Discussion
Thirteen studies were identiWed which described risk factors
(factors signiWcantly more prevalent in fallers than nonfallers),
in a variety of inpatient settings. Despite the heterogeneity
of the settings, populations and risk factors studied,
a small number of factors repeatedly emerged as signiWcant:
gait instability; lower limb weakness; urinary incontinence/
frequency or need for assisted toileting; previous fall history;
agitation/confusion or impaired judgement; prescription of
‘culprit’ drugs, in particular centrally acting sedative hypnotics.
The prevalence of these risk factors is signiWcantly
higher than one would expect to see in community dwelling
older persons [12], perhaps conWrming the impression that
different intervention strategies may be necessary in this
group. A very large number of papers were identiWed in
which falls risk assessment tools were described, but only
Wve had ever been subjected to validation in one, let alone
two, patient populations and most had obscure derivation
and arbitrary scoring, giving no basis for use in clinical practice
despite their publication in peer-reviewed journals. Those
tools for which the validation methodology was sound did
show high sensitivity and speciWcity in predicting falls under
research conditions, but had not been validated in multiple
settings or used as part of effective falls prevention strategies.