Cognitive-Executive Screening as a Predictor of Falls in Inpatient Rehabilitation Hospitals: A Retrospective Observational Study.

Abstract

This retrospective cohort study aimed to evaluate whether integrating cognitive-executive dysfunction assessment enhances fall risk prediction beyond Morse Fall Scale in inpatient rehabilitation. Records at an inpatient rehabilitation hospital were reviewed to extract fall status data. Cognitive-executive dysfunction was characterized using non-verbal measures like the Clock Drawing Test, call light/button use, and need for speech-language services for cognitive goals. Of the 1033 patient-charts reviewed, 36 (3.48%) had experienced falls. Fallers had worse Morse Fall Scores (P=0.001) and were four times as likely to require speech-language cognitive services compared to non-fallers (Odd's Ratio = 4.368, P = 0.025) . Adding speech-language cognitive services to Morse Falls scale improved fall risk prediction, increasing model's discriminative performance (73% vs. 69%) and specificity (70.8% vs. 63.9%). In inpatient rehabilitation, incorporating speech-language therapy for cognitive-executive goals improves fall risk prediction beyond Morse Fall Scale alone. The enhanced specificity achieved by combining cognitive-executive screening and Morse Falls score helps better identify patients who are not at a high risk for falls, and thereby optimize resources. These findings underscore the value of integrating speech therapy with nursing, and physical therapy and occupational therapy to establish a comprehensive strategy for fall prevention in inpatient rehabilitation.