• practice guidelines;
  • accidental falls—prevention and control;
  • aged;
  • emergency medicine;
  • geriatric assessment;
  • outcomes


  1. Top of page
  2. Abstract
  3. References

Objective: To determine the effect of a practice guideline for the ED management of falls in community-dwelling elders on selected health outcomes. Methods: The experimental design was a pre-post-intervention comparison with one-year pre- and post-intervention phases. The guideline was presented to emergency physicians and nurses during a two-week interval between these two periods. The intervention also included health information provided to the subjects and a one-time educational intervention directed at primary care providers. The number of falls in the year following the ED visit was determined by telephone interview. The number of hospitalizations for falls was determined from the HMO database of all health care encounters. Results: 1,899 patients were eligible for the study; 1,140 pre-intervention and 759 post-intervention patients. Of these, 1,504 (79%) were interviewed by telephone 12 to 15 months after their initial ED visits. Eighteen percent of the pre-intervention and 21% of the post-intervention subjects reported at least one fall in the 12 months following their ED visits (p = 0.162). The rate of falls per 100 patient years was 36.2 in both groups. Three percent of both groups were hospitalized at least once for a fall in the year following their ED visits. One percent in each group were hospitalized for a hip fracture. Conclusions: The attempted implementation of a practice guideline for the ED management of falls in community-dwelling elders did not result in a reduction in total falls, or in hospitalizations for falls, injuries, or fractures.


  1. Top of page
  2. Abstract
  3. References
  • 1
    Campbell A. J., Reinken J., Allan B. C., Martinez G. S.. Falls in old age: a study of frequency and related clinical factors. Age Ageing. 1981; 10: 26470.
  • 2
    Blake A. J., Morgan K., Bendall M. J., et al. Falls by elderly people at home: prevalence and associated factors. Age Ageing. 1988; 17: 36572.
  • 3
    Nelson R. C., Amin M. A.. Falls in the elderly. Emerg Med Clin N Am. 1990; 8: 30924.
  • 4
    O'Loughlin J. L., Robitaille Y., Boivin J. F., Suissa S. Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. Am J Epidemiol. 1993; 137: 34254.
  • 5
    Campbell A. J., Borrie M. J., Spears G. F., Jackson S. L., Brown J. S., Fitzgerald J. L.. Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing. 1990; 19: 13641.
  • 6
    Baker S. P., Harvey A. J.. Fall injury in the elderly. Clin Geriatr Med. 1985; 1: 50112.
  • 7
    McNamara R. M., Rousseau E., Sanders A. B.. Geriatric emergency medicine: a survey of practicing emergency physicians. Ann Emerg Med. 1992; 21: 796801.
  • 8
    Jones J. S., Rousseau E. W., Schropp M. A., Sanders A. B.. Geriatric training in emergency medicine residency programs. Ann Emerg Med. 1992; 21: 8259.
  • 9
    Baraff L. J., Della Penna R., Williams W., Sanders A.. Practice guideline for the emergency department management of falls in community dwelling elderly patients ≥65 years of age. Ann Emerg Med. 1997; 30: 4809.
  • 10
    Baraff L. J., Lee T. J., Kader S., Della Penna R.. Effect of a practice guideline on the process of emergency department care of falls in elder patients. Acad Emerg Med. 1999; 6: 121623.
  • 11
    Rothman K. J.. Modern Epidemiology. Boston : Little Brown & Co., 1986, p 203.
  • 12
    STATA Statistical Software, Release 5.0. College Station TX : Stata Corporation, 1997.
  • 13
    Tinetti M. E., Speechley M.. Prevention of falls among the elderly. N Engl J Med. 1989; 320: 10559.
  • 14
    Perry B. C.. Falls among the elderly: a review of the methods and conclusions of epidemiologic studies. J Am Geriatr Soc. 1982; 30: 36771.
  • 15
    Hornbrook M. C., Stevens V. J., Wingfield D. J., Hollis J. F., Greenlick M. R., Ory M. G.. Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist. 1994; 34: 1623.
  • 16
    Cummings S. R., Nevitt M. C., Kidd S.. Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc. 1988; 36: 6136.
  • 17
    Sattin R. W., Lambert Huber D. A., DeVito C. A., et al. The incidence of fall injury events among the elderly in a defined population. Am J Epidemiol. 1990; 131: 102837.
  • 18
    Jacobsen S. J., Goldberg J., Miles T. P., Brody J. A., Stiers W., Rimm A. A.. Hip fracture incidence among the old and very old: a population-based study of 745,435 cases. Am J Public Health. 1990; 80: 8713.
  • 19
    Priority area 9: unintentional injuries. Hyattsville , MD : U.S. Department of Health and Human Services, DHHS Publication No (PHS) 95-1256-1, 1995.
  • 20
    Stuck A. E., Aronow H. U., Steiner A., et al. A trial of annual in-home comprehensive geriatric assessments for elderly people living in the community. N Engl J Med. 1995; 333: 11848.
  • 21
    Rubenstein L. Z., Josephson K. R., Wieland G. D., English P. A., Sayre J. A., Kane R. L.. Effectiveness of a geriatric evaluation unit. A randomized clinical trial. N Engl J Med. 1984; 311: 166470.
  • 22
    Stevens V. J., Hornbrook M. C., Wingfield D. J., Hollis J. F., Greenlick M. R.. Recruitment and intervention for a falls prevention project: the study of accidental falls in the elderly. In: WeindruchR., HadleyE. C., OryM. G. (eds). Reducing Frailty and Falls in Older Persons. Springfield , IL : Charles C Thomas, 1991, pp 27792.
  • 23
    Rubenstein L. V., Calkins D. R., Young R. T., et al. Improving patient function: a randomized trial of functional disability screening. Ann Intern Med. 1989; 111: 83642.
  • 24
    Williams M. E., Williams T. F., Zimmer J. G., Hall W. J., Podgorski C. A.. How does the team approach to outpatient geriatric evaluation compare with traditional care: a report of a randomized controlled trial. J Am Geriatr Soc. 1987; 35: 10718.