Fall incidence in hospitalized patients and prediction of its risk factors using a weighted Poisson model



Falls in hospital as a major cause of disability and death threaten patients’ safety and quality of life. We studied fall incidence in hospital, and predicted its risk factors using weighted Poisson (WP) model versus other models.


This cross-sectional study was performed on the patients referred to two central hospitals in Qazvin, Iran between 2017 and 2019. The data were collected using the Morse scale and fall reporting forms in the hospital patient safety units (288 falls). Factors including age, gender, time of fall, fall location, cause of fall and its complications, drugs administrated, disease history, post-fall care measures, presence of companion, and length of hospital stay were assessed. The WP model was compared with other models.


Fall incidence was 2.5 per 1000 patient days. Among them, 62.5% were elderly (mean age 65.7 ± 19.21 yr). Using the WP model, age, gender, fall location and fall cause, drugs administered, post-fall care measures (P < 0.001), and the presence of companion were identified as risk factors for falling (P < 0.001) Older females, those without a companion, and those without post-fall care measures and with medication history were at a higher risk. Falls from bed were the prevalent type of fall (IRR = 1.65). Falls in the internal ward were lower than in other wards (IRR = 0.67).


The WP model is suggested as an appropriate model to predict fall risk factors. Fall rate may be reduced by combining information on risk factors with the strategies of training nurses or caregivers, or making possible changes in patients’ environment.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

Data availability

The authors declare that data and material are available.


  1. Al Tehewy MM, Amin GE, Nassar NW (2015) A study of rate and predictors of fall among elderly patients in a university hospital. J Patient Safe 11(4):210–214. https://doi.org/10.1097/PTS.0000000000000117

    Article  Google Scholar 

  2. Avanecean D, Calliste D, Contreras T, Lim Y, Fitzpatrick A (2017) Effectiveness of patient-centered interventions on falls in the acute care setting: a quantitative systematic review protocol. Syst Rev Implement Rep 15(12):3006–3048. https://doi.org/10.11124/JBISRIR-2016-003331

    Article  Google Scholar 

  3. Balakrishnan MN, Koutras V, Milienos FS (2017) A weighted Poisson distribution and its application to cure rate models. Commun Stat-Theor M 47(17):4297–4310. https://doi.org/10.1080/03610926.2017.1373817

  4. Benjamin DM (2003) Reducing medication errors and increasing patient safety: case studies in clinical pharmacology. J Clin Pharmacol 43(7):768–783

    Article  Google Scholar 

  5. Brown CV, Ali S, Fairley R, Lai BK, Arthrell J, Walker M, Tips G (2013) Risk factors for falls among hospitalized trauma patients. Am Surg 79(5):465–469. https://doi.org/10.1590/1983-1447.2014.04.50716

    Article  PubMed  Google Scholar 

  6. Bui LV, Mor Z, Chemtob D, Ha ST, Levine H (2018) Use of geographically weighted Poisson regression to examine the effect of distance on tuberculosis incidence: a case study in Nam Dinh, Vietnam. PLoS One 13(11):e0207068. https://doi.org/10.1371/journal.pone.0207068

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  7. Bóriková I, Tomagová M, Miertová M, Žiaková K (2017) Predictive value of the Morse fall scale: review study. Cent Eur J Nurs Midw 8(1):588–595. https://doi.org/10.15452/CEJNM.2017.08.0006

    Article  Google Scholar 

  8. Cameron ID, Dyer SM, Panagoda CE, Murray GR, Hill KD, Cumming RG, Kerse N, Bone C (2018) Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst Rev 9:CD005465. https://doi.org/10.1002/14651858

    CAS  Article  PubMed  Google Scholar 

  9. Chen K, Cheng Y, Berkout O, Lindhiem O (2017) Analyzing proportion scores as outcomes for prevention trials: a statistical primer. Prev Sci 18(3):312–321. https://doi.org/10.1007/s11121-016-0643-6

    Article  PubMed  PubMed Central  Google Scholar 

  10. Costa-Dias MJ, Oliveira AS, Martins T, Araújo F, Santos AS, Moreira CN, José H (2014) Medication fall risk in old hospitalized patients: a retrospective study. Nurse Educ Today 34:171–176. https://doi.org/10.1016/j.nedt.2013.05.016

    Article  PubMed  Google Scholar 

  11. da Mata LRF, Azevedo C, Policarpo AG, Moraes JT (2017) Factors associated with the risk of fall in adults in the postoperative period: a cross-sectional study. Rev Lat Am Enfermagem 25:e2904. https://doi.org/10.1590/1518-8345.1775.2904

