Older Adult Falls Seen by Emergency Medical Service Providers

Abstract

Introduction Among people aged ≥65 years, falling is the leading cause of emergency department visits. Emergency medical services (EMS) are often called to help older adults who have fallen, with some requiring hospital transport. Chief aims were to determine where falls occurred and the circumstances under which patients were transported by EMS, and to identify future fall prevention opportunities. Methods In 2012, a total of 42 states contributed ambulatory data to the National EMS Information System, which were analyzed in 2014 and 2015. Using EMS records from 911 call events, logistic regression examined patient and environmental factors associated with older adult transport. Results Among people aged ≥65 years, falls accounted for 17% of all EMS calls. More than one in five (21%) of these emergency 911 calls did not result in a transport. Most falls occurred at home (60.2%) and residential institutions such as nursing homes (21.7%). Logistic regression showed AORs for transport were greatest among people aged ≥85 years (AOR=1.14, 95% CI=1.13, 1.16) and women (AOR=1.30, 95% CI=1.29, 1.32); for falls at residential institutions or nursing homes (AOR=3.52, 95% CI=3.46, 3.58) and in rural environments (AOR=1.15, 95% CI=1.13, 1.17); and where the EMS impression was a stroke (AOR=2.96, 95% CI=2.11, 4.10), followed by hypothermia (AOR=2.36, 95% CI=1.33, 4.43). Conclusions This study provides unique insight into fall circumstances and EMS transport activity. EMS personnel are in a prime position to provide interventions that can prevent future falls, or referrals to community-based fall prevention programs and services.

Coordinating Care for Falls via Emergency Responders: A Feasibility Study of a Brief At-Scene Intervention

“…Ours is one of the few tests of an EMT-delivered, at-scene, public-health-oriented outreach intervention to prevent future falls among elder community-dwelling 9-1-1 callers. The frequency of 9-1-1 calls for falls in our study (12–16%) was very consistent with national data showing that among adults aged 65+, calls for falls account for 17% of all EMS calls (12). Older adults who have fallen and called 9-1-1 are at very high risk for recurrent falls (13) and serious injury or death.…”

“…Prior research has noted the EMS providers are in an opportune position to provide fall-risk-reduction interventions and/or referrals to community programs and services (12). Ours is one of the few tests of an EMT-delivered, at-scene, public-health-oriented outreach intervention to prevent future falls among elder community-dwelling 9-1-1 callers.…”

“…Older adults who have fallen and called 9-1-1 are at very high risk for recurrent falls (13) and serious injury or death. Given that at least a quarter of those who call 9-1-1 for a fall do not require transport to a health-care facility for emergency care (12, 14), there is enormous opportunity to reach this highly vulnerable group (12, 13) with timely prevention efforts as part of the at-scene EMS response. The intensity of the intervention that achieves the optimal effect in terms of motivating older adult behavior change remains uncertain and is a key area for future study.…”

Repeated Emergency Medical Services Use by Older Adults: Analysis of a Comprehensive Statewide Database

“…A higher rate of repeat transport for males was observed in the multivariable model, but the association was small. The higher rate of repeat transports for older adults in health or residential institutions compared to home dwelling older adults is also consistent with prior work, 36 and suggests this population as a potential target for interventions. Our data do not include patient characteristics such as comorbidities and functional status that likely at least partially explain the observed association between living in a residential institution and repeat EMS transports.…”

Frequent 911 Fall Calls in Older Adults: Opportunity for Injury Prevention Strategies

“…One person called 75 times over the study period. Previous work demonstrated that 80% of fall calls to 911 resulted in transport for further care . The current study demonstrated that there is a dramatic shift in transport to care, with individuals who call more frequently having an 80% chance of no need for transport to care.…”