Paniagua Miguel A, Malphurs Julie E, Phelan Elizabeth A
University of Miami Miller School of Medicine, Miami VA Medical Center, GRECC and Research Service, Miami, FL 33125, USA.
Am J Emerg Med. 2006 Jul;24(4):413-7. doi: 10.1016/j.ajem.2005.12.005.
Little is known about the characteristics of elderly persons who present to an ED after a fall or about the nature of the care received for the fall itself. We identified elders presenting to a large urban United States ED after a fall, determined risk factors that may have contributed to the fall, and assessed the extent to which falls were addressed in the ED setting. One hundred seventeen fallers were identified. Nearly half were aged 80 years or older. After age, polypharmacy was the most common fall risk factor, followed by more than 1 contributing medical condition and cognitive impairment. Fall risk factors differed significantly for older compared with younger subgroups. More than half (57%) who had fallen were admitted. Of the remainder who fell and were discharged, more than half were scheduled for follow-up of their fall-related injury only, with no follow-up scheduled to address prevention of future falls. In summary, elders who present to an ED after having fallen have a variety of risk factors for falls that can be addressed to reduce their risk of future falls and injury; however, many may not receive such follow-up care. There must be increased awareness among ED providers of the need for a medical evaluation of a fall. Randomized trials evaluating the effect of a focused fall risk factor assessment after presentation to the ED may be warranted.
对于跌倒后前往急诊科（ED）的老年人的特征，以及针对跌倒本身所接受的护理性质，我们知之甚少。我们确定了跌倒后前往美国一个大型城市急诊科的老年人，确定了可能导致跌倒的风险因素，并评估了急诊科对跌倒问题的处理程度。共识别出117名跌倒者。近一半年龄在80岁及以上。除年龄外，使用多种药物是最常见的跌倒风险因素，其次是存在不止一种相关疾病和认知障碍。与较年轻的亚组相比，年龄较大的亚组跌倒风险因素有显著差异。超过一半（57%）的跌倒者被收治。其余跌倒后出院的人中，超过一半仅被安排对跌倒相关损伤进行随访，未安排针对预防未来跌倒的随访。总之，跌倒后前往急诊科的老年人有多种跌倒风险因素，这些因素可以通过相应措施来降低他们未来跌倒和受伤的风险；然而，许多人可能无法得到此类后续护理。急诊科医护人员必须提高对跌倒进行医学评估必要性的认识。或许有必要开展随机试验，评估在患者前往急诊科后进行针对性跌倒风险因素评估的效果。
