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Characteristics and outcomes of older adults presented to Spanish emergency departments after a fall

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Abstract

Purpose

To study patient profile, fall-related characteristics and immediate outcomes according to age and to determine the effect of age in the outcomes among older patients presenting to ED after a fall.

Methods

Cross-sectional analysis of the FALL-ER registry that included patients aged ≥ 65 years old that presented to five Spanish EDs after a fall. Patients were classified into three age categories, and demographic, comorbidity, chronic medication, fall-related characteristics, health care resources and immediate outcomes data were analysed.

Results

We included 1610 patients, 541 (28%) aged 65–74, 647 (40.2%) aged 74–84 and 512 (31.8%) aged ≥ 85 years old. Indoor falls, with no witnesses, at night and due to non-identified causes were significantly more likely among the oldest old. Medications related to risk of falling and antithrombotic therapy significantly increased with age category. Physical, functional and psychological consequences and healthcare resource use increased significantly with age group. Age was independently associated with severe injury (adjusted OR 1.02; IC 95% 1.01–1.04), fear of falling (adjusted OR 1.02; IC 95% 1.01–1.04) and acute functional impairment (adjusted OR 1.02; IC 95% 1.00–1.04).

Conclusions

Indoor falls, with no witnesses, at night and due to non-identified causes were significantly more likely among the oldest old. The probability of presenting with severe injury, fear of falling and acute functional impairment increases with age.

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References

  1. del Nogal Lázaro (2009) M. Falls among older persons. Med Clin 133:147–153

    Article  Google Scholar 

  2. Tinetti ME, Speechley M, Ginter SF (1988) Risk factors for falls among elderly persons living in the community. N Engl J Med 319:1701–1707

    Article  CAS  PubMed  Google Scholar 

  3. Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Järvinen M et al (1999) Fall-induced injuries and deaths among older adults. JAMA 281:1895–1899

    Article  CAS  PubMed  Google Scholar 

  4. Albert M, McCaig LF, Ashman JJ (2013) Emergency department visits by persons aged 65 and over: United States, 2009–2010. NCHS Data Br 130:1–8

    Google Scholar 

  5. Shankar KN, Liu SW, Ganz DA (2017) Trends and characteristics of emergency department visits for fall-related injuries in older adults, 2003–2010. West J Emerg Med. 18:785–793

    Article  PubMed  PubMed Central  Google Scholar 

  6. Cigolle CT, Ha J, Min LC, Lee PG, Gure TR, Alexander NB et al (2015) The epidemiologic data on falls, 1998–2010: more older Americans report falling. JAMA Intern Med. 175:443–445

    Article  PubMed  Google Scholar 

  7. Sirois MJ, Émond M, Ouellet MC, Perry J, Daoust R, Morin J et al (2013) Cumulative incidence of funciontal decline after minor injuries in previously independent older Canadian individuals in the emergency department. J Am Geriatr Soc 61:1661–1668

    Article  PubMed  Google Scholar 

  8. Tirrell GP, Sri-on J, Lipsitz LA, Camargo CA Jr, Kabrhel C, Liu SW (2015) Evaluation of older adult patients with falls in the emergency department: discordance with national guidelines. Acad Emerg Med 22:461–467

    Article  PubMed  Google Scholar 

  9. Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C (1999) Prevention of falls in the elderly trial (PROFET): a randomized controlled trial. Lancet 353:93–97

    Article  CAS  PubMed  Google Scholar 

  10. Carpenter CR, Scheatzle MD, D’Antonio JA, Ricci PT, Coben JH (2009) Identification of fall risk factors in older adult emergency department patients. Acad Emerg Med 16:211–219

    Article  PubMed  Google Scholar 

  11. Kenny RA, Rubenstein LZ, Tinetti ME, Brewer K, Cameron KA, Capezuti EA et al (2011) Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc 59:148–157

    Article  Google Scholar 

  12. Tiedemann A, Sherrington C, Orr T, Hallen J, Lewis D, Kelly A et al (2013) Identifying older people at high risk of future falls: development and validation of a screening tool for use in emergency departments. Emerg Med J. 30:918–922

    Article  PubMed  Google Scholar 

  13. Rosenberg MS, Carpenter CR, Bromley M, Caterino JM, Chun A, Gerson L et al (2014) Geriatric emergency department guidelines. Ann Emerg Med 63:e7–e25

    Article  Google Scholar 

  14. Carpenter CR, Avidan MS, Wildes T, Stark S, Fowler SA, Lo AX (2014) Predicting geriatric falls following an episode of emergency department care: a systematic review. Acad Emerg Med 21:1069–1082

