Presented at the Society for Academic Emergency Medicine’s Annual Meeting (Boston, MA), 2003; The Pennsylvania Chapter–American College of Emergency Physician’s annual meeting (Pittsburgh, PA), 2003; and The American College of Emergency Physician’s Scientific Assembly (Boston, MA), 2003.
Identification of Fall Risk Factors in Older Adult Emergency Department Patients
Article first published online: 4 MAR 2009
© 2009 by the Society for Academic Emergency Medicine
Academic Emergency Medicine
Volume 16, Issue 3, pages 211–219, March 2009
How to Cite
Carpenter, C. R., Scheatzle, M. D., D’Antonio, J. A., Ricci, P. T. and Coben, J. H. (2009), Identification of Fall Risk Factors in Older Adult Emergency Department Patients. Academic Emergency Medicine, 16: 211–219. doi: 10.1111/j.1553-2712.2009.00351.x
This work was funded in part by a grant from the Emergency Medicine Foundation.
- Issue published online: 4 MAR 2009
- Article first published online: 4 MAR 2009
- Received June 17, 2008; revisions received September 2 and October 14, 2008; accepted October 19, 2008.
- emergency medicine;
- injury prevention
Objectives: Falls represent an increasingly frequent source of injury among older adults. Identification of fall risk factors in geriatric patients may permit the effective utilization of scarce preventative resources. The objective of this study was to identify independent risk factors associated with an increased 6-month fall risk in community-dwelling older adults discharged from the emergency department (ED).
Methods: This was a prospective observational study with a convenience sampling of noninstitutionalized elders presenting to an urban teaching hospital ED who did not require hospital admission. Interviews were conducted to determine the presence of fall risk factors previously described in non-ED populations. Subjects were followed monthly for 6 months through postcard or telephone contact to identify subsequent falls. Univariate and Cox regression analysis were used to determine the association of risk factors with 6-month fall incidence.
Results: A total of 263 patients completed the survey, and 161 (61%) completed the entire 6 months of follow-up. Among the 263 enrolled, 39% reported a fall in the preceding year, including 15% with more than one fall and 22% with injurious falls. Among those completing the 6 months of follow-up, 14% reported at least one fall. Cox regression analysis identified four factors associated with falls during the 6-month follow-up: nonhealing foot sores (hazard ratio [HR] = 3.71, 95% confidence interval [CI] = 1.73 to 7.95), a prior fall history (HR = 2.62, 95% CI = 1.32 to 5.18), inability to cut one’s own toenails (HR = 2.04, 95% CI = 1.04 to 4.01), and self-reported depression (HR = 1.72, 95% CI = 0.83 to 3.55).
Conclusions: Falls, recurrent falls, and injurious falls in community-dwelling elder ED patients being evaluated for non–fall-related complaints occur at least as frequently as in previously described outpatient cohorts. Nonhealing foot sores, self-reported depression, not clipping one’s own toenails, and previous falls are all associated with falls after ED discharge.