Abstract
BackgroundLittle is known about the prevalence of modifiable risk factors of falling in elderly persons with a fall-history who do not visit the Accident and Emergency (A&E) Department after one or more falls. The objective of this study was to determine the prevalence of modifiable risk factors in a population that visited the A&E Department after a fall (A&E group) and in a community-dwelling population of elderly individuals with a fall history who did not visit the A&E Department after a fall (non-A&E group).MethodsTwo cohorts were included in this study. The first cohort included 547 individuals 65 years and older who were visited at home by a mobile fall prevention team. The participants in this cohort had fall histories but did not visit the A&E Department after a previous fall. These participants were age- and gender-matched to persons who visited the A&E Department for care after a fall. All participants were asked to complete the CAREFALL Triage Instrument.ResultsThe mean number of modifiable risk factors in patients who did not visit the A&E Department was 2.9, compared to 3.8 in the group that visited the A&E Department (p<0.01). All risk factors were present in both groups but were more prevalent in the A&E group, except for the risk factors of balance and mobility (equally prevalent in both groups) and orthostatic hypotension (less prevalent in the A&E group). The risk factors of polypharmacy, absence of orthostatic hypotension, fear of falling, impaired vision, mood and high risk of osteoporosis were all independently associated with visiting the A&E Department.ConclusionAll modifiable risk factors for falling were found to be shared between community-dwelling elderly individuals with a fall history who visited the A&E Department and those who did not visit the Department, although the prevalence of these factors was somewhat lower in the A&E group. Preventive strategies aimed both at patients presenting to the A&E Department after a fall and those not presenting after a fall could perhaps reduce the number of recurrent falls, the occurrence of injury and the frequency of visits to the A&E Department.
Highlights
Little is known about the prevalence of modifiable risk factors of falling in elderly persons with a fallhistory who do not visit the Accident and Emergency (A&E) Department after one or more falls
From the 17,340 persons invited to participate in the mobile prevention program, 1,861 older persons replied that they were interested in an assessment by the mobile team
Eight hundred and eighty-five patients (17.7%) of these patients were excluded, 199 patients because of severe cognitive impairment, 90 patients because of admittance to the Intensive care unit (ICU) or Department of Neurology after presentation at the A&E Department, 25 patients because they were not able to speak or understand Dutch, 132 patients because of death resulting from the fall, 46 patients because of living in a nursing home, seven patients because the fall resulted from external violence, 214 patients because they were sent the Carefall Triage Instrument (CTI) at an earlier visit to the A&E Department and 218 patients for administrative reasons
Summary
Fall-related injuries are the third leading cause of years lived with disability, according to the World Health Organization’s report ‘Global burden of disease’ [12]. A high incidence of falls is associated with a high susceptibility to injury This susceptibility is based on the prevalence of co-morbid disease and age-related physiological deterioration and could cause serious consequences to result from a mild fall [14]. Older persons who have sustained a fall are at risk of falling again and of osteoporotic fractures Because of these consequences, both primary and secondary prevention of falls is crucial. Over the last several decades, many studies have been published regarding the prevention of secondary falls and fractures, and contradictory results have been found [15]. This disparity may have been due to differences in the populations and strategies used in these studies, and other triage strategies might be useful
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