Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
University of Michigan, Ann Arbor, Michigan, USA.
BMC Emerg Med. 2023 Feb 10;23(1):14. doi: 10.1186/s12873-023-00784-z.
Fall injuries and trauma-related hospitalizations are the most common causes of injury and in-hospital stay amongst the elderly population. After the age of 65, the severity and frequency of fall-related problems increases; the repercussions are challenging for senior citizens, caregivers, and healthcare professionals. This study aims to determine the injuries and outcomes resulting from falls in elderly patients presenting to Emergency Department of a tertiary care hospital.
A cohort study design was used. All elderly patients aged ≥ 60 years who visit the Emergency Department with a history of a fall as a primary complaint presenting to the ED of a tertiary care hospital in Karachi, Pakistan were included. A purposive sampling strategy was used to enroll 318 patients from August 2021 to February 2022. The outcome was risk of mortality. Each individual was followed for 90 days to study the outcome. A multivariable logistic regression was applied to check the association between the outcome and covariates. Crude and adjusted risk ratios were reported. A p-value ≤ 0.05 was considered significant.
Of the 318 participants, 265 (83.3%) were fall injury patients with comorbidities. More than half of the patients in both groups were female [32 (60.4%) & 146 (55.1%)]. Eyeglasses were used by most of the fall patients both without and with comorbidities [21 (39.6%) & 152 (57.4%) p 0.018]. There were multiple reasons for a fall including imbalance/dizziness, which was reported by one third of participants in both groups [15 (28.3%) & 77 (29.1%)] followed by a fall from stairs/steps/escalator [15 (28.3%) & 44 (16.6%) p 0.005]. At the end of one month, of those who had a comorbidity 20 (7.5%) expired. The risk of mortality among fall related injuries in elderly patients who were more than 80 years was 1.48 times (95% CI: 1.20-2.10) more likely when compared to those patients who were younger than 80 years.
Efforts should be made to improve management of the underlying etiology of falls to prevent them in future. The factors that contribute to falls should be identified. Strategies and interventions should be planned to mitigate this risk of fall in elderly to improve their quality of life.
在老年人群体中，跌倒损伤和与创伤相关的住院治疗是最常见的损伤和住院原因。65 岁以后，跌倒相关问题的严重程度和频率会增加；这对老年人、护理人员和医疗保健专业人员来说是一个挑战。本研究旨在确定在巴基斯坦卡拉奇的一家三级保健医院的急诊科就诊的老年患者因跌倒而导致的损伤和结果。
本研究采用队列研究设计。所有年龄在 60 岁及以上、以跌倒为主要主诉就诊于三级保健医院急诊科的老年患者均纳入本研究。采用目的抽样策略，于 2021 年 8 月至 2022 年 2 月期间从该急诊科招募了 318 名患者。该研究的结局是死亡率风险。对每位患者随访 90 天以研究结局。采用多变量逻辑回归检查结局与协变量之间的关联。报告了粗风险比和调整风险比。p 值≤0.05 被认为具有统计学意义。
在 318 名参与者中，265 名（83.3%）为有合并症的跌倒损伤患者。两组中均有超过一半的患者为女性[32 名（60.4%）和 146 名（55.1%）]。跌倒患者均有戴眼镜，无合并症和有合并症的患者中戴眼镜的比例分别为[39.6%（21 名）和 57.4%（152 名）]，p=0.018。跌倒的原因有多种，包括平衡/头晕，两组各有三分之一的参与者报告有该原因[28.3%（15 名）和 29.1%（77 名）]，其次是从楼梯/台阶/自动扶梯上跌倒[28.3%（15 名）和 16.6%（44 名）]，p=0.005。在一个月结束时，有合并症的患者中有 20 名（7.5%）死亡。与 80 岁以下的患者相比，80 岁以上的老年患者因跌倒相关损伤而死亡的风险高 1.48 倍（95%CI：1.20-2.10）。
应努力改善对跌倒根本病因的管理，以预防未来的跌倒。应确定导致跌倒的因素。应计划制定策略和干预措施，以降低老年患者跌倒的风险，提高他们的生活质量。
