Conley Scale: assessment of a fall risk prevention tool in a General Hospital


Conley Scale
fall prevention
clinical risk management


Introduction: Umberto I Teaching Hospital adopted 'Scale of Conley' as internal procedure for fall risk assessment, with the aim of strengthening surveillance and improving prevention and management of impatient falls.

Materials and Methods: Case-control study was performed. Fall events from 1st March 2012 to 30th September 2013 were considered. Cases have been matched for gender, department and period of hospitalization with two or three controls when it is possible. A table including intrinsic and extrinsic fall risk factors, not foreseen by Conley Scale, and setted up after a literature overview was built. Univariate analysis and conditional logistic regression model have been performed.

Results: 50 cases and 102 controls were included. Adverse event fall were associated with filled Conley scale at the admission to care unit (OR=4.92, 95%CI= 2.34-10.37). Univariate analysis identified intrinsic factors increasing risk of falls: dizziness (OR= 3.22; 95%CI= 1.34-7.75), psychomotor agitation (OR= 2.61; 95%CI= 1.06-6.43); and use of means of restraint (OR=5.05 CI= 1.77-14.43). Conditional logistic regression model revealed a significant association with the following variables: use of instruments of restraint (HR= 5.54, 95%IC= 1.2-23.80), dizziness (OR= 3.97, 95%CI= 1.22-12.89).

Discussion: Conley Scale must be filled at the access of patient to care unit. There were no significant differences between cases and controls with regard to risk factors provided by Conley, except for the use of means of restraint. Empowerment strategies for Conley compilation are needed.


Sutton JC, Standen PJ, Wallace WA. Patient accidents inhospital - incidence, documentation and significance. Br J Clin Pract 1994;48:63. [Google Scholar]

Fagin ID, Vita M. Who? Where? When? How? An analysis of 868 inpatient accidents. Hospitals 1965;39:60-65. Available from: PubMed PMID: 14335129. [Google Scholar]

Lavoro Md, della Salute e delle Politiche sociali . Protocollo per il monitoraggio degli Eventi Sentinella Ministero del Lavoro, della Salute e delle Politiche Sociali. Proceedings of . . [Google Scholar]

RNAO - Registered Nurses' Association of Ontario. Prevention of Falls and Fall Injuries in the Older Adult 2005. pdf. (last accessed: February 2015)

Morse JM, Janice M. Preventing patient falls. Sage: . [Google Scholar]

Barelli P. Informazioni dalla letteratura per una buona pratica infermieristica, Prevenzione delle cadute nell'anziano". Dossier Infad 2006;5:6. [Google Scholar]

Rubenstein RZ, Laurence Z. Falls in older people: epidemiology, risk factors and strategies for prevention. Age and ageing 2006;35:37. [Google Scholar] (last accessed: February 2015).

Morse JM, Black C, Oberle K, Donahue P. A prospective study to identify the fall-prone patient. Soc Sci Med 1989;28(1):81-86. Available from: PubMed PMID: 2928815. doi: 10.1016/0277-9536(89)90309-2. [Google Scholar]

Conley D, Schultz AA, Selvin R. The challenge of predicting patients at risk for falling: development of the Conley Scale.. Medsurg Nurs 1999;8(6):348-354. Available from: PubMed PMID: 11000772. [Google Scholar]

Morse JM, Morse RM, Tylko SJ. Development of a scale to identify the fall-prone patient. Canadian Journal on Aging/La Revue canadienne du vieillissement 1989;8(04):366-377. Available from: doi: 10.1017/S0714980800008576. [Google Scholar]

Tinetti ME. Preventing Falls in Elderly Persons. N Engl J Med 2003 Jan;348(1):42-49. Available from: PubMed PMID: 24552316. doi: 10.1056/NEJMcp020719. [Google Scholar]

