93 An Epidemiological Study of Falls Presentations in the Elderly in a Regional Hospital

Abstract

Abstract Aims To identify the characteristics and outcomes for older people who present to a regional hospital Emergency Department (ED) with a fall and to determine factors associated with admission and representation. Methods In this retrospective cohort study, data for patients with falls (>= 65 years) who presented to the ED was collected from 01/06/2014-30/11/2014 and 01/06/2015-30/11/2015 Falls episodes were reviewed for: Place and time of fall; polypharmacy and medication subtypes; comorbidity count; cognitive impairment; ED assessments; Major injury; Representations and readmissions within 90 days and review by Geriatric Emergency Department Intervention (GEDI) nurse. Characteristics of persons admitted and discharged after a fall was compared. Characteristics associated with representation and admissions were reviewed with a logistic regression analysis. Results Episodes of older people with falls presenting to the ED (n=280) had high prevalence of complex multimorbidity (82.8%) and polypharmacy (66.4%), more so in episodes resulting in admission and representation. Most falls occurred indoors, presented to the ED during daytime and arrived by ambulance. 50% of episodes resulted in admission. Investigations in the ED regardless of need for discharge or admission showed only 4% having postural blood pressures recorded, 22% had a physiotherapy review and 31% had a GEDI nurse review. Though 86% of falls episodes had a primary ED diagnoses recorded as falls-related injury, two thirds of admitted episodes did not have a diagnosis of major injury. There were 80 representations. Polypharmacy and prior ED presentations were associated with representation. Comorbidity, previous falls and major injury were associated with admission. Conclusions Older adults who present to the ED after a fall were complex and had high rates of admission and representation. The focus of clinical assessments was on injuries. This profile enables building future interventions that address risk factors and falls prevention.