Outcomes after Falls Continue to Worsen Despite Trauma and Geriatric Care Advancements

Abstract

The most common mechanism of traumatic injury is ground-level fall. The objective of this study was to understand how patients sustaining falls and their outcomes have evolved. An institutional trauma database was used to identify adult patients who suffered a fall and were admitted to a Level I trauma center during two distinct time periods: 1998 to 2003 (past) and 2008 to 2013 (current). Data on anticoagulant use and comorbidities was gathered by retrospective chart review of patients treated during 2003 and 2013. Univariable analyses and multivariable regression were used to evaluate demographics and outcomes. A total of 6116 patients were identified, with a 24 per cent increase in number of falls between groups. Current fall patients are older (70 vs 66 years, P < 0.001), more often admitted to intensive care (28 vs 12%, P < 0.001), have longer lengths of stay (5 vs 4 days, P < 0.001), are frequently discharged to skilled nursing facilities (24 vs 8%, P < 0.001), and have higher mortality (5 vs 3%, P = 0.002). The adjusted odds of mortality for patients treated during 2003 and 2013 was associated with age, gender, injury severity score, and Glasgow Coma Scale score. Current fall patients use more health care resources and have worse outcomes, despite advances in trauma and geriatric care.

When falls become fatal—Clinical care sequence

“…From 2007 to 2016, the fall-related mortality of people aged 65 and over has increased by 31% [ 8 ]. Despite medical advancements, fall-related mortality has not improved [ 9 ]. However, what remains unknown are the root causes of the increasing fall- related mortality.…”

Axillo-subclavian dissection and pseudoaneurysm following inferior glenohumeral dislocation: Case report and literature review

“…Ground-level falls are a significant cause of morbidity, mortality, and healthcare expenditures with an aging population [5]. Falls are a common mechanism of injury and carry an associated mortality that is higher than many other injuries [6].…”

Falls and long-term survival among older adults residing in care homes

“…In older adults from developed countries, unintentional injuries are between the fifth and the seventh most common causes of death [4,5], and the majority of unintentional injuries are caused by falls [2,4,6]. Furthermore, mortality due to accidental falls has recently increased in older adults [7][8][9][10], and the rapid ageing of the population makes it probable that this trend will increase in the future [7,11]. Older adults have significantly higher mortality from minor injuries than those under 50s [12] and the interval from injury to death could be longer for minor or moderate injuries (for example rib fracture and chest or muscle contusions) than for more severe ones (hip, vertebral or skull fractures) [13].…”