Milisen K, Staelens N, Schwendimann R, De Paepe L, Verhaeghe J, Braes T, et al. Fall prediction in inpatients by bedside nurses using the St. Thomas's Risk Assessment Tool in Falling Elderly Inpatients (STRATIFY) instrument: a multicenter study.. J Am Geriatr Soc 2007;55(5):725-733. Available from: PubMed PMID: 17493192. doi: 10.1111/j.1532-5415.2007.01151.x. [Google Scholar]

Oliver D, Britton M, Seed P, Martin FC, Hopper AH. Development and evaluation of evidence based risk assessment tool (STRATIFY) to predict which elderly inpatients will fall: case-control and cohort studies. BMJ 1997 Oct;315(7115):1049-1053. Available from: PubMed PMID: 9366729. doi: 10.1136/bmj.315.7115.1049. [Google Scholar]

Suprani R, Taglioni M. [Scale Mosaic: definition and testing of a tool for assessing the risk of falling and the care planning during hospitalization].. Prof Inferm 2014;67(2):95-105. Available from: PubMed PMID: 25134507. [Google Scholar]

Smith J, Forster A, Young J. Use of the 'STRATIFY' falls risk assessment in patients recovering from acute stroke. Age Ageing 2005 Dec;35(2):138-143. Available from: PubMed PMID: 16368736. doi: 10.1093/ageing/afj027. [Google Scholar]

Bellandi T, Brandi A, Rasero L. . . [Google Scholar]

Myers H. Hospital fall risk assessment tools: A critique of the literature. Int J Nurs Pract 2003;9(4):223-235. Available from: doi: 10.1046/j.1440-172X.2003.00430.x. [Google Scholar]

Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ. Will my patient fall?. JAMA 2007 Jan;297(1):77-86. Available from: PubMed PMID: 17200478. doi: 10.1001/jama.297.1.77. [Google Scholar]

Chiari P, Mosci D, Fontana S, et al. Valutazione degli strumenti di misura del rischio di cadute dei pazienti. Assistenza Infermieristica e Ricerca 2002;21:117. [Google Scholar]

Kleinbaum DG, Klein M. Parametric survival models. In Survival analysis. New York: Springer; 2012. [Google Scholar]

Lovallo C, Rolandi S, Rossetti AM, Lusignani M. Accidental falls in hospital inpatients: evaluation of sensitivity and specificity of two risk assessment tools. J Adv Nurs 2010;66(3):690-696. Available from: PubMed PMID: 20423404. doi: 10.1111/j.1365-2648.2009.05231.x. [Google Scholar]

Rhymes J, Jaeger R. Falls. Prevention and management in the institutional setting.. Clin Geriatr Med 1988;4(3):613-622. Available from: PubMed PMID: 3136903. [Google Scholar]

Bates DW, Pruess K, Souney P, Platt R. Serious falls in hospitalized patients: Correlates and resource utilization. The American Journal of Medicine 1995;99(2):137-143. Available from: doi: 10.1016/S0002-9343(99)80133-8. [Google Scholar]

Leipzig RM, Cumming RG, Tinetti ME. Drugs and falls in older people: a systematic review and meta-analysis: I. Psychotropic drugs.. J Am Geriatr Soc 1999;47(1):30-39. Available from: PubMed PMID: 9920227. doi: 10.1111/j.1532-5415.1999.tb01898.x. [Google Scholar]

Prevention OF, PANEL, Orthopaedic Surgeons , author . Guideline for the prevention of falls in older persons. J Am Geriatr Soc 2001;49(5):664-672. Available from: doi: 10.1046/j.1532-5415.2001.49115.x. [Google Scholar]

Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community.. N Engl J Med 1988 Dec;319(26):1701-1707. Available from: PubMed PMID: 3205267. doi: 10.1056/NEJM198812293192604. [Google Scholar]

Nevitt MC, Cummings SR, Kidd S, et al. Risk factors for recurrent non syncopal falls: a prospective study. JAMA 1989;261(18):2663. Available from: doi: 10.1001/jama.1989.03420180087036. [Google Scholar]

