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Profile of older patients attended in the emergency department after falls: a FALL-ER registry study of the magnitude of the problem and opportunities for improving hospital emergency care

Miró O, Brizzi BN, Aguiló S, Alemany X, Jacob J, Llorens P, Herrero Puente P, González Ramón B, Castro Jiménez V, Torres Machado V, Cenjor R, Gil A, Rico V, Martínez Nadal G, Lázaro del Nogal M, Martín-Sánchez FJ

Área de Urgencias, Hospital Clínic, Barcelona, Spain. Universitat de Barcelona, Barcelona, Spain. Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, Spain. Servicio de Urgencias. Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain. Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital Universitario General de Alicante, Spain. Universidad Miguel Hernández, Elche, Alicante, Spain. Servicio de Urgencias. Hospital Central de Asturias, Spain. Instituto de Investigación Sanitaria del Principado de Asturias, Asturias, Spain. Unidad de Caídas. Servicio de Geriatría del Hospital Clínico San Carlos. Madrid, Spain. Facultad de Medicina de la Universidad Complutense, Madrid, Spain. Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, Spain.

Objective. To profile patients aged 65 years or older who are attended in a hospital emergency department after falls. To describe the falls, their severity, and factors relevant to recommended preventive measures.
Methods. The FALL-ER is a multipurpose, multicenter prospective registry of a systematically described cohort of patients aged 65 years or older attended in 5 hospital emergency departments on 52 days of the same year. We collected data on 68 independent variables. Patients were classified according to whether they had received recommendations related to preventing falls in any of the following categories: exercise, education on fall prevention, referral to a specialist or
changes in medication.
Results. A total of 1507 patients or carers were interviewed (93.6% of the 1610 patients in the registry). The cohort was of advanced age and had high rates of comorbidity, polypharmacy, and history of geriatric syndromes. The majority of falls occurred during the day and in the patients home. Half the falls were not witnessed. Forty-eight percent of the patients reported fear of falling, 22% had acute functional impairment, 16% were admitted, and 0.6% died in the hospital. Recommendations directed to preventing falls were received by 509 (33.8%) cases. Loss of hearing acuity, self-reported cognitive impairment, emergency first aid at the site of the fall, fear of falling again, acute functional impairment, and hospitalization were associated with a greater likelihood of receiving recommendations for preventing falls. Loss of visual acuity was associated with a lower likelihood of receiving recommendations.
Conclusions. Only a third of elderly patients attended in an emergency department after falls receive recommendations that target preventing further falls. Certain patient and fall characteristics are associated with a greater likelihood of receiving such recommendations.

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