Community-dwelling seniors who present to the emergency department with a fall do not receive Guideline care and their fall risk profile worsens significantly: a 6-month prospective study
Fall risk is a major contributor to fracture risk; implementing fall reduction programmes remains a challenge for health professionals and policy-makers.
Materials and methods
We aimed to (1) ascertain whether the care received by 54 older adults after an emergency department (ED) fall presentation met internationally recommended ‘Guideline Care’, and (2) prospectively evaluate this cohort’s 6-month change in fall risk profile. Participants were men and women aged 70 years or older who were discharged back into the community after presenting to an urban university tertiary-care hospital emergency department with a fall-related complaint. American Geriatric Society (AGS) guideline care was documented by post-presentation emergency department chart examination, daily patient diary of falls submitted monthly, patient interview and physician reconciliation where needed. Both at study entry and at a 6-month followup, we measured participants physiological characteristics by Lord’s Physiological Profile Assessment (PPA), functional status, balance confidence, depression, physical activity and other factors.
We found that only 2 of 54 (3.7%) of the fallers who presented to the ED received care consistent with AGS Guidelines. Baseline physiological fall risk scores classified the study population at a 1.7 SD higher risk than a 65-year-old comparison group, and during the 6-month followup period the mean fall-risk score increased significantly (i.e. greater risk of falls) (1.7±1.6 versus 2.2±1.6, p=0.000; 29.5% greater risk of falls). Also, functional ability [100 (15) versus 95 (25), p=0.002], balance confidence [82.5 (44.4) versus 71.3 (58.7), p=0.000] and depression [0 (2) versus 0 (3), p=0.000] all worsened over 6 months. Within 6 months of the index ED visit, five participants had suffered six fall-related fractures.
We conclude that this group of community-dwelling fallers, who presented for ED care with a clinical profile suggesting a high risk of further falls and fracture, did not receive Guideline care and worsened in their fall risk profile by 29.5%. This gap in care, at least in one centre, suggests further investigation into alternative approaches to delivering Guideline standard health service.
KeywordsFall risk Fracture risk Guideline care Seniors
This study was funded by the Vancouver Coastal Health Research Institute Interdisciplinary Research Grant (2002). Allison Salter was an NSERC scholar; Karim Khan and Meghan Donaldson carry Canadian Institutes of Health Research (CIHR) New Investigator and Doctoral Trainee Awards, respectively. Riyad Abu-Laban and Heather McKay are Michael Smith Foundation for Health Research (MSFHR) Career Scholars. Stephen Lord is an Australian NHMRC Principal Research Fellow. Operating funds for this study came from a CIHR interdisciplinary teams enchancement (ICE-IMHA) grant and a Michael Smith Foundation for Health Research Infrastructure Units (Oxland, PI) grant. Doug McKnight provided expert clinical and research mentorship for this study.
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