Kalula Sebastiana Zimba, de Villiers Linda, Ross Kathleen, Ferreira Monica
Division of Geriatric Medicine, The Albertina and Walter Sisulu Institute of Ageing, University of Cape Town and Groote Schuur Hospital.
S Afr Med J. 2006 Aug;96(8):718-21.
It is common for older patients to present to accident and emergency (AE) departments after a fall. Management should include assessment and treatment of the injuries and assessment and correction of underlying risk factors in order to prevent recurrent falls.
To determine management of older patients presenting after a fall to the AE department of Groote Schuur Hospital in Cape Town, South Africa.
Hospital records were reviewed for a random sample of 100 patients aged 65 years and older presenting to the AE department after a fall, between December 2001 and May 2002.
The mean age of the sample was 78.6 years (range 65-98 years); 72% of subjects were female. History of a previous fall, and history of drug or alcohol intake, were recorded in less than 20% of cases. Blood pressure and pulse rate were recorded in approximately 90% of cases, and pulse rhythm and postural blood pressure in 2%. Examination of the musculoskeletal system was done in 86% of cases and that of other systems in less than 50%; cognitive assessment was conducted in less than 30%. Radiological investigations were performed in 89% of cases, glucose and haemoglobin in 32%, renal profile and electrocardiogram in 5%, and urinalysis in 4%. Three-quarters of the patients were referred for further management: 52% to orthopaedic surgery, 12% to other surgical subspecialties, 6% to the general medical department, and 6% to other hospitals and clinics. No referrals were made to geriatric medicine, physiotherapy or occupational therapy.
In managing elderly patients after a fall, the AE department focused on injuries sustained. Little effort was made to establish and manage risk factors, hence to prevent recurrent falls. Guidelines are needed for the management of such patients in AE departments.
老年患者跌倒后前往急诊部门就诊很常见。管理措施应包括对损伤的评估与治疗，以及对潜在风险因素的评估与纠正，以防止再次跌倒。
确定南非开普敦格罗特·舒尔医院急诊部门收治的跌倒老年患者的管理情况。
回顾了2001年12月至2002年5月期间随机抽取的100例65岁及以上跌倒后前往急诊部门就诊患者的医院记录。
样本的平均年龄为78.6岁（范围65 - 98岁）；72%的受试者为女性。不到20%的病例记录了既往跌倒史以及药物或酒精摄入史。约90%的病例记录了血压和脉搏率，2%记录了脉搏节律和体位性血压。86%的病例进行了肌肉骨骼系统检查，不到50%的病例进行了其他系统检查；不到30%的病例进行了认知评估。89%的病例进行了放射学检查，32%进行了血糖和血红蛋白检查，5%进行了肾功能检查和心电图检查，4%进行了尿液分析。四分之三的患者被转诊进行进一步治疗：52%转诊至骨科手术，12%转诊至其他外科专科，6%转诊至普通内科，6%转诊至其他医院和诊所。未转诊至老年医学、物理治疗或职业治疗科室。
在处理跌倒后的老年患者时，急诊部门主要关注所受损伤。在识别和管理风险因素以预防再次跌倒方面做得很少。急诊部门需要针对此类患者的管理指南。
