Frequency of ED revisits and death among older adults after a fall

Abstract

Introduction Falls among older adults (aged ≥65 years) are the leading cause of both injury deaths and emergency department (ED) visits for trauma. We examine the characteristics and prevalence of older adult ED fallers as well as the recurrent ED visit and mortality rate. Methods This was a retrospective analysis of a cohort of elderly fall patients who presented to the ED between 2005 and 2011 at two urban, level-1 trauma, teaching hospitals with approximately 80,000-95,000 annual visits. We examined the frequency of ED revisits and death at 3 days, 7 days, 30 days, and 1 year controlling for certain covariates. Results Our cohort included 21,340 patients. The average age was 78.6. An increasing proportion of patients revisited the ED over the course of a year, ranging from 2% of patients at 3 days to 25% at 1 year. Death rates increased from 1.2% at 3 days to 15% at 1 year. 10,728 (50.2%) patients returned to the ED at some point during our 7-year study period and 36% of patients had an ED revisit or death within 1 year. In multivariate logistic regression, male sex and comorbidities were associated with ED revisits and death. Conclusion Over a third of older adult ED fall patients had an ED revisit or died within one year. Falls are one of the geriatric syndromes that contribute to frequent ED revisits and death rates. Future research should determine whether falls increase the risk of such outcomes and how to prevent future fall and death.

Characteristics of fall‐related traumatic brain injury in older adults

“…There are many risk factors for falls, including history of previous falls, polypharmacy, environment, and many patients with minor injuries are discharged from the emergency department (ED) without a complete falls risk assessment . Recent studies have shown that older adults with falls who presented to the ED had an increased frequency of ED revisits, especially those with head trauma …”

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 .…”

Identification of Emergency Department Visits in Medicare Administrative Claims: Approaches and Implications

“…20 While one previous study similarly sought to combine facility and provider claims to define ED visitation, our approach allows for repeat ED visitation within 72 hours, which have been shown to be common and were excluded by prior work. 21–23 We therefore considered any hospital inpatient or outpatient claim for an ED visit on the same day, previous day, or following calendar day as an overlapping visit that should not be counted as a unique ED encounter (Table 1). Additionally, because providers or facilities claims may often include multiple ED visits on the same claim as a result of the claim adjudication and reporting processes, the number of ED visits captured by each definition can exceed the total number of claims.…”