Department of Internal Medicine, section Geriatrics, Leiden University Medical Center, PO Box 9600, 2300 RC, Leiden, The Netherlands.
Institute of Evidence-Based Medicine in Old Age | IEMO, Leiden, The Netherlands.
Scand J Trauma Resusc Emerg Med. 2021 Mar 4;29(1):43. doi: 10.1186/s13049-021-00859-5.
Falls in older Emergency Department (ED) patients may indicate underlying frailty. Geriatric follow-up might help improve outcomes in addition to managing the direct cause and consequence of the fall. We aimed to study whether fall characteristics and the result of geriatric screening in the ED are independently related to adverse outcomes in older patients with fall-related ED visits.
This was a secondary analysis of the observational multicenter Acutely Presenting Older Patient (APOP) study, of which a subset of patients aged ≥70 years with fall-related ED visits were prospectively included in EDs of two Dutch hospitals. Fall characteristics (cause and location) were retrospectively collected. The APOP-screener was used as a geriatric screening tool. The outcome was 3- and 12-months functional decline and mortality. We assessed to what extent fall characteristics and the geriatric screening result were independent predictors of the outcome, using multivariable logistic regression analysis.
We included 393 patients (median age 80 (IQR 76-86) years) of whom 23.0% were high risk according to screening. The cause of the fall was extrinsic (49.6%), intrinsic (29.3%), unexplained (6.4%) or missing (14.8%). A high risk geriatric screening result was related to increased risk of adverse outcomes (3-months adjusted odds ratio (AOR) 2.27 (1.29-3.98), 12-months AOR 2.20 (1.25-3.89)). Independent of geriatric screening result, an intrinsic cause of the fall increased the risk of 3-months adverse outcomes (AOR 1.92 (1.13-3.26)) and a fall indoors increased the risk of 3-months (AOR 2.14 (1.22-3.74)) and 12-months adverse outcomes (AOR 1.78 (1.03-3.10)).
A high risk geriatric screening result and fall characteristics were both independently associated with adverse outcomes in older ED patients, suggesting that information on both should be evaluated to guide follow-up geriatric assessment and interventions in clinical care.
老年急诊科（ED）患者跌倒可能表明存在虚弱。老年科随访除了治疗跌倒的直接原因和后果外，还有助于改善结局。我们旨在研究 ED 中跌倒特征和老年筛查结果是否与跌倒相关 ED 就诊的老年患者的不良结局独立相关。
这是一项多中心急性出现老年患者（APOP）观察性研究的二次分析，其中两所荷兰医院的 ED 前瞻性纳入了年龄≥70 岁且与跌倒相关的 ED 就诊患者亚组。回顾性收集跌倒特征（原因和地点）。APOP 筛查器用作老年筛查工具。结局为 3 个月和 12 个月的功能下降和死亡率。我们使用多变量逻辑回归分析评估跌倒特征和老年筛查结果在多大程度上是结局的独立预测因素。
我们纳入了 393 名患者（中位年龄 80（IQR 76-86）岁），其中 23.0%根据筛查结果为高风险。跌倒的原因是外在（49.6%）、内在（29.3%）、不明（6.4%）或缺失（14.8%）。高风险老年筛查结果与不良结局风险增加相关（3 个月调整优势比（AOR）2.27（1.29-3.98），12 个月 AOR 2.20（1.25-3.89））。独立于老年筛查结果，跌倒的内在原因增加了 3 个月不良结局的风险（AOR 1.92（1.13-3.26）），跌倒在室内增加了 3 个月（AOR 2.14（1.22-3.74））和 12 个月不良结局的风险（AOR 1.78（1.03-3.10））。
高风险老年筛查结果和跌倒特征均与老年 ED 患者的不良结局独立相关，这表明应该评估两者的信息以指导临床护理中的老年评估和干预。
