# A Managerial Approach to Investigate Fall Risk in a Rehabilitation Hospital
## 4 Discussion
Considering the previously cited works, we found that the majority of first falls involved patients who used assistive aids. This finding was confirmed in a previous study by [PERSON] and [PERSON] [54], who ascertained that older adults (albeit with a mean age higher than that of the 238 patients enrolled for this study) using walking aidswere more prone to falls than patients not using these aids in a residential aged care facility. In the most similar previous study, however, [PERSON] and [PERSON] [43] did not seem to have comprehensively considered these aspects in their proposed managerial approach. In this study, the analysis of the 238 fallers suggested that the state of consciousness might be a very important clinical parameter since the results of our descriptive statistical data analysis highlight that 87.8% of the patients were vigilant and well oriented, in contrast to 6.3% who were confused, and 5.9% who reported a psychomotor agitation. Furthermore, 10.1% of the 238 fallen patients showed a visual impairment that can be considered one of the most predisposing factors for a fall. This finding is consistent with the systematic review of [PERSON] et al. [55], who highlighted that, among other factors, confusion and cognitive impairment are also risk factors for geriatric patient falls in rehabilitation hospital settings. Again, in the most similar previous study, [PERSON] and [PERSON] [43] did not consider these aspects in more detail in their proposed managerial approach. Although not analyzing the fall risk using a managerial approach, previous studies have also reported similar results regarding the time, location, and mechanisms of falls. For instance, [PERSON] et al. [45] also observed that most of the falls happened during mornings and afternoons; furthermore, the same authors also ascertained that the recovery room and the toilet were the riskiest locations, and the most frequent falling mechanisms proved to be patients' getting off the bed and wheelchairs. Finally, the focus was also on the impact of medications on fall risk. As shown in Figure 1 and Table 2, the collected data revealed that more than half of the fallers took hypotensive drugs and were under diuretic therapy. As already discussed in this section, [PERSON] et al. [45] indicated that antidepressants may increase the risk up to two times than that of a control group (non-fallers) with (among others) similar Morse scores. Antidepressants were administered to only 16.4% of the fallers in this study, suggesting that the presented result might be controversial. Conversely, [PERSON] et al. [45] revealed that diuretics might be considered among the administrated FRIDs associated with fall events when matching cases and controls according to age, sex, and hospital ward; however, this association was absent when the cases and controls were matched, among others, based on their Morse scores. Nevertheless, according to the authors' admission, since the sample size was relatively small, and there were also no homogeneous diagnoses at admission, further observation may refute or diminish the former non-statistical correlation. Finally, in other studies, different researchers established that diuretics strongly affected the risk of falls [56], another finding in line with our study. Regarding the data shown in Table 3, particular attention was paid to analyzing the potential differences that could have led to the recurrence of falls. As previously mentioned, to the best of our knowledge, no similar managerial studies were found in which these aspects were analyzed to a similar level of detail. However, previous researchers have compared the anamnestic and clinical parameters of fallers and recurrent fallers. For instance, [PERSON] et al. [57] performed a retrospective study to gain insights into the potential predictors of inpatient falls in an academic hospital in the USA. The authors revealed that a total of 1082 inpatients fell during the considered period, and only about 120 patients (11% of the overall number) experienced repeated falls.