    Article  PubMed  PubMed Central  Google Scholar 

  15. Rivero-Santana A, Del Pino-Sedeño T, Ramallo-Fariña Y, Vergara I, Serrano-Aguilar P (2017) Usefulness of scoring risk for adverse outcomes in older patients with the Identification of Seniors at Risk scale and the Triage Risk Screening Tool: a meta-analysis. Emergencias. 29:49–60

    PubMed  Google Scholar 

  16. Martín-Sánchez FJ, Rodríguez-Adrada E, Vidan MT, Díez Villanueva P, Llopis García G, González Del Castillo J et al (2018) Impact of geriatric assessment variables on 30-day mortality among older patients with acute heart failure. Emergencias. 30:149–155

    PubMed  Google Scholar 

  17. Supervía Caparrós A, Pallás Villaronga O, Clemente Rodríguez C, Aranda Cárdenas D, Pi-Figueras Valls M, Cirera Lorenzo I (2017) Characteristics of emergency poisoning cases in elderly versus younger patients. Emergencias. 29:335–338

    PubMed  Google Scholar 

  18. Conroy S, Nickel CH, Jónsdóttir AB, Fernandez M, Banerjee J, Mooijaart S et al (2016) The development of a European curriculum in Geriatric Emergency Medicine. Eur Geriatr Med 7:315–321

    Article  Google Scholar 

  19. Bell AJ, Talbot-Stern JK, Hennessy A (2000) Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Med J Aust 173:179–182

    CAS  PubMed  Google Scholar 

  20. Pfortmueller CA, Kunz M, Lindner G, Zisakis A, Puig S, Exadaktylos AK (2014) Fall-related emergency department admission: fall environment and settings and related injury patterns in 6357 patients with special emphasis on the elderly. Sci World J 2014:256519

    Article  Google Scholar 

  21. Morteza Bagi HR, Ahmadi S, Hosseini M (2017) Demographics of fall-related trauma among the elderly presenting to emergency department; a cross-sectional study. Emergency (Tehran). 5:e78

    PubMed  PubMed Central  Google Scholar 

  22. Trevisan C, Di Gregorio P, Debiasi E, Pedrotti M, La Guardia M, Manzato E et al (2017) Factors influencing short-term outcomes for older patients accessing emergency departments after a fall: the role of fall dynamics. Gait Posture 58:463–468

    Article  PubMed  Google Scholar 

  23. Cimilli Ozturk T, Ak R, Unal Akoglu E, Onur O, Eroglu S, Saritemur M (2017) Factors associated with multiple falls among elderly patients admitted to emergency department. Int J Gerontol. 11:85–89

    Article  Google Scholar 

  24. Sri-On J, Tirrell GP, Bean JF, Lipsitz LA, Liu SW (2017) Revisit, subsequent hospitalization, recurrent fall, and death within 6 months after a fall among elderly emergency department patients. Ann Emerg Med 70:516–521

    Article  PubMed  Google Scholar 

  25. Orces CH (2009) Trends in hospitalization for fall-related injury among older adults in the United States, 1988–2005. Ageing Res 1:e1. https://doi.org/10.4081/ar.2010.e1

    Article  CAS  Google Scholar 

  26. Orces CH (2013) Emergency department visits for fall-related fractures among older adults in the USA: a retrospective cross-sectional analysis of the National Electronic Injury Surveillance System All Injury Program, 2001–2008. BMJ Open 3:e001722

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kim SH (2016) Risk factors for severe injury following indoor and outdoor falls in geriatric patients. Arch Gerontol Geriatr 62:75–82

    Article  PubMed  Google Scholar 

  28. Miró O, Brizzi BN, Aguiló S, Alemany X, Jacob J, Llorens P et al (2018) Profile of older patients attended in the emergency department after falls: a FALL-ER registry study of the magnitude of the problem and opportunities for improving hospital emergency care. Emergencias. 30:231–240

    PubMed  Google Scholar 

  29. World Health Organization. WHO Global report on falls Prevention in older Age [internet]. Geneva: World Health Organization; 2008. http://apps.who.int/iris/bitstream/10665/43811/1/9789241563536_eng.pdf. Accessed 17 Dec 2017.

  30. Alarcón T, González-Montalvo JI, Otero Puime A (2009) Assessing patients with fear of falling. Does the method use change the results? A systematic review. At Prim. 41:262–268

    Article  Google Scholar 

  31. Zia A, Kamaruzzaman SB, Tan MP (2017) The consumption of two or more fall risk-increasing drugs rather than polypharmacy is associated with falls. Geriatr Gerontol Int. 17:463–470

    Article  PubMed  Google Scholar 

  32. Mahony D, Sullivan D, Byrne S, Connor MN, Ryan C, Gallagher P (2015) STOPP/START criteria for potentially inappropriate prescribing in older people: version 2. Age Ageing 44:213–218

