Hyponatraemia in older medical patients: Implications for falls and adverse outcomes of hospitalisation.
Intern Med J. 2014 Jul 16;
Authors: Ahamed S, Anpalahan M, Savvas S, Gibson S, Torres J, Janus E
Abstract
BACKGROUND: Recent evidence suggests an association between hyponatraemia and falls.
AIMS: To determine the association of hyponatraemia with admission-associated falls (i.e. falls as part of the presenting complaint or during admission) and predefined adverse outcomes of hospitalisation.
METHODS: A case controlled study of patients aged >65 years admitted with hyponatraemia during a six-month period was conducted. The relevant data were collected by review of medical records and analysed in univariate and multivariate models.
RESULTS: The prevalence of hyponatraemia was 22% and more likely to be associated with the admission diagnoses of cardiovascular (P=0.04) and metabolic disorders (P< 0.001), use of diuretics (P=0.037) and a higher Charlson comorbidity score (P=0.035). Hyponatraemia was independently associated with admission-associated falls (OR 3.12, CI: 1.84-4.38, P<0.001). The increased odds of falling were similar for mild (OR 3.15, CI 1.75-5.66) vs. moderate to severe hyponatraemia (OR 3.07, CI 1.57-6.03). Although hyponatraemia had a significant independent association with increased length of stay (LOS) (OR 1.48, CI 1.22-1.79, P< 0.001) and change in residential care status to a more dependent category at discharge (OR 4.28, CI 1.68-10.859, P=0.002), it was not associated with mortality or time to first unplanned readmission. Hyponatraemia was significantly associated with the need for inpatient rehabilitation; however, this was no longer significant when adjusted for falls.
CONCLUSION: Hyponatraemia is independently associated with increased risk of admission-associated falls. The degree of falls risk is similar regardless of the severity of hyponatraemia. Hyponatraemia is also an important determinant of many adverse outcomes of hospitalisation.
PMID: 25039672 [PubMed - as supplied by publisher]