Factors associated with fall severity Among Older Patients Admitted to the Emergency Department in Guadeloupe (French West Indies): A retrospective cohort study

Abstract

Introduction: Falls are a common geriatric syndrome in older people. Falls are associated with adverse health events such as dependency, unplanned emergency admissions and death. This study aimed to identify factors associated with fall severity (hospitalization) in patients aged 70 years and over admitted to the emergency department in Guadeloupe. Method: Single-center, observational, retrospective study of patients aged 70 years and over, admitted to the emergency department (ED) of the University Hospital of Guadeloupe for a fall, between 1 May 2018 and 30 April 2019. Fall severity was defined as the need for hospitalization. Bivariate analysis was used to determine the associations between fall severity and sociodemographic characteristics, comorbidities, history of falls and polypharmacy (defined as the daily use of at least 5 drugs). Polypharmacy was analyzed as a binary variable (yes/no), and in categories (0–3 (ref.), 4–6, 7–9 and ≥ 10 drugs). Results: During the study period, 625 patients who attended the ED for a fall were included. Mean age was 82.6 ± 7.6 years, 48.8% were men. Of these, 277 patients (44.3%) were admitted to the hospital, and three patients (0.5%) died. In bivariate analysis, only polypharmacy was associated with hospitalization for fall (OR: 1.63 [95%CI: 1.33–2.02]). The odds ratios for polypharmacy categories were 1.46 [95%CI 0.99 − 2.14], 1.65 [1.09–2.50] and 1.48 [0.76–2.85] for 4–6, 7–9 and ≥ 10 drugs respectively. Conclusion: Polypharmacy was associated with hospitalization as a proxy for fall severity. Regular review of drug prescription is essential to reduce polypharmacy in older adults.