    Article  Google Scholar 

  33. Montali F, Campaniello G, Benatti M, Rastelli G, Pedrazzoni M, Cervellin G (2015) Impact of different drug classes on clinical severity of falls in an elderly population: epidemiological survey in a trauma center. J Clin Gerontol Geriatr. 6:63–67

    Article  Google Scholar 

  34. Rossat A, Fantino B, Nitenberg C, Annweiler C, Poujol L, Herrmann FR et al (2010) Risk factors for falling in community-dwelling older adults: which of them are associated with the recurrence of falls? J Nutr Health Aging. 14:787–791

    Article  CAS  PubMed  Google Scholar 

  35. Buatois S, Perret-Guillaume C, Gueguen R, Miget P, Vançon G, Perrin P et al (2010) A simple clinical scale to stratify risk of recurrent falls in community-dwelling adults aged 65 years and older. Phys Ther 90:550–560

    Article  PubMed  Google Scholar 

  36. López Altimiras X, Gené Tous E, De Giorgi A, Gadea Polo A, Martín Horcajo R, Jiménez Hernández S (2017) Nontherapeutic international normalized ratio results in hospital emergency patients on vitamin K antagonists: prevalence and associated factors. Emergencias. 29:93–98

    PubMed  Google Scholar 

  37. Tinetti ME, Liu WL, Claus EB (1993) Predictors and prognosis of inability to get up after falls among elderly persons. JAMA 269:65–70

    Article  CAS  PubMed  Google Scholar 

  38. Fleming J, Brayne C (2008) Inability to get up after falling, subsequent time on floor, and summoning help: prospective cohort study in people over 90. BMJ 337:1279–1282

    Article  Google Scholar 

  39. Southerland LT, Stephens JA, Robinson S, Falk J, Phieffer L, Rosenthal JA, Caterino JM (2016) Head trauma from falling increases subsequent emergency department visits more than other fall-related injuries in older adults. J Am Geriatr Soc 64:870–874

    Article  PubMed  PubMed Central  Google Scholar 

  40. Adekoya N, Majumder R (2004) Fatal traumatic brain injury, West Virginia, 1989–1998. Public Health Rep 119:486–492

    Article  PubMed  PubMed Central  Google Scholar 

  41. Bloch F, Blandin M, Ranerison R, Claessens YE, Rigaud AS, Kemoun G (2014) Anxiety after a fall in elderly subjects and subsequent risk of developing post-traumatic stress disorder at two months. A pilot study. J Nutr Health Aging. 18:303–306

    Article  CAS  PubMed  Google Scholar 

  42. Makino K, Makizako H, Doi T, Tsutsumimoto K, Hotta R, Nakakubo S et al (2018) Impact of fear of falling and fall history on disability incidence among older adults: prospective cohort study. Int J Geriatr Psychiatry. 33:658–662

    Article  PubMed  Google Scholar 

  43. Cronin M, O’Regan CM, Kearney M, Kenny R (2014) Functional and economic associations of fear of falling. Eur Geriatr Med. 5:S172–S173

    Google Scholar 

  44. Esbrí-Víctor M, Huedo-Rodenas I, López-Utiel M, Navarro-López JL, Martínez-Reig M, Serra-Rexach JA, Romero-Rizos L, Abizanda P (2017) Frailty and fear of falling: the FISTAC study. J Frailty Aging. 6:136–140

    PubMed  Google Scholar 

  45. Patel KV, Phelan EA, Leveille SG, Lamb SE, Missikpode C, Wallace RB et al (2014) High prevalence of falls, fear of falling, and impaired balance in older adults with pain in the United States: findings from the 2011 National Health and Aging Trends Study. J Am Geriatr Soc 62:1844–1852

    Article  PubMed  PubMed Central  Google Scholar 

  46. Ferreira A, Chaves P, Simões D (2016) The effect of a fall prevention exercise programme on fear of falling in the elderly. Eur Geriatr Med. 7:S189

    Google Scholar 

  47. Bhangu J, Hall P, Devaney N, Bennett K, Carroll L, Kenny RA et al (2018) The prevalence of unexplained falls and syncope in older adults presenting to an Irish urban emergency department. Eur J Emerg Med. https://doi.org/10.1097/MEJ.0000000000000548

    Article  PubMed  Google Scholar 

  48. Fan CW, Duggan J, Rodger D, Brazil E, Mc Carthy F (2017) Increased number of community-living older adults attending an emergency department with falls and fractures: North Dublin experience. Ir J Med Sci 186:693–697

    Article  CAS  PubMed  Google Scholar 

  49. Burns ER, Stevens JA, Lee R (2016) The direct costs of fatal and non-fatal falls among older adults—United States. J Saf Res. 58:99–103

    Article  Google Scholar 

  50. Greenberg MR, Kane BG, Totten VY, Raukar NP, Moore EC, Sanson T et al (2014) Injury due to mechanical falls: future directions in gender-specific surveillance, screening, and interventions in emergency department patients. Acad Emerg Med 21:1380–1385

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

This work was possible in part by a competitive Grant of the Fundación MAPFRE (C.I. 14/371-E_BS).

