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Probability of new falls and factors associated with them in aged patients treated in emergency departments after falling: data from the FALL-ER registry

García-Martínez A, Gil-Rodrigo A, Placer A, Alemany X, Aguiló S, Torres-Machado V, Jacob J, Herrero P, Llorens P, Martín-Sánchez FJ, Miró O

Servicio de Urgencias, Hospital Clínic, Barcelona, Spain. Servicio de Urgencias, Unidad de Estancia Corta y Hospitalización a Domicilio, Hospital General Universitario de Alicante, Spain. Servicio de Urgencias, Hospital de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain. Servicio de Urgencias, Hospital Central de Asturias, Oviedo, Spain. Universidad Miguel Hernández, Elche, Alicante, Spain. Servicio de Urgencias, Hospital Clínico San Carlos, Universidad Complutense, Madrid, Spain. Universidad de Barcelona, Spain.

Objective. To identify characteristics associated with a new fall in a patient who received emergency department care after an accidental fall and to develop a risk model to predict repeated falls.
Method. The FALL-ER registry included accidental falls in patients over the age of 65 years treated in 5 Spanish emergency departments. Independent variables analyzed were patient characteristics at baseline, fall characteristics,
immediate consequences, and functional status on discharge. Patients were followed with telephone interviews for 6 months to record the occurrence of new falls. Multivariate regression analysis was used to identify variables associated with falling again and to develop a risk model. We identified 3 levels of risk for new falls (low, intermediate, and high).
Results. A total of 1313 patients were studied; 147 patients (11.2%) reported having another fall. Variables associated with risk of falling again were having had a fall in the 12 months before the index fall, neurological disease, anemia, use of non-opioid analgesics, falling at home, falling at night, head injury on falling, and need for help when rising
from a chair. The probability of falling again was 3.5%, 10.5%, and 23.3%, respectively, in patients at low, intermediate, and high risk. The model’s ability to discriminate was moderate: the area under the receiver operating characteristic curve was 0.688 (95% CI, 0.640-0.736).
Conclusion. One in 9 older adults treated in an emergency department for an accidental fall will fall again within 6 months. It is possible to identify patients at higher risk for whom preventive measures should be implemented.

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