180-Day functional decline among older patients attending an emergency department after a fall

Miró, Òscar; Brizzi, Berenice Nayla; Aguiló, Sira; Alemany, Xavier; Jacob, Javier; Llorens, Pere; Puente, Pablo Herrero; Machado, Victoria Torres; Cenjor, Raquel; Gil, Adriana; Rico, Verónica; Carretero, María Álvarez; Cuccolini, Lucía; Nadal, G.; Fernández-Pérez, Cristina; Nogal, Montserrat Lázaro del; Platts‐Mills, Timothy F.; Martín‐Sánchez, Francisco Javier

doi:10.1016/j.maturitas.2019.08.008

Cited by 8 publications

(6 citation statements)

References 27 publications

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“…We used the FALL-ER registry, which constitutes the first Spanish multicenter registry of older people attended in ED for a fall and evaluated up to 180 days after discharge. 3,34 We herein report an all-cause mortality of 7.5% at 6 months, which is in line with mortality rates described in similar studies: 1.2% at 3 days, 10 8.7% at 6 months, 24 and 15% at 1 year. 10 Notably, we found that the risk of death during the following months after a fall was significantly higher in men.…”

Section: Discussionsupporting

confidence: 91%

“…This study analyzed a large sample of older patients who came to the ED after a fall, and evaluated sex differences from the perspective of promoting gender equity in health. We used the FALL‐ER registry, which constitutes the first Spanish multicenter registry of older people attended in ED for a fall and evaluated up to 180 days after discharge 3,34 . We herein report an all‐cause mortality of 7.5% at 6 months, which is in line with mortality rates described in similar studies: 1.2% at 3 days, 10 8.7% at 6 months, 24 and 15% at 1 year 10 .…”

Section: Discussionsupporting

confidence: 84%

“…Several trials have included participants who visit the ED after age‐related falls in an attempt to identify the best fall‐prevention interventions 3,7–10,19,34 . Unfortunately, the effect of modifications in the baseline social situation after falling have been much less investigated.…”

Section: Discussionmentioning

confidence: 99%

“…42,43 There are few studies focused on functional decline with a short-medium follow-up after a fall-related ED visit. 3,34 Recently, clinical decision tools to predict functional decline have been published, including gender, age, baseline physical and cognitive function, frailty, place of residence, comorbidity, severity and mechanism of injury and hospital department admitting the patient to compose a risk model to predict 1-year disability and mortality of injured older adults attended in the ED. 19 The follow-up of our sample showed a higher mortality during the 30-day follow-up in males.…”

Section: Discussionmentioning

confidence: 99%

“…Several trials have included participants who visit the ED after age-related falls in an attempt to identify the best fall-prevention interventions. 3,[7][8][9][10]19,34 Unfortunately, the effect of modifications in the baseline social situation after falling have been much less investigated. Potential ED interventions should focus on improving physical impairment and psychological limitations of the acute period (i.e., changes in mobility, feelings of isolation, fear of falling, correct nutritional support, revision of polypharmacy), not only related to the fall itself, but also by exploring the resources of the environment of the individual (availability of caregivers, tele-assistance services, adaptation of the home to functional changes).…”

Section: Discussionmentioning

confidence: 99%

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Sex differences in mortality of older adults with falls after emergency department consultation: FALL‐ER registry

Miró

Gil‐Rodrigo

García‐Martínez

et al. 2023

J American Geriatrics Society

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BackgroundTo investigate if sex is a risk factor for mortality in patients consulting at the emergency department (ED) for an unintentional fall.MethodsThis was a secondary analysis of the FALL‐ER registry, a cohort of patients ≥65 years with an unintentional fall presenting to one of 5 Spanish EDs during 52 predefined days (one per week during one year). We collected 18 independent patient baseline and fall‐related variables. Patients were followed for 6 months and all‐cause mortality recorded. The association between biological sex and mortality was expressed as unadjusted and adjusted hazard ratios (HR) with the 95% confidence interval (95% CI), and subgroup analyses were performed by assessing the interaction of sex with all baseline and fall‐related mortality risk variables.ResultsOf 1315 enrolled patients (median age 81 years), 411 were men (31%) and 904 women (69%). The 6‐month mortality was higher in men (12.4% vs. 5.2%, HR = 2.48, 95% CI = 1.65–3.71), although age was similar between sexes. Men had more comorbidity, previous hospitalizations, loss of consciousness, and an intrinsic cause for falling. Women more frequently lived alone, with self‐reported depression, and the fall results in a fracture and immobilization. Nonetheless, after adjustment for age and these eight divergent variables, older men aged 65 and over still showed a significantly higher mortality (HR = 2.19, 95% CI = 1.39–3.45), with the highest risk observed during the first month after ED presentation (HR = 4.18, 95% CI = 1.31–13.3). We found no interaction between sex and any patient‐related or fall‐related variables with respect to mortality (p > 0.05 in all comparisons).ConclusionsMale sex is a risk factor for death following ED presentation for a fall in the older population adults aged 65 and over. The causes for this risk should be investigated in future studies.

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