FALLS PRESENTING TO THE ACCIDENT AND EMERGENCY DEPARTMENT - TYPES OF PRESENTATION AND RISK FACTOR PROFILE

The aim of this study was to evaluate the type and frequency of falls presenting to an inner city casualty department, and to identify modif iable risk factors in these patients. A prospective descriptive study evaluated those over 65 years presenting to an inner city casualty dep artment with falls. Over a 4-week, recruitment period, all consenting subjects completed a semi-structured questionnaire regarding their fal ls and cognitive status. Those with unexplained (UF) or recurrent fall s (RF) underwent a more detailed assessment: history and examination, gait and balance assessment, visual acuity measurement and neurocardio vascular investigations (including orthostatic blood pressure, carotid sinus massage and head-up tilt testing). Of 200 patients with falls, 188 were interviewed; 29% could recall a reason for falling (accidenta l) and 30% had UF or RF. A cohort of 26 cognitively normal patients wi th UF and RF was fully investigated. In 23/26 patients risk factors fo r falls were found (median: three risk factors). These included: culpr it medication (10), gait abnormalities (9) and carotid sinus hypersens itivity (19). Falls are a common presenting complaint yet a fall is re adily explained in less than one-third of cases. Investigation of RF a nd UF has a high yield for possibly modifiable cardiac and non-cardiac risk factors. Targeted multi-disciplinary rapid assessment of patient s attending the Accident and Emergency Department because of a fall mi ght reduce the number of hospital admissions.