Fall-Related Emergency Department Admission: Fall Environment and Settings and Related Injury Patterns in 6357 Patients with Special Emphasis on the Elderly

Abstract

Principals. Throughout the world, falls are a major public health problem and a socioeconomic burden. Nevertheless there is little knowledge about how the injury types may be related to the aetiology and setting of the fall, especially in the elderly. We have therefore analysed all patients presenting with a fall to our Emergency Department (ED) over the past five years. Methods. Our retrospective data analysis comprised adult patients admitted to our Emergency Department between January 1, 2006, and December 31, 2010, in relation to a fall. Results. Of a total of 6357 patients 78% (n = 4957) patients were younger than 75 years. The main setting for falls was patients home (n = 2239, 35.3%). In contrast to the younger patients, the older population was predominantly female (56.3% versus 38.6%; P < 0.0001). Older patients were more likely to fall at home and suffer from medical conditions (all P < 0.0001). Injuries to the head (P < 0.0001) and to the lower extremity (P < 0.019) occurred predominantly in the older population. Age was the sole predictor for recurrent falls (OR 1.2, P < 0.0001). Conclusion. Falls at home are the main class of falls for all age groups, particularly in the elderly. Fall prevention strategies must therefore target activities of daily living. Even though falls related to sports mostly take place in the younger cohort, a significant percentage of elderly patients present with falls related to sporting activity. Falls due to medical conditions were most likely to result in mild traumatic brain injury.

Influence of fall environment and fall direction on risk of injury among pre-frail and frail adults

“…In another study on the circumstances of falls among patients age 75 and older in an emergency department, more falls were reported indoors at home but, similar to our study, with a lower risk of severe injury [42]. A potential explanation is that falls at home may not involve further hazards that may cause additional injury [42].…”

Risk factors for ground-level falls differ by sex

“…It has been found, however, to have a high mortality rate and a long duration (days) of hospitalization, and the patients in the present study were no exception (Table 2) [1,2,[6][7][8][11][12][13][14]. Taylor et al [15] investigated the effect of age on mortality among patients hospitalized for blunt injury and reported that the mortality rate increased with age, being 5.2% among those aged 65 to 74 years, 6.7% among those aged 75 to 84 years, and 9.22% among those aged 85 years or older.…”

Falls in Older Patients with Cancer Undergoing Surgery: Prevalence and Association with Geriatric Syndromes and Levels of Disability Assessed in Preoperative Evaluation

“…Our study showed that our patients were more likely to experience their most recent fall at home rather than outside the home. While we could not find any other study assessing this finding in older patients with cancer, prior studies on community-dwelling older adult populations have shown that most falls, especially in frail people, happen at home [ 20 , 21 ]. This is likely due to older frail patients spending more time at home.…”