Aims: Delirium is often under-recognized in inpatient palliative care units (PCU), with prevalence rates up to 58%. This study aimed to explore the relationship between delirium, as measured by the 4 ‘A’s Test (4AT) tool, and fall rates among patients in PCU.
Methods: A retrospective cohort observational study was conducted in an inpatient PCU, from 1stJanuary 2022 and 1stJanuary 2023. Data was collected from 267 patients, including demographic information, functional status and symptom burden. 4AT scores were categorized as negative 4AT(<4), positive 4AT(4-8), strongly positive 4AT(>8). Statistical analyses included chi-square tests, t-tests and multivariable regression analysis.
Results: Of the 267 patients, 174(65%) had completed 4AT assessments. Delirium prevalence, defined as a 4AT score ≥4, was 42%. 27 patients experienced a total of 39 falls during admission. No statistically significant differences in fall rates were observed across 4AT categories. Patients with strongly positive 4AT scores demonstrated lower functional performance and reduced mobility. Notably, patients with 4AT scores between 4 and 8 had the highest fall incidence, poorer symptom control, longer average lengths of stay compared with other groups.
Conclusions: Although no linear association between delirium severity and fall rates was identified, findings suggest that patients with moderate delirium and preserved mobility may be at greatest fall risk. Routine delirium screening using the 4AT may support targeted care planning, improved symptom management, and more effective resource allocation in palliative care settings.