Revisit, Subsequent Hospitalization, Recurrent Fall, and Death Within 6 Months After a Fall Among Elderly Emergency Department Patients - 23/09/17
, Gregory P. Tirrell, BS b, Jonathan F. Bean, MD, MPH c, Lewis A. Lipsitz, MD d, e, Shan W. Liu, MD, SD bAbstract |
Study objective |
We seek to describe the risk during 6 months and specific risk factors for recurrent falls, emergency department (ED) revisits, subsequent hospitalizations, and death within 6 months after a fall-related ED presentation.
Methods |
This was a secondary analysis of a retrospective cohort of elderly fall patients who presented to the ED from one urban teaching hospital. We included patients aged 65 years and older who had an ED fall visit in 2012. We examined the frequency and risk factors of adverse events (composite of recurrent falls, ED revisits, subsequent hospitalization, and death, selected a priori) at 6 months.
Results |
Our study included 350 older adults. Adverse events steadily increased, from 7.7% at 7 days, 21.4% at 30 days, and 50.3% at 6 months. Within 6 months, 22.6% of patients had at least one recurrent fall, 42.6% revisited the ED, 31.1% had subsequent hospitalizations, and 2.6% died. In multivariable logistic regression analysis, psychological or sedative drug use predicted recurrent falls, ED revisits, subsequent hospitalizations, and adverse events.
Conclusion |
More than half of fall patients had an adverse event within 6 months of presenting to the ED after a fall. The risk during 6 months of these adverse events increased with psychological or sedative drug use. Larger future studies should confirm this association and investigate methods to minimize recurrent falls through management of such medications.
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| Please see page 517 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Robert J. Zalenski, MD, MA |
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| Author contributions: JS and SWL had full access to all of the data in the study; acquired, analyzed, and interpreted data; and take responsibility for the integrity of the data and the accuracy of the data analysis. JS, GPT, and SWL were responsible for study concept and design and drafting of the article. JS, JFB, LAL, and SWL were responsible for critical revision of the article for important intellectual content. All authors read and approved the final article. JS takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that no such relationships exist. Funded by the Hartford Foundation's Center of Excellence. |
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| Trial registration number: 2012-p-000450/1; MGH |
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| A podcast for this article is available at www.annemergmed.com. |
Vol 70 - N° 4
P. 516 - octobre 2017 Retour au numéro
Article précédent
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