    Article  PubMed  PubMed Central  Google Scholar 

  12. Dadgari A, Hojati H, Mirrezaie SM (2020) The relationship between the risk of falling and fear of falling among aged hospitalized patients. Nursing Practice Today 7(1):30–37

    Google Scholar 

  13. Dal Bello-Haas VP, Thorpe LU, Lix LM, Scudds R, Hadjistavropoulos T (2012) The effects of a long-term care walking program on balance, falls and well-being. BMC Geriatr 12:76. https://doi.org/10.1186/1471-2318-12-76

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gale CR, Westbury LD, Cooper C, Dennison EM (2018) Risk factors for incident falls in older men and women: the English longitudinal study of ageing. BMC Geriatr 18:117. https://doi.org/10.1186/s12877-018-0806-3

    Article  PubMed  PubMed Central  Google Scholar 

  15. Gazibara T, Kurtagic I, Kisic-Tepavcevic D, Nurkovic S, Kovacevic N, Gazibara T, Pekmezovic T (2017) Falls, risk factors and fear of falling among persons older than 65 years of age. Psychogeriatric 17(4):215–223. https://doi.org/10.1111/psyg.12217

    Article  Google Scholar 

  16. Gu YY, Balcaen K, Ni Y, Ampe J, Goffin J (2016) Review on prevention of falls in hospital settings. Chin Nurs Res 3:7e10. https://doi.org/10.1016/j.cnre.2015.11.002

    Article  Google Scholar 

  17. Hadidi N (2008) Interventions for preventing falls in acute and chronic-care hospitals: a systematic review and meta-analysis. J Am Geriatr Soc 56(9):1776–1777. https://doi.org/10.1111/j.1532-5415.2008.01783.x

    Article  PubMed  Google Scholar 

  18. Hassan RAM, Dória MT, Baracat EC, Filassi JR (2017) Fatores preditivos de margens cirúrgicas comprometidas no tratamento do carcinoma ductal in situ da mama. Ver Bras Mastol 27(1):36–40

    Google Scholar 

  19. Herdman TH, Kamitsuru S (2015) Nursing diagnosis: definitions and classifications 2015–2017. 10th edition. Wiley–Blackwell, Chichester, pp 488

  20. Kisacik OG, Cigerci Y (2019) Characteristics of Ιnpatient falls in a hospital setting: a retrospective study from Turkey. Int J Caring Sci 12(2):768

    Google Scholar 

  21. Lake ET, Shang J, Klaus S, Dunton NE (2010) Patient falls: association with hospital magnet status and nursing unit staffing. Res Nurs Health 33:413e425. https://doi.org/10.1002/nur.20399

    Article  Google Scholar 

  22. Lee E (2018) Use of the nursing outcomes classification for falls and fall prevention by nurses in South Korea. Int J Nurs Knowl 30:28–33. https://doi.org/10.1111/2047-3095.12201

    Article  PubMed  Google Scholar 

  23. Luzia MF, Victor MAG, Lucena MF (2014) Nursing diagnosis risk for falls: prevalence and clinical profile of hospitalized patients. Rev Lat Am Enfermagem 22(2):262–268. https://doi.org/10.1590/0104-1169.3250.2411

    Article  PubMed Central  Google Scholar 

  24. Luzia MF, Cassola TP, Suzuki LM, Dias VLM, Pinho LB, Lucena A (2018) Incidence of falls and preventive actions in a university hospital. Rev Esc Enferm USP 52:e03308. https://doi.org/10.1590/s1980-220x2017024203308

    Article  PubMed  Google Scholar 

  25. Meneguin S, Ayres JA, Bueno GH (2014) Caracterizaçãodas quedas de pacientesem hospital especializadoem cardiologia. Rev Enferm UFSM 4(4):784–791. https://doi.org/10.5902/2179769213554

    Article  Google Scholar 

  26. Miake-Lye IM, Hempel S, Ganz DA, Shekelle PG (2013) Inpatient fall prevention programs as a patient safety strategy: a systematic review. Ann Intern Med 158:390–396. https://doi.org/10.7326/0003-4819-158-5-201303051-00005

    Article  PubMed  Google Scholar 

  27. Morris R, O’Riordan S (2017) Prevention of falls in hospital. Clin Med (Lond) 17(4):360–362. https://doi.org/10.7861/clinmedicine.17-4-360