Hodgkinson B, Lambert L, Wood J, et al. Falls in acute hospitals: a systematic review. Joanna Briggs Institute for Evidence Based Nursing and Midwifery. 1998

Rawsky E. Review of the literature on falls among the elderly.. Image J Nurs Sch 1998;30(1):47-52. Available from: PubMed PMID: 9549941. doi: 10.1111/j.1547-5069.1998.tb01235.x. [Google Scholar]

Frewen J, King-Kallimanis B, Boyle G, Kenny RA. Recent syncope and unexplained falls are associated with poor cognitive performance. Age Ageing 2014 Dec;44(2):282-286. Available from: PubMed PMID: 25520310. doi: 10.1093/ageing/afu191. [Google Scholar]

American Geriatrics Society , author . Guidelines for prevention of falls in older persons. J Am Geriatr Soc 2001;49:664. [Google Scholar]

Mahoney J, Sager M, Dunham NC, Johnson J. Risk of falls after hospital discharge.. J Am Geriatr Soc 1994;42(3):269-274. Available from: PubMed PMID: 8120311. doi: 10.1111/j.1532-5415.1994.tb01750.x. [Google Scholar]

Robbins AS, Rubenstein LZ, Josephson KR, Schulman BL, Osterweil D, Fine G. Predictors of falls among elderly people. Results of two population-based studies.. Arch Intern Med 1989;149(7):1628-1633. Available from: PubMed PMID: 2742437. [Google Scholar]

Connell BR. Role of the environment in falls prevention.. Clin Geriatr Med 1996;12(4):859-880. Available from: PubMed PMID: 8890120. [Google Scholar]

Perell KL, Nelson A, Goldman RL, Luther SL, Prieto-Lewis N, Rubenstein LZ. Fall risk assessment measures: an analytic review.. J Gerontol A Biol Sci Med Sci 2001;56(12). Available from: PubMed PMID: 11723150. [Google Scholar]

Hendrich A, Nyhuis A, Kippenbrock T, Soja ME. Hospital falls: development of a predictive model for clinical practice.. Appl Nurs Res 1995;8(3):129-139. Available from: PubMed PMID: 7668855. doi: 10.1016/S0897-1897(95)80592-3. [Google Scholar]

Lord SR. Visual risk factors for falls in older people. Age Ageing 2006;35:42. [Google Scholar]

Morris JC, Rubin EH, Morris EJ, et al. Senile dementia of the Alzeimer's type, an important risk factor for serious falls. J Gerontol 1987;42(4):412-417. Available from: doi: 10.1093/geronj/42.4.412. [Google Scholar]

Tutuarima JA, van der Meulen JH, de Haan RJ, van Straten A, Limburg M. Risk factors for falls of hospitalized stroke patients.. Stroke 1997;28(2):297-301. Available from: PubMed PMID: 9040678. doi: 10.1161/01.STR.28.2.297. [Google Scholar]

Cumbler EU, Simpson JR, Rosenthal LD, Likosky DJ. Inpatient falls: defining the problem and identifying possible solutions. Part I: an evidence-based review.. Neurohospitalist 2013;3(3):135-143. Available from: PubMed PMID: 24167647. doi: 10.1177/1941874412470665. [Google Scholar]

Simpson JR, Rosenthal LD, Cumbler EU, et al. Inpatient falls: defining the problem and identifying possible solutions. Part II: Application of Quality Improvement Principles to Hospital Falls. Neurohospitalist 2013;3(4):203-208. Available from: PubMed PMID: 24198902. doi: 10.1177/1941874412470666. [Google Scholar]

Aranda-Gallardo M, Morales-Asencio JM, Canca-Sanchez JC, Barrero-Sojo S, Perez-Jimenez C, Morales-Fernandez A, et al. Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis. BMC Health Serv Res 2013;13(1):122. Available from: PubMed PMID: 23547708. doi: 10.1186/1472-6963-13-122. [Google Scholar]