Oregon Health & Science University, Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Portland, Oregon.
Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, Oregon.
West J Emerg Med. 2022 May 14;23(3):375-385. doi: 10.5811/westjem.2021.11.54327.
Older adults who fall commonly require emergency services, but research on long-term outcomes and prognostication is sparse. We evaluated older adults transported by ambulance after a fall in the Northwestern United States (US) and longitudinally tracked subsequent healthcare use, transitions to skilled nursing, hospice, mortality, and prognostication to one year.
This was a planned secondary analysis of a cohort study of community-dwelling older adults enrolled from January 1-December 31, 2011, with follow-up through December 31, 2012. We included all adults ≥ 65 years transported by 44 emergency medical services agencies in seven Northwest counties to 51 hospitals after a fall. We matched Medicare claims, state inpatient data, state trauma registry data, and death records. Outcomes included mortality, healthcare use, and new claims for skilled nursing and hospice to one year.
There were 3,159 older adults, with 147 (4.7%) deaths within 30 days and 665 (21.1%) deaths within one year. There was an initial spike in inpatient days, followed by increases in skilled nursing and hospice. We identified four predictors of mortality: respiratory diagnosis; serious brain injury; baseline disability; and Charlson Comorbidity Index ≥ 2. Having any of these predictors was 96.6% sensitive (95% confidence interval [CI]: 95.7, 97.5%) and 21.4% specific (95% CI: 19.9, 22.9%) for 30-day mortality, and 91.6% sensitive (95% CI: 89.5, 93.8%). and 23.8% specific (95% CI: 22.1, 25.5%) for one-year mortality.
Community-dwelling older adults requiring ambulance transport after a fall have marked increases in healthcare use, institutionalized living, and mortality over the subsequent year. Most deaths occur following the acute care period and can be identified with high sensitivity at the time of the index visit, yet with low specificity.
经常跌倒的老年人通常需要紧急服务，但关于长期结果和预后的研究很少。我们评估了在美国西北部（美国）因跌倒而被救护车运送的老年人，并对随后的医疗保健使用情况、向熟练护理、临终关怀、死亡率和一年预后进行了纵向跟踪。
这是一项对 2011 年 1 月 1 日至 12 月 31 日期间登记的居住在社区的老年人队列研究的计划二次分析，随访至 2012 年 12 月 31 日。我们包括所有≥65 岁的成年人，他们从西北七个县的 44 个紧急医疗服务机构被送往 51 家医院后因跌倒而被救护车运送。我们匹配了医疗保险索赔、州住院数据、州创伤登记数据和死亡记录。结果包括一年以内的死亡率、医疗保健使用情况以及熟练护理和临终关怀的新索赔。
有 3159 名老年人，其中 30 天内有 147 人（4.7%）死亡，一年内有 665 人（21.1%）死亡。住院天数最初出现激增，随后熟练护理和临终关怀的人数增加。我们确定了四个死亡率预测因素：呼吸诊断；严重脑损伤；基线残疾；Charlson 合并症指数≥2。有任何这些预测因素的患者，30 天死亡率的敏感性为 96.6%（95%置信区间[CI]：95.7，97.5%），特异性为 21.4%（95% CI：19.9，22.9%），1 年死亡率的敏感性为 91.6%（95% CI：89.5，93.8%），特异性为 23.8%（95% CI：22.1，25.5%）。
因跌倒而需要救护车运送的居住在社区的老年人在随后的一年中，其医疗保健使用、机构化生活和死亡率显著增加。大多数死亡发生在急性治疗期之后，可以在指数就诊时以高敏感性识别，但特异性较低。
