UBC Theses and Dissertations
Management and outcome after a fall : a 6-month prospective study of 54 older men and women presenting to the emergency department Salter, Allison Elizabeth
Objective: To prospectively compare the care received by 54 older adults after an emergency department (ED) fall presentation with the recommended 'Guideline Care' as published by the American Geriatrics Society (AGS). Secondary objectives include a longitudinal description and change evaluation of this cohort's fall risk profile, functional status, balance confidence, prevalence of depression, physical activity and living arrangements. Design: 6-month prospective observational study. Participants and Setting: 54 men and women aged 70 years or older who were discharged back to the community after presenting to the Vancouver General Hospital ED with a fall-related complaint. Measurements: AGS Guideline care was documented by chart review and questionnaires. Physiological characteristics were measured by Lord's Physiological Profile Assessment (PPA). Functional status, balance confidence, depression, physical activity and other factors were measured by validated questionnaires. Results: This cohort of fallers who presented to the ED did not receive AGS Guideline Care; only two participants received care consistent with AGS guidelines. Baseline physiological fall-risk scores classified the population at 1.7 SD higher risk than a 65-yr old comparison group and the mean fall-risk score increased (i.e., greater risk of falls) (1.7 ± 1.6 vs. 2.2 ± 1.6, p < 0.000) during the 6-month followup period. Also, functional ability (100 (15) vs. 95 (25), p= 0.002), balance confidence (82.5 (44.4) vs. 71.3 (58.7), p < 0.000) and depression (0 (2) vs. 0 (3), p < 0.000) all worsened over 6 months. Within 6 months of the index ED visit, 5 participants had suffered 6 fall-related fractures. Summary & Conclusion: Medical care of older people who fall and are not admitted to hospital is inconsistent with the AGS Guidelines. This research is the first to prospectively highlight a gap in care of this high-risk group. As fallers who present to the ED constitute a population at high risk of future fracture, this thesis highlights the need for interventions that will address the gap in care that I have identified.
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