Shankar Kalpana Narayan, Treadway Nicole J, Taylor Alyssa A, Breaud Alan H, Peterson Elizabeth W, Howland Jonathan
Department of Emergency Medicine, Boston University Medical Center and Boston University School of Medicine, One Boston Medical Center Place, Dowling 1 South, Boston, MA, 02118, USA.
Boston Medical Center Injury Prevention Center, One Boston Medical Center Place, Boston, MA, 02118, USA.
Inj Epidemiol. 2017 Dec;4(1):18. doi: 10.1186/s40621-017-0114-y. Epub 2017 Jun 19.
Falls are a common and debilitating health problem for older adults. Older adults are often treated and discharged home by emergency department (ED)-based providers with the hope they will receive falls prevention resources and referrals from their primary care provider. This descriptive study investigated falls prevention activities, including interactions with primary care providers, among community-dwelling older adults who were discharged home after presenting to an ED with a fall-related injury.
We enrolled English speaking patients, aged ≥ 65 years, who presented to the ED of an urban level one trauma center with a fall or fall related injury and discharged home. During subjects' initial visits to the ED, we screened and enrolled patients, gathered patient demographics and provided them with a flyer for a Matter of Balance course. Sixty-days post enrollment, we conducted a phone follow-up interview to collect information on post-fall behaviors including information regarding the efforts to engage family and the primary care provider, enroll in a falls prevention program, assess patients' attitudes towards falling and experiences with any subsequent falls.
Eighty-seven community-dwelling people between the ages of 65 and 90 were recruited, the majority (76%) being women. Seventy-one percent of subjects reported talking to their provider regarding the fall; 37% reported engaging in falls prevention activities. No subjects reported enrolling in a fall prevention program although two reported contacting falls program staff. Fourteen percent of subjects (n=12) reported a recurrent fall and 8% (7) reported returning to the ED after a recurrent fall.
Findings indicate a low rate of initiating fall prevention behaviors following an ED visit for a fall-related injury among community-dwelling older adults, and highlight the ED visit as an important, but underutilized, opportunity to mobilize health care resources for people at high risk for subsequent falls.
跌倒对于老年人来说是一个常见且使人衰弱的健康问题。老年人通常由急诊科的医护人员进行治疗并出院回家，期望他们能从初级保健医生那里获得预防跌倒的资源和转诊。这项描述性研究调查了社区居住的老年人在因跌倒相关损伤到急诊科就诊后出院回家时的预防跌倒活动，包括与初级保健医生的互动。
我们纳入了年龄≥65岁、以英语为母语、因跌倒或跌倒相关损伤到城市一级创伤中心急诊科就诊并出院回家的患者。在受试者首次就诊急诊科时，我们对患者进行筛查和招募，收集患者人口统计学信息，并为他们提供一份关于“平衡问题”课程的传单。入组60天后，我们进行了电话随访访谈，以收集跌倒后行为的信息，包括有关让家人和初级保健医生参与的努力、参加预防跌倒计划、评估患者对跌倒的态度以及任何后续跌倒经历的信息。
招募了87名年龄在65岁至90岁之间的社区居住者，大多数（76%）为女性。71%的受试者报告与他们的医生谈论过跌倒情况；37%的受试者报告参与了预防跌倒活动。尽管有两名受试者报告联系了跌倒预防计划工作人员，但没有受试者报告参加了预防跌倒计划。14%的受试者（n = 12）报告再次跌倒，8%（7名）受试者报告再次跌倒后返回了急诊科。
研究结果表明，社区居住的老年人因跌倒相关损伤到急诊科就诊后，开始预防跌倒行为的比例较低，并突出了急诊科就诊是为后续跌倒高危人群调动医疗保健资源的一个重要但未充分利用的机会。
