SEARCH

SEARCH BY CITATION

Keywords:

  • accidental falls;
  • emergency services;
  • hospital;
  • preventive services;
  • systematic review;
  • aged;
  • elders

Abstract

  1. Top of page
  2. Abstract
  3. References

Objective: To perform a systematic review of the emergency medicine literature to assess the appropriateness of an intervention to identify, counsel, and refer emergency department (ED) patients >64 years old who are at high risk for falls. Methods: The systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. A reference librarian did two PubMed searches using the following: ED visits, patients >64 years old, falls, high risk, and effectiveness of intervention. Emergency Medical Abstracts, Science Citation Index, and the Cochrane Collaboration database were searched. Two team members reviewed the abstracts and selected pertinent articles. References were screened for additional pertinent articles. Results: Twenty-six articles were reviewed. None were ED-based primary or secondary falls prevention in older patients. One randomized controlled trial of an intervention to decrease subsequent falls in elder community-dwelling patients who presented with a fall showed a structured interdisciplinary approach significantly reducing the number of falls. Two ED-based studies showed it was possible to identify ED patients at risk for falls. Conclusions: Based on one randomized controlled trial demonstrating a significant reduction in the risk of further falls, the burden of suffering caused by falls, and other studies demonstrating the value of interventions to reduce the risk of falling, the authors recommend that EDs conduct research to evaluate the effectiveness of clinical interventions to identify, counsel, and refer ED patients >64 years old who are at high risk for an unintentional fall.

References

  1. Top of page
  2. Abstract
  3. References
  • 1
    Burt CW. Injury-related visits to hospital emergency departments: United States, 1992. Advance data from Vital and Health Statistics; no. 261. Hyattsville , MD : National Center for Health Statistics, 1995.
  • 2
    Baker SP, O'Neill B., Ginsburg MJ The Injury Fact Book. Second Edition. New York : Oxford University Press, 1992, p 137.
  • 3
    Centers for Disease Control. Public health surveillance of 1990 injury control objective for the nation. CDC surveillance summary. MMWR 1988; 37:SS-1:1-68.
  • 4
    Evans R. Trauma and Falls. In: SandersAB. Emergency Care of the Elder Person. St. Louis : Beverly Cracom Publications, 1996, pp 15370.
  • 5
    U.S. Preventive Services Task Force. Guide to Clinical Preventive Services, Second Edition, Baltimore , MD : Williams & Wilkins, 1996.
  • 6
    Rhodes KV, Gordon JA, Lowe RA, and the SAEM Public Health and Education Task Force Preventive Services Work Group. Preventive care in the emergency department, part I: Clinical preventive services—are they relevant to emergency medicine? Acad Emerg Med 2000; 7: 103641.
  • 7
    Irvin CB, Wyer PC, Gerson LW, and the SAEM Public Health and Education Task Force Preventive Services Work Group. Preventive care in the emergency department, part II: Clinical preventive services—an emergency medicine evidence-based review. Acad Emerg Med 2000; 7: 104254.
  • 8
    Moher D., Cook DJ, Eastwood S., Olkin I., Rennie D., Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: the QUOROM statement. Quality of reporting of meta-analyses. Lancet 1999; 354: 1896900.
  • 9
    The Cochrane Collaborative Handbook, The Cochrane Library Version 3.0.2. Oxford , United Kingdom : Update Software, 1997.
  • 10
    Briss PA, Zaza S., Pappaioanou M. Developing an evidence based guide to community preventive services—methods. Am J Prev Med 2000; 18(1S):P3543.
  • 11
    Close J., Ellis M., Hooper R., Glucksman E., Jackson S., Swift C. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 1999; 353: 936.
  • 12
    Gerson LW, Rousseau EW, Hogan TM, Bernstein E., Kalbfleisch N. Multi center study of case finding in elderly emergency department patients. Acad Emerg Med 1995; 2: 72934.
  • 13
    Miller DK, Lewis LM, Nork MJ, Morley JE. Controlled trial of a geriatric case-finding and liaison service in an emergency department. J Am Geriatr Soc 1996; 44: 51320.
  • 14
    Baraff LJ, Della Penna R., Williams N., Sanders A. Practice guideline for the ED management of falls in community-dwelling elderly persons. Ann Emerg Med 1997; 30: 48092.
  • 15
    Baraff LJ, Lee TJ, 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.
  • 16
    Baraff LJ, Lee TJ, Kader S., Della Penna R. Effect of a practice guideline for emergency department care of falls in elderly patients on subsequent falls and hospitalizations for injuries. Acad Emerg Med 1999; 6: 122431.
  • 17
    McCaig LF. National Hospital Ambulatory Medical Care Survey: 1998 Emergency Department Summary. Advance data from Vital and Health Statistics; no. 313. Hyattsville , MD : National Center for Health Statistics, 2000.
  • 18
    Nelson ME, Fiatarone MA, Morganti CM, Trice I., Greenberg RA, Evans WJ. Effects of high intensity strength training on multiple risk factors for osteoporotic fracture: a randomized controlled trial. JAMA 1994; 272: 190914.
  • 19
    Fiatarone MA, O'Neill EF, Ryan ND. Exercise training and nutritional supplementation for physical frailty in very elderly people. N Engl J Med 1994; 330: 176975.
  • 20
    Province MA, Hadley EC, Hornbrook MC. The effects of exercise on falls in elderly patients: a pre-planned meta-analysis of the FICSIT trials. JAMA 1995; 273: 13417.
  • 21
    Tinetti ME, Baker DI, McAvay G. A multifactorial intervention to reduce the risk of falling among elderly people living in the community. N Engl J Med 1994; 331: 8217.
  • 22
    Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D. The value of assessing falls in an elderly population: a randomized clinical trial. Ann Intern Med 1990; 113: 30816.
  • 23
    Ory MG, Schechtman KB, Miller JP. Frailty and injuries in later life: the FICSIT trials. J Am Geriatr Soc 1993; 41: 28396.
  • 24
    Reinsch S., MacRae P., Lachenbruch PA, Tobis JS. Attempts to prevent falls and injury: a prospective community study. Gerontologist 1992; 32: 4506.
  • 25
    Mulrow CD, Gerety MB, Katen D. A randomized trial of physical rehabilitation for very frail nursing home residents. JAMA 1994; 271: 51924.
  • 26
    Johansson G., Jarnlo GB. Balance training in 70 year-old women. Phys Ther Theory Pract 1991; 7: 1215.
  • 27
    Crilly RG, Willems DA, Trenholm KJ, Hayes KC, Delaquerriere-Richardson LF. Effect of exercise on postural sway in the elderly. Gerontologist 1989; 35: 13743.
  • 28
    Lauritzen JB, Petersen MM, Lund B. Effect of external hip protectors on hip fractures. Lancet 1993; 341: 113.
  • 29
    Wolf-Klein GP, Silverstone FA, Basavaraju N., Foley CJ, Pascaru A., Ma PH. Prevention of falls in the elderly population. Arch Phys Med Rehabil 1998; 69: 68991.