The role of alcohol in unintentional falls among young and middle-aged adults: a systematic review of epidemiological studies

Kool, Bridget; Ameratunga, Shanthi; Jackson, Rod

doi:10.1136/ip.2008.021303

Cited by 49 publications

(40 citation statements)

References 52 publications

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“…GCS) is caused by alcohol intoxication, intracranial lesion or other injuries. Ground level falls is the major cause of injury among alcohol intoxicated patients and the elderly [35]. Our results show that low energy traumas, such as GLF, significantly increase the risk of delayed admission.…”

Section: Discussionmentioning

confidence: 72%

Factors correlating with delayed trauma center admission following traumatic brain injury

Raj

Siironen

Kivisaari

et al. 2013

Scand J Trauma Resusc Emerg Med

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BackgroundDelayed admission to appropriate care has been shown increase mortality following traumatic brain injury (TBI). We investigated factors associated with delayed admission to a hospital with neurosurgical expertise in a cohort of TBI patients in the intensive care unit (ICU).MethodsA retrospective analysis of all TBI patients treated in the ICUs of Helsinki University Central Hospital was carried out from 1.1.2009 to 31.12.2010. Patients were categorized into two groups: direct admission and delayed admission. Patients in the delayed admission group were initially transported to a local hospital without neurosurgical expertise before inter-transfer to the designated hospital. Multivariate logistic regression was utilized to identify pre-hospital factors associated with delayed admission.ResultsOf 431 included patients 65% of patients were in the direct admission groups and 35% in the delayed admission groups (median time to admission 1:07h, IQR 0:52–1:28 vs. 4:06h, IQR 2:53–5:43, p <0.001). In multivariate analysis factors increasing the likelihood of delayed admission were (OR, 95% CI): male gender (3.82, 1.60-9.13), incident at public place compared to home (0.26, 0.11-0.61), high energy trauma (0.05, 0.01-0.28), pre-hospital physician consultation (0.15, 0.06-0.39) or presence (0.08, 0.03-0.22), hypotension (0.09, 0.01-0.93), major extra cranial injury (0.17, 0.05-0.55), abnormal pupillary light reflex (0.26, 0.09-0.73) and severe alcohol intoxication (12.44, 2.14-72.38). A significant larger proportion of patients in the delayed admission group required acute craniotomy for mass lesion when admitted to the neurosurgical hospital (57%, 21%, p< 0.001). No significant difference in 6-month mortality was noted between the groups (p= 0.814).ConclusionDelayed trauma center admission following TBI is common. Factors increasing likelihood of this were: male gender, incident at public place compared to home, low energy trauma, absence of pre-hospital physician involvement, stable blood pressure, no major extra cranial injuries, normal pupillary light reflex and severe alcohol intoxication. Focused educational efforts and access to physician consultation may help expedite access to appropriate care in TBI patients.

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Section: Discussionmentioning

confidence: 72%

Factors correlating with delayed trauma center admission following traumatic brain injury

Raj

Siironen

Kivisaari

et al. 2013

Scand J Trauma Resusc Emerg Med

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“…46–48 Finally, single-site HF has also been associated with reductions in alcohol consumption and alcohol-related problems, 27 which may lead to fewer injuries (e.g., falls) or interpersonal difficulties (e.g., physical fights) associated with injury, since the involvement of alcohol may precipitate those difficulties. 49,50 …”