Funding

This study was funded by MAPFRE (C.I. 14/371-E_BS).

Author information

Authors and Affiliations

  1. Emergency Department, San Carlos Clinical Hospital, Madrid, Spain

    Francisco Javier Martín-Sánchez, Berenice Nayla Brizzi, Juan González del Castillo, Victoria Cantó Blázquez & Clara González Jiménez

  2. Faculty of Medicine of the Complutense University, Madrid, Spain

    Francisco Javier Martín-Sánchez & Montserrat Lázaro del Nogal

  3. San Carlos Clinical Research Institute Hospital San Carlos (IdISSC), Madrid, Spain

    Francisco Javier Martín-Sánchez

  4. Emergency Area, Hospital Clínic, Barcelona, Spain

    Sira Aguilo Mir & Oscar Miró

  5. Emergency Department, Bellvitge Hospital, L’Hospitalet de Llobregat, Barcelona, Spain

    Victoria Torres Machado & Javier Jacob Rodríguez

  6. Emergency Department, Short Stay and Hospitalization at Home, General University Hospital of Alicante, Alicante, Spain

    Adriana Gil & Pere Llorens

  7. Emergency Department, Central Hospital of Asturias, Oviedo, Spain

    Raquel Cenjor & Pablo Herrero Puente

  8. Universitat de Barcelona, Barcelona, Spain

    Oscar Miró

  9. University Miguel Hernández, Elche, Alicante, Spain

    Pere Llorens

  10. Health Research Institute of the Principality of Asturias, Asturias, Spain

    Pablo Herrero Puente

  11. Preventive Medicine Department of the San Carlos Clinical Hospital, Madrid, Spain

    Cristina Fernández Pérez

  12. Accidental Falls Unit, Geriatrics Department of the San Carlos Clinical Hospital, Madrid, Spain

    Montserrat Lázaro del Nogal

Authors
  1. Francisco Javier Martín-Sánchez
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  2. Berenice Nayla Brizzi
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  3. Juan González del Castillo
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  4. Victoria Cantó Blázquez
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  5. Clara González Jiménez
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  6. Sira Aguilo Mir
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  7. Victoria Torres Machado
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  8. Adriana Gil
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  9. Raquel Cenjor
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  10. Oscar Miró
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  11. Javier Jacob Rodríguez
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  12. Pere Llorens
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  13. Pablo Herrero Puente
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  14. Cristina Fernández Pérez
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  15. Montserrat Lázaro del Nogal
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Corresponding author

Correspondence to Francisco Javier Martín-Sánchez.

Ethics declarations

Conflict of interest

The authors declare they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the Research Committee of the five participant institutions and with the Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Addendum

Centres and researchers of the FALL-ER registry (FALLs attended at the Emergency Room): Geriatrics Department, San Carlos Clinical Hospital (HCSC), Madrid: Montserrat Lázaro del Nogal (Coordinator), Pedro Gil Gregorio. Emergency Department of the HCSC: F. Javier Martín Sánchez (Coordinator), Juan González del Castillo, Begoña González Ramón, Verónica Castro Jiménez, María Álvarez Carretero, Victoria Cantó Blázquez, Clara González Jiménez, Lucía Cuccolini, Berenice Nayla Brizzi, Juan J. González Armengol, Pedro Villarroel. Emergency Department, General University Hospital of Alicante, Alicante: Pere Llorens (Coordinator), Adriana Gil, Sergio Guzmán, Isis Baño, Patricia Javaloyes. Emergency Department, Hospital de Bellvitge de l’Hospitalet de Llobregat, Barcelona: Javier Jacob Rodríguez (Coordinator), Victoria Torres Machado. Emergency Department, Hospital Clinic, Barcelona: Òscar Miró (Coordinator), Sira Aguilo, Xavier Alemany, Verònica Rico, Gemma Martínez Nadal. Emergency Department, Central University Hospital of Asturias, Oviedo: Pablo Herrero Puente (Coordinator), Raquel Cenjor, Sara Lago Esteve. Preventive Medicine Department, HCSC: Cristina Fernández. Admission and Clinical Documentation Department, HCSC: Carlos A Elvira.

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Martín-Sánchez, F.J., Brizzi, B.N., González del Castillo, J. et al. Characteristics and outcomes of older adults presented to Spanish emergency departments after a fall. Eur Geriatr Med 9, 631–640 (2018). https://doi.org/10.1007/s41999-018-0103-x

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  • DOI: https://doi.org/10.1007/s41999-018-0103-x

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