First Fall-Related Injuries Requiring Hospitalization Increase the Risk of Recurrent Injurious Falls: A Nationwide Cohort Study in Taiwan

Abstract

ObjectivesRecurrent falls not only have risk factors different from those of single falls but also have less favorable outcomes. The aim of our study was to determine the association between the injury characteristics of a first fall and the likelihood of recurrent injurious falls in a cohort of hospitalized patients.MethodsWe designed a nationwide retrospective cohort study and selected hospitalized patients who had injurious falls between 2001 and 2010. Cox proportional hazards models were used to estimate the hazard ratios (HRs) of recurrent injurious falls requiring hospitalization in the following year on the basis of the patients’ demographic characteristics, comorbidities, and the characteristics of injuries from the first injurious fall requiring hospitalization.ResultsAmong the 504 512 patients hospitalized for injurious falls, 19 442 experienced recurrent injurious falls requiring hospitalization. The 1-year incidence of recurrent injurious falls requiring hospitalization was 3.85%. The incidence density was the highest within the 3-month period after the first injurious fall. The risk of recurrent injurious falls among patients aged 40 to 64, 65 to 74, and ≥ 75 years increased progressively (HR: 2.11, 95% confidence interval [CI]: 1.90–2.34; HR: 2.80, 95% CI: 2.51–3.11; and HR: 3.80, 95% CI: 3.42–4.23, respectively). The length of hospitalization (LOH) ≥ 15 or ≥ 31 days (HR: 1.39, 95% CI: 1.30–1.48; and HR: 1.59, 95% CI: 1.43–1.77, respectively) and injury to the head (HR: 1.59, 95% CI: 1.53–1.65) or spine (HR: 1.66, 95% CI: 1.59–1.74) were also found to be major risk factors.ConclusionsOur findings show that the LOH and head and spine injuries are associated with an increased risk of recurrent injurious falls leading to hospitalization. The risk of recurrent injurious falls requiring hospitalization increased significantly among adults older than 40 years. We suggest further research on the effects of injury characteristics associated with the first injurious fall requiring hospitalization and resultant anatomical damages on the risk of recurrent injurious falls requiring hospitalization. High-risk patients should receive tailored rehabilitation addressing their respective injuries within 3 months after hospital discharge.

GAPcare: The Geriatric Acute and Post‐Acute Fall Prevention Intervention in the Emergency Department: Preliminary Data

“…In the latter study, fall assessments were completed on average 5 to 10 weeks after the initial ED visit. Prompt evaluation and fall risk assessment, as can be done immediately after the injury in the ED, may prevent falls in the high‐risk immediate post‐fall period . The ED visit is an opportune time to initiate fall prevention measures because patients are optimally engaged, caregivers are often present, and hospital‐based staff, such as pharmacists and physical therapists (PTs), are available .…”

“…Prompt evaluation and fall risk assessment, as can be done immediately after the injury in the ED, may prevent falls in the high-risk immediate post-fall period. 7,[11][12][13] The ED visit is an opportune time to initiate fall prevention measures because patients are optimally engaged, caregivers are often present, and hospital-based staff, such as pharmacists and physical therapists (PTs), are available. 14 However, EDs are busy environments, and ED clinicians lack the time and training 15 to perform fall risk assessments.…”

GAPcare: the Geriatric Acute and Post-acute Fall Prevention Intervention—a pilot investigation of an emergency department-based fall prevention program for community-dwelling older adults

“…Because the intervention takes place in the ED, participants do not need to arrange transportation to complete the study. In addition, the immediate post-fall period is a high-risk time for older adults to have repeat falls [12]. This intervention is delivered prior to patients returning home, which is an ideal time to prevent falls in this high-risk period.…”

“…This intervention brings together patients, caregivers, pharmacy and PT professionals, and clinicians to provide a patient-centric, collaborative approach to fall prevention that bridges the ED visit with outpatient resources. Performing a fall prevention intervention in the ED (as opposed to after the ED visit) provides more timely evaluation, which is of critical importance because seniors are at high risk of recurrent falls in the immediate post-fall period [12]. Unlike other current fall prevention protocols, this intervention starts immediately after the fall in the ED when patients and caregivers are highly engaged and motivated to prevent further fall occurrences [13].…”

Fear of falling and associated factors in community elderly with cataracts

“…For people older than 75 years, it is one of the most cited barriers for adoption of physical activity (23) Fear of falling can result in a sequence of events leading to social isolation and to loss of function (24) . Physical weakness, social isolation, functional decline and polypharmacy have been largely associated to increase of recurrent falling incidence (25) . The fear of falling is not only an acute result from a fall, but an acknowledgement of a risk probability.…”