and the adjusted residuals were calculated. Logistic regression analysis was performed with the presence of falls within one month of admission as the dependent variable and CBA severity as the independent variable.</p><p>【Results】This study included 879 patients, with a median age of 76 years（interquartile range：65-83）years. The fall group（68 patients）had a higher proportion of patients with the most severe to moderate CBA severity than the non-fall group（811 patients）. CBA severity in the fall group was as follows：most severe, 4（5.9 ％）；severe, 24（35.3 ％）；moderate, 24（35.3 ％）；mild, 11（16.2 ％）；and normal, 5（7.4 ％）. Residual analysis showed that significantly more patients in the fall group had severe CBA（p ＜0.01）and significantly more patients in the non-fall group had mild CBA（p ＜0.01）. Logistic regression analysis using the presence or absence of falls within one month of admission as the dependent variable showed that the association between falls and CBA severity was significant（odds ratio 1.92；95 ％ CI, 1.00-3.68；p ＜0.05）, even after adjustment for factors related to falls, such as age 70 years or older, as covariates.</p><p>【Conclusions】 Severe CBA severity was significantly associated with the risk of early falls in hospitalized patients in recovery units.</p>