    Article  Google Scholar 

  28. Najafpour Z, Godarzi Z, Arab M, Yaseri M (2019) Risk factors for falls in hospital in-patients: a prospective nested case control study. Int J Health Policy Manag 8(5):300–306. https://doi.org/10.15171/ijhpm.2019.11

    Article  PubMed  PubMed Central  Google Scholar 

  29. Nakaya T, Fotheringham AS, Brunsdon C, Charlton M (2005) Geographically weighted Poisson regression for disease association mapping. Stat Med 24:2695–2717. https://doi.org/10.1002/sim.2129

    CAS  Article  PubMed  Google Scholar 

  30. Pi HY, Gao Y, Wang J, Hu MM, Nie D, Peng PP (2016) Risk factors for in-hospital complications of fall-related fractures among older Chinese: a retrospective study. Biomed Res Int 2016:8612143. https://doi.org/10.1155/2016/8612143

    Article  PubMed  PubMed Central  Google Scholar 

  31. Severo IM, Kuchenbecker RS, Vieira DFVB, Lucena AF, Almeida MA (2018) Risk factors for fall occurrence in hospitalized adult patients: a case–control study. Rev Lat Am Enferm 26:3016. https://doi.org/10.1590/1518-8345.2460.3016

    Article  Google Scholar 

  32. Sheikhghomi S, Rahimi-Movaghar V, Jafarpour S, Saadat S (2015) Epidemiology and short-term mortality in traumatic patients admitted to Shariati Hospital in Iran between 2012 and 2013. Chin J Traumatol 18(5):275–278. https://doi.org/10.1016/j.cjtee.2014.06.002

    Article  PubMed  Google Scholar 

  33. Stubbs B, Binnekade T, Eggermont L, Sepehry AA, Patchay S, Schofield P (2014) Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis. Arch Phys Med Rehabil 95:175–187. https://doi.org/10.1016/j.apmr.2013.08.241

    Article  PubMed  Google Scholar 

  34. Stubbs B, Mueller C, Gaughran F, Lally J, Vancampfort D, Lamb SE, Koyanagi A, Sharma S, Stewart R, Perera G (2018) Predictors of falls and fractures leading to hospitalization in people with schizophrenia spectrum disorder: a large representative cohort study. Schizophr Res 201:70–78. https://doi.org/10.1016/j.schres.2018.05.010

    Article  PubMed  Google Scholar 

  35. Vakili V, Taghipour A, Mosa Farkhani E, Beygi B, Pirizadeh E (2019) Risk factors for falls among elderly people: a population-based case-control study. Elder Health J 5(2):84–91

    Google Scholar 

  36. Vitor AF, Moura LA, Fernandes APNL, Botarelli FR, Araújo JNM, Vitorino ICC (2015) Risk for falls in patients in the postoperative period. Cogitare Enferm 20(1):29–37

    Article  Google Scholar 

  37. Wildes TM, Dua P, Fowler SA, Miller JP, Carpenter CR, Avidan MS, Stark S (2015) Systematic review of falls in older adults with cancer. J Geriatr Oncol 6:70–83. https://doi.org/10.1016/j.jgo.2014.10.003

    Article  PubMed  Google Scholar 

Download references


The authors would like to thank the staff in the patient safety units of Rajaee and Velayat hospitals. This study was financially supported by Qazvin University of Medical Science, Qazvin, Iran.

Author information




Siamak Yaghoubi contributed to conception and design, revising critically for important intellectual content, and final approval of the version to be published.

Somayeh Ahmadi Gooraji contributed to conception and design, analysis and interpretation of data; drafting the article or revising it critically for important intellectual content, and final approval of the version to be published.

Maryam Habibi & Farideh Torkaman contributed to data collecting, and final approval of the version to be published.

Corresponding author

Correspondence to Somayeh Ahmadi Gooraji.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical issues

This study was approved by the ethics committee and the institutional review board (Approval number IR.QUMS.REC.1397.044) of Qazvin University of Medical Sciences, Qazvin, Iran.

Consent to participate

The authors declare that they have consent to participate.

Consent for publication

The authors declare that they have consent for publication.

Code availability (software application)

The authors declare that code is available.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Yaghoubi, S., Gooraji, S.A., Habibi, M. et al. Fall incidence in hospitalized patients and prediction of its risk factors using a weighted Poisson model. J Public Health (Berl.) (2021). https://doi.org/10.1007/s10389-021-01476-3

Download citation


  • Accidental fall
  • Hospitalization
  • Risk factors
  • Poisson distribution
  • Linear model
  • Generalized linear models