Abstract
Abstract Background Nursing Home Residents (NHR) are the most-frail group of older persons, with many comorbidities that increase their risk of falling. Falls are a frequent reason for ED attendance by NHR’s as it is for all older persons, but little is reported on their characteristics and outcomes specifically. Methods A prospective cohort study of all NH presentations with falls to the ED of a university teaching hospital over a one-year period. Detailed operational and clinical phenotype characteristics, and outcomes were recorded in all instances. Results There were 519 ED presentations by 344 NHR over one year. Almost half of all presentations (48.2%, 250/519), were as result of a fall, by 172 residents. The majority were female (137/250, 55%), with an average age of 77.8 years (±10.8). Many, 84.3% (145/172), had a prior fall in the past six-months. Almost half had a diagnosis of dementia (124/250, 49.6%). A third mobilised with a Zimmer-frame (83/250), and 10.8% (27/250) wheelchair. 33.2% (83/250) had visual impairment. The mean Barthel Index was 9.55 (±5.12) indicating high-dependency. NHRs fallers frequently attended ED outside routine working hours, with 36.8% (92/250) and 27.6% (69/250) presenting after 5pm (Monday to Friday), or at the weekend respectively. 54.8% of patients were admitted (137/250), and only 25.6% of patients had review by a GP prior to ED-referral (64/250). The average Length Of Stay (aLOS) for admitted NHR fallers was 10.4 (±9.1) days. Injurious falls were noted in only 10.4% (26/250) presentations. aLOS for those admitted with documented injuries (14/26, 54%) was 5.0 days (±7.0, n=14). Conclusion NH residents have complex clinical needs and falls is a frequent reason for attending ED. Better access to “out of hours” clinical support within the NH, and better integrated falls prevention programmes/ care pathways between NHs and primary/secondary services are necessary to enhance care and optimise falls prevention.
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