Section: Discussionmentioning

confidence: 99%

Housing First Is Associated with Reduced Use of Emergency Medical Services

Mackelprang¹,

Collins²,

Clifasefi³

2014

Prehospital Emergency Care

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Objective Chronically homeless adults with severe alcohol problems are disproportionately burdened with healthcare problems and are high utilizers of emergency medical services (EMS). Single-site Housing First (HF), which provides immediate, permanent, low-barrier, nonabstinence-based, supportive housing, has been associated with reduced publicly funded service utilization. The aims of the current study were to determine whether time spent in single-site HF predicted decreases in EMS contacts 2 years subsequent to single-site HF move-in, and to describe medical conditions and injuries associated with EMS contacts in a sample of chronically homeless individuals with severe alcohol problems. Methods Participants were 91 chronically homeless adults with severe alcohol problems who were enrolled in a single-site HF program between December 2005 and March 2007 in Seattle, Washington. We obtained administrative data on exposure to HF and EMS utilization for the 2 years prior to and the 2 years subsequent to participants’ move-in date. EMS utilization variables included patient type (i.e., primary presenting problem), trauma/injury mechanism (i.e., EMS classification of the cause of the trauma or injury), level of care (i.e., basic life support, advanced life support), and transport destination. Results After controlling for baseline EMS contacts, participants evinced 3% fewer EMS contacts for each additional month of single-site HF exposure. From the baseline to follow-up period, the mean number of EMS contacts declined from 15.85 (SD = 22.96) to 9.54 (SD = 15.08), representing a 54% reduction in the number of EMS contacts. Most calls were responded to by EMTs providing basic life support, and the majority resulted in transport to a local level I trauma center. The most common presenting difficulties were medical illness and trauma. Substance use and psychiatric difficulties were infrequently documented as the primary problem. Conclusions Our findings support recent assertions that housing is health care and indicate that the amount of time spent in single-site HF is associated with significant reductions in EMS utilization for at least 2 years subsequent to move-in. These findings also underscore the high levels of medical illness and trauma exposure among chronically homeless adults with severe alcohol problems.

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“…The identified risk factors for falls include demographic characteristics (such as older age [3]–[5], [9], [10], female gender [4], [5], [10], [11], unmarried status [10], [12], and low educational level [10]), anthropometric measurements (such as larger waist circumference [5]), health status (such as use of medication [4], [13]–[15], low physical health [2], [9], [10], [16], cognitive impairment [14], [17], mobility impairment [1], [13]–[15], [17], [18], visual impairment [19], history of falls [1], [3], [20], [21], depression [17], [21], and malnutrition [22]–[25]), and health behavior (such as decline in activities of daily living [4], [11], low or high mobility level [9], [10], [13], and alcohol consumption [16], [26]). …”

Section: Introductionmentioning

confidence: 99%

Nutritional Status and Falls in Community-Dwelling Older People: A Longitudinal Study of a Population-Based Random Sample

Chien

Guo

2014

PLoS ONE

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BackgroundFalls are common in older people and may lead to functional decline, disability, and death. Many risk factors have been identified, but studies evaluating effects of nutritional status are limited. To determine whether nutritional status is a predictor of falls in older people living in the community, we analyzed data collected through the Survey of Health and Living Status of the Elderly in Taiwan (SHLSET).MethodsSHLSET include a series of interview surveys conducted by the government on a random sample of people living in community dwellings in the nation. We included participants who received nutritional status assessment using the Mini Nutritional Assessment Taiwan Version 2 (MNA-T2) in the 1999 survey when they were 53 years or older and followed up on the cumulative incidence of falls in the one-year period before the interview in the 2003 survey.ResultsAt the beginning of follow-up, the 4440 participants had a mean age of 69.5 (standard deviation = 9.1) years, and 467 participants were “not well-nourished,” which was defined as having an MNA-T2 score of 23 or less. In the one-year study period, 659 participants reported having at least one fall. After adjusting for other risk factors, we found the associated odds ratio for falls was 1.73 (95% confidence interval, 1.23, 2.42) for “not well-nourished,” 1.57 (1.30, 1.90) for female gender, 1.03 (1.02, 1.04) for one-year older, 1.55 (1.22, 1.98) for history of falls, 1.34 (1.05, 1.72) for hospital stay during the past 12 months, 1.66 (1.07, 2.58) for difficulties in activities of daily living, and 1.53 (1.23, 1.91) for difficulties in instrumental activities of daily living.ConclusionNutritional status is an independent predictor of falls in older people living in the community. Further studies are warranted to identify nutritional interventions that can help prevent falls in the elderly.

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The role of alcohol in unintentional falls among young and middle-aged adults: a systematic review of epidemiological studies

Cited by 49 publications

References 52 publications

Factors correlating with delayed trauma center admission following traumatic brain injury

Factors correlating with delayed trauma center admission following traumatic brain injury

Housing First Is Associated with Reduced Use of Emergency Medical Services

Nutritional Status and Falls in Community-Dwelling Older People: A Longitudinal Study of a Population-Based Random Sample

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