Abstract
Morbidity related is important in older adults who fall and are consequently referred to emergency departments (ED). The aim of this study is to determine 6-month all-causes mortality in patients over 75 years referred to an emergency department after a fall at home, and to define the criteria associated with death. The design was a prospective observational study with a 6-month follow-up in an Emergency Department of a tertiary teaching hospital, Paris, France. We included for a 6-month period patients over 75 years who visited the Emergency Department for a fall that occurred at home and measured the 6-month all-causes mortality. Uni- and multivariate assessment of factors related to mortality were adjusted for the occurrence of trauma. We enrolled 433 patients. Mean age was 86 years and two-thirds were women. The population was in relatively good health and preserved autonomy. The prevailing consequence was trauma and 11% had metabolic disorders. 64 patients (15%) died within 6 months. Factors associated with mortality included decrease in Katz score, male gender, a fall of intrinsic origin and the occurrence of adverse metabolic events. Markers of fragility such as poor previous level of autonomy, clinical disorders and metabolic abnormalities, as cause or consequence, indicate a potentially poor outcome more than the presence of severe trauma. As metabolic abnormalities can be an indirect marker of a long delay before emergency medical care, this study underscored the importance of early warning system for the frailest old individuals in order to prevent such complications.
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Acknowledgments
We are indebted to J. Roussel, F. Blainville and M. Annoussamy from the Unité de Recherche Clinique (URC) Paris Centre (Cochin-Necker) for the invaluable help provided in the running of the study. We wish to thank all the staff of the emergency department of Cochin, the patients and their families for their participation. The study was funded by The Fondation Caisses d’Epargne pour la solidarité and supported by the French Fondation National de Gérontologie and the Assistance Publique des Hôpitaux de Paris; they were not involved in the study design, methods, subject recruitment, data collections, analysis and preparation of paper.
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Bloch, F., Jegou, D., Dhainaut, JF. et al. Can metabolic abnormalities after a fall predict short term mortality in elderly patients?. Eur J Epidemiol 24, 357–362 (2009). https://doi.org/10.1007/s10654-009-9342-y
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DOI: https://doi.org/10.1007/s10654-009-9342-y