Falls are the most frequently reported adverse events in inpatient settings. About 30%of people over 65 years will fall every year making it a major socioeconomic problem in elderly. Hyponatremia is the most common electrolyte abnormality in hospitalized elderly persons with a prevalence of 34%,which increases with age. Mild chronic hyponatremia may appear to be asymptomatic and remain unnoticed by both physician and patient but has been associated with gait unsteadiness and attention deficits in the elderly. The study objective was to determine the incidence of hyponatremia in patients above 65 years who experienced a fall and associated risk factors for falls.
During a twelve month period from September 2009 September 2010 serum sodium levels were evaluated in 60 cases of falls in patients aged 65years and older and in 60 randomly selected non fall patients aged 65years and older seen in acute inpatient setting. The following data were extracted for all patients: age, gender, medical morbidities, and number of medications, details of medications, serum sodium level and length of hospital stay. Initial blood chemistry on day of fall was used for evaluation of hyponatremia. Nonfall group blood chemistry on day of admission was used. Hyponatremia was classified as Serum Na level less then 136mmol/l. Fall/nonfall groups who had a glucose level on chemistry above 200 mg/dl were excluded from study. Use of medication including drugs potentially associated with hyponatremia SSRI, diuretics, antihypertensive, benzodiazepines and psycholeptics was also analyzed in both groups.
Majority of fallers were female (75%) and mean age of fall and nonfall groups were 78[pm]8 and 79[pm]7 respectively. Hyponatremia was detected in 18 (30%) of fall group, compared to 5(18%) in nonfall group (P value 0.0004). Mean sodium level was 131[pm]3meq/l and lowest level of serum sodium was 124meql/l in fall group. In fall group when controlling for other independent risk factors hyponatremic patients were four times more likely to fall (Pvalue0.004). . Those in the fall group had a longer length of stay and were more likely to be nursing home residents. A greater proportion of fallers had multiple medical comorbidities (HTN, CHF, AF) and were on more likely to be on four or more medications at presentation than nonfallers.
Hyponatremia is an independent risk factor for falls in elderly acute inpatient setting and should be added to the list of common conditions causing falls. Clinicians should not overlook this very common condition which may account for significant number of falls which leads to injuries and increase healthcare costs. Screening for low serum sodium level and treating it when present may be a step forward to prevent falls and related injuries.
Table 1Characteristics of Fall and Non Fall groups
|Characteristics||Fall group n 60(%)||Non Fall group n 60(%)||P values|
|Multiple chronic conditions||49(81.6)||32(53.3)||0.0016|
|Nursing home residency||27(45)||14(23.3)||0.0203|
|Mean length of stay||16+4||7+4||0.0001|
To cite this abstract:Fernandes N. Hyponatremia and Falls in Elderly Inpatient Hospital Setting Neychelle Fernandes Md,arnold Eiser Md,facp,mary Musuku Md. Abstract published at Hospital Medicine 2012, April 1-4, San Diego, Calif. Abstract 97647. Journal of Hospital Medicine. 2012; 7 (suppl 2). https://www.shmabstracts.com/abstract/hyponatremia-and-falls-in-elderly-inpatient-hospital-setting-neychelle-fernandes-mdarnold-eiser-mdfacpmary-musuku-md/. Accessed September 17, 2019.