Abstract
Background
The number of attendances to emergency department (ED) due to falls and fractures increases as the population ages. The community-based falls prevention strategy may reduce the number of falls requiring medical attention.
Aim
Our aim was to determine the changes over time in community-living older adults on the number of attendances to an urban ED over a 5 year period.
Methods
Community-living adults aged ≥65 years from a catchment attending with falls and fractures to an ED in 2010 and 2014 were identified through an electronic patient record. The age, gender and patient-related outcome (admit, discharge with and without follow-up, died in department) were collected. Patient-related outcome was compared by age group.
Results
There were 477 and 772 attendances with falls and fractures in 2010 and 2014, respectively. Between 3 and 7% were repeat attendees. Compared with 2010, in 2014, there were more women attendees; the proportion of patients aged ≥80 years were higher, more likely to be admitted and discharged without follow-up. Patients aged 85+ were six times more likely to require admission compared with under 75’s.
Conclusion
With the rapidly ageing population in North Dublin, there is an urgent need to prioritise comprehensive assessment and provide a coordinated falls programme when older adults present to ED to reduce the risk of future falls and injuries.
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References
Gannon B, O’Shea E, Hudson E. The economic cost of falls and fractures in people aged 65 and over in Ireland. Technical report to NCAOP/HSE/DOHC. http://www.hse.ie/eng/services/publications/olderpeople/The_economic_costs_of_falls_and_fractures_in_people_aged_65_and_over_in_Ireland.pdf
Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL (1990) Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing 19(2):136–141
Alexander BH, Rivara FP, Wolf ME (1992) The cost and frequency of hospitalisation for fall-related injuries in older adults. Am J Public Health 82(7):1020–1023
Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C (1999) Prevention of Falls in the Elderly Trial (PROFET): a randomised controlled trial. Lancet 355:93–97
Seematter-Bagnoud L, Wietlisbach V, Yersin B, Bula CJ (2006) Healthcare utilization of elderly persons hospitalised after a non-injurious fall in a Swiss academic medical center. J Am Geriatr 54(6):891–897
Central statistics office (Ireland): Profile 2—Older and Younger, 2012
Strategy to Prevent Falls and Fractures in Ireland’s Ageing Population. Report of the National Steering Group on the Prevention of Falls in Older People and the Prevention and Management of Osteoporosis throughout Life (2008)
Report of the National Acute Medicine by the Royal College of Physicians Ireland, The Irish Association of the directors of nursing and midwifery, Therapy Professions Committee, Quality and Clinical Care Directorate, Health Service Executive, 2010
Wave 2-Key Findings report for TILDA. The over 50’s in a changing Ireland: Economic Circumstances, health and wellbeing. 2014 https://www.ucd.ie/t4cms/Wave2-Key-Findings-Report%20-%20The%20Over%2050s%20in%20a%20Changing%20Ireland.pdf
Stevens JA, Sogolow ED (2005) Gender differences for non-fatal unintentional fall related injuries among older adults. Inj Prev 11(2):115–119
McMahon CG, Cahir CA, Kenny RA, Bennett K (2014) Inappropriate prescribing in older fallers presenting to an Irish emergency department. Age Ageing 43:44–50
Herman M, Gallagher E, Scott V (2006) The evolution of seniors’ fall prevention in British Columbia. Ministry of Health, British Columbia
AGS, BGS and AAOS Panel on Falls Prevention (2001) Guideline for prevention of falls in older persons. JAGS 49(5):664–672
Richardson K, Bennett K, Kenny RA (2015) Polypharmacy including falls risk-increasing medications and subsequent falls in community-living middle-aged and older adults. Age Ageing 44(1):90–96
Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM (1999) Falls prevention over 2 years: a randomised controlled trial in women 80 years and older. Age Ageing 28:513–518
Tinetti ME, Baker DI, McAvay G, Claus EB, Garrett P, Gottschalk M, Koch ML, Trainor K, Horwitz RI (1994) A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 331(13):821–827
Skelton D, Dinan S, Campbell M, Rutherford O (2005) Tailored group exercise (Falls Management Exercise—FaME) reduces falls in community-living older frequent fallers (an RCT). Age Ageing 34(6):636–639
Luukinen H, Lehtola S, Lokelainen J, Vaananen-Sainio R, Lotvonen S, Koistinen P (2007) Pragmatic exercise-oriented prevention of falls among the elderly: a population-based, randomized controlled trial. Prev Med 44(3):265–271
Acknowledgement
We wish to acknowledge Mich Vartuli’s expertise in data extraction from the electronic patient record for the study.
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We declare that we have no (financial) conflicts of interest.
Ethical approval
Ethical approval was not obtained as the data were extracted as part of an audit from the Electronic Patient Record by Ms Mich Vartuli without any patient identifier and no patient was contacted for the purpose of the study.
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Fan, C.W., Duggan, J., Rodger, D. et al. Increased number of community-living older adults attending an emergency department with falls and fractures: North Dublin experience. Ir J Med Sci 186, 693–697 (2017). https://doi.org/10.1007/s11845-017-1587-y
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DOI: https://doi.org/10.1007/s11845-017-1587-y