Characteristics and outcomes of older patients presenting to the emergencydepartment after a fall: a retrospective analysis

Objectives: To study older patients presenting to the emergency department after a fall - factors associated with the fall, injuries sustained and out come. Design: A retrospective analysis using the Emergency Department Information System (EDIS), the Trauma Registry and the patient information database (C CIS), in addition to the patient's emergency and inpatient medical records. Setting: Emergency department of a major inner city teaching hospital, 1 Ju ne 30 November 1997. Patients: All patients over 65 years presenting to the emergency department (ED) after a fail, for whom complete medical records were available. Results: Of 803 patients over 65 years presenting to the ED after a fall, c omplete records were available for 733 (91.3%) (283 men and 450 women). Ext rinsic (accidental) causes were implicated in more than a third of falls (3 13 patients [42.7%]). A high proportion of the patients were living at home (520; 70.9%) and walking unaided (389; 53.1%). Although absolute numbers o f women increased with age, men were as likely as women to present after a fall. Many patients had fallen before - 39% of the men (111/283) and 24% of the women (110/450). In 78 patients (10.6%), alcohol misuse may have been a direct cause of the fall. The overall injury rate was 70.5% (517/733 pati ents), the most common injury being an isolated fracture (269/517 patients; 52.0%). In all, 419 patients (57.2%) were admitted to hospital, 48% (200/4 19) with a fracture and 52% (219/419) for investigation of the medical caus e of the fall. The median length of hospital stay was 6 days (mean, 10.4 da ys; range, 1-129 days); 35% (146/419) of patients were in hospital for more than 10 days. Conclusion: Older patients presenting to the ED after a fall had high injur y rates, high admission rates and often prolonged hospitalisation. About a third had fallen before. Patients at risk can be identified in the ED and r eferred to falls prevention programs.