Highlights
- •Functional outcomes of older adults after a fall-related ED visit are less well understood.
- •Three out of 4 older patients attended for a fall in EDs had some degree of functional impairment before the event.
- •One out of 3 cases had a clinically significant functional decline at 180 days.
- •Age ≥85 years, fall-related fracture, hospitalization and post-fall syndrome were associated with 180-day poor outcome.
Abstract
Objectives
To determine functional changes and factors affecting 180-day functional prognosis
among older patients attending a hospital emergency department (ED) after a fall.
Study design
Retrospective analysis from a prospective cohort study (FALL-ER Registry) spanning
one year that included individuals aged ≥65 years attending four Spanish EDs after
a fall. We collected 9 baseline and 6 fall-related factors.
Main outcome measures
Barthel Index (BI) was measured at baseline, discharge and 30, 90 and 180 days after
the index fall. Absolute and relative BI changes were calculated. Absolute difference
of ≥10 points between BI at baseline and at 180 days was considered a clinically significant
functional decline.
Results
452 patients (mean age 80 ± 8 years; 70.8% women) were included. Baseline BI was 79.3 ± 23.1
points. Compared with baseline, functional status was significantly lower at the 4
follow-up time points (-8.7% at discharge; and −6.9%, −7.9% and −9.5% at 30, 90 and
180 days; p < 0.001 for all comparisons in relation to baseline; p = 0.001 for change
over time). One hundred and thirty-three (29.6%) patients had a clinically significant
functional decline at 180 days. Age ≥85 years (OR = 2.24, 95%CI 1.23–4.08; p = 0.008),
fall-related fracture (OR = 2.45, 95%CI 1.43–4.28; p = 0.001), hospitalization (OR = 1.91;
95%CI 1.11–3.29; p = 0.019) and post-fall syndrome (OR = 1.77, 95%CI 1.13-2.77; p = 0.013)
were independently associated with 180-day clinically significant functional decline.
Conclusion
Patients ≥65 years attending EDs after a fall experience a consistent and persistent
negative impact on their functional status. Several factors may help identify patients
at increased risk of functional impairment.
Keywords
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Article info
Publication history
Published online: August 15, 2019
Accepted:
August 14,
2019
Received in revised form:
May 12,
2019
Received:
November 4,
2018
Identification
Copyright
© 2019 Elsevier B.V. All rights reserved.
