Geriatric screening, fall characteristics and 3- and 12\u2009months adverse outcomes in older patients visiting the emergency department with a fall

Laura C Blomaard,Leonie J Van Meer,Jacinta A Lucke,Simon P Mooijaart,Sander Anten,Bas De Groot,Jelle De Gelder,Julia Leander,Jacobijn Gussekloo

doi:10.1186/s13049-021-00859-5

Abstract

BackgroundFalls in older Emergency Department (ED) patients may indicate underlying frailty. Geriatric follow-up might help improve outcomes in addition to managing the direct cause and consequence of the fall. We aimed to study whether fall characteristics and the result of geriatric screening in the ED are independently related to adverse outcomes in older patients with fall-related ED visits.MethodsThis was a secondary analysis of the observational multicenter Acutely Presenting Older Patient (APOP) study, of which a subset of patients aged ≥70 years with fall-related ED visits were prospectively included in EDs of two Dutch hospitals. Fall characteristics (cause and location) were retrospectively collected. The APOP-screener was used as a geriatric screening tool. The outcome was 3- and 12-months functional decline and mortality. We assessed to what extent fall characteristics and the geriatric screening result were independent predictors of the outcome, using multivariable logistic regression analysis.ResultsWe included 393 patients (median age 80 (IQR 76–86) years) of whom 23.0% were high risk according to screening. The cause of the fall was extrinsic (49.6%), intrinsic (29.3%), unexplained (6.4%) or missing (14.8%). A high risk geriatric screening result was related to increased risk of adverse outcomes (3-months adjusted odds ratio (AOR) 2.27 (1.29–3.98), 12-months AOR 2.20 (1.25–3.89)). Independent of geriatric screening result, an intrinsic cause of the fall increased the risk of 3-months adverse outcomes (AOR 1.92 (1.13–3.26)) and a fall indoors increased the risk of 3-months (AOR 2.14 (1.22–3.74)) and 12-months adverse outcomes (AOR 1.78 (1.03–3.10)).ConclusionsA high risk geriatric screening result and fall characteristics were both independently associated with adverse outcomes in older ED patients, suggesting that information on both should be evaluated to guide follow-up geriatric assessment and interventions in clinical care.

Highlights

Falls among older people are common and often result in injuries and Emergency Department (ED) visits, [1, 2] which are associated with adverse outcomes such as ED revisits, functional decline and mortality [3,4,5,6]
Fall-related injuries have been shown to be associated with adverse outcomes, it is unknown to what extent falls can be attributed to frailty and whether the cause and circumstances of falls are associated with adverse outcomes apart from the result of geriatric screening in the ED
Patients in whom the cause and circumstances of the fall are associated with adverse outcomes may benefit from more comprehensive ED management and geriatric follow-up, whereas for patients in whom the fall is not associated with adverse outcomes standard ED management may be appropriate [13, 14]

Summary

Introduction

Fall-related injuries (e.g. hip fracture) have been shown to be associated with adverse outcomes, it is unknown to what extent falls can be attributed to frailty and whether the cause and circumstances of falls are associated with adverse outcomes apart from the result of geriatric screening in the ED. Patients in whom the cause and circumstances of the fall are associated with adverse outcomes may benefit from more comprehensive ED management and geriatric follow-up, whereas for patients in whom the fall is not associated with adverse outcomes standard ED management may be appropriate [13, 14]. We aimed to study whether fall characteristics and the result of geriatric screening in the ED are independently related to adverse outcomes in older patients with fall-related ED visits

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Conclusion