Ten‐year mortality in older patients attending the emergency department after a fall. Issue 1 (22nd January 2015)

• Record Type: Journal Article
• Authors: Tan, Maw Pin; Kamaruzzaman, Shahrul Bahyah; Zakaria, Mohd Idzwan; Chin, Ai‐Vyrn; Poi, Philip Jun Hua
• Is Part Of: Geriatrics and gerontology international. Volume 16:Issue 1(2016)
• Page Start: 111
• Page End: 117
• Publication Date: 2015-01-22
• Subjects: accidental falls -- aged -- disability -- fractures -- mortality; Geriatrics -- Periodicals; Gerontology -- Periodicals; Geriatrics -- Japan -- Periodicals; Gerontology -- Japan -- Periodicals; 618.97
• DOI: 10.1111/ggi.12446
• Languages: English
• ISSNs: 1444-1586

Abstract

Abstract : Aim: To determine the dependency scores, long‐term mortality and factors associated with mortality in older people presenting to the emergency department (ED) with a fall. Methods: Information on sociodemographics, dependency using the Barthel index and fall characteristics were collected from consecutive patients attending the ED over a 6‐month period. Barthel score was reassessed at 12 months. Ten‐year mortality data were obtained through the National Registry Department. Results: A total of 198 participants, with a mean age (standard deviation) of 76.2 years (6.3 years) and 74% women, were recruited. Of these, 70% sustained falls indoors, while 49% of falls occurred between 06.00 to 12.00 hours. Total Barthel scores were significantly lower at 1‐year follow up compared with baseline (median [interquartile range], 20 [2] vs 18 [5], P < 0.001). Age ≥75 years was significantly associated with mortality at 1, 3, 5 and 10 years (HR 3.12, 95% CI 1.48–6.56; HR 2.32, 95% CI 1.37–3.92; HR 1.87, 95% CI 1.21–2.88; and HR 2.25, 95% CI 1.60–3.17, respectively). Indoor falls (HR 2.54, 95% CI 1.07–6.06; HR 2.01, 95% CI 1.10–3.69), hospital admission (HR 2.16, 95% CI 1.14–4.10; HR 1.84, 95% CI 1.11–3.07) and Barthel ≤18 (HR 2.99, 95% CI 1.39–6.44; HR 2.47, 95% CI 1.40–4.33) were significantly associated with 1‐year and 3‐year mortality. Hospital admission (HR 1.94, 95% CI 1.24–3.01; HR 1.53, 95% CI 1.06–2.23) and Barthel ≤18 (HR 2.27, 95% CI 1.41–3.66; HR 1.85, 95% CI 1.27–2.68) remained significantly associated with increased mortality at 5 and 10 years. Conclusion: Functional ability is significantly reduced at 1 year after an initial presentation to the ED with a fall. Mortality is increased at 1 and 3 years in fallers who experienced indoor falls. The excess mortality associated with hospital admission and lower disability scores is persistent at 5 and 10 years. The results of the present study are invaluable in prognostication and healthcare decision‐making for this group of frail older patients.Geriatr Gerontol Int 2016; 16: 111–117.