RESUMO
OBJECTIVES: To determine functional changes and factors affecting 180-day functional prognosis among older patients attending a hospital emergency department (ED) after a fall. STUDY DESIGN: Retrospective analysis from a prospective cohort study (FALL-ER Registry) spanning one year that included individuals aged ≥65 years attending four Spanish EDs after a fall. We collected 9 baseline and 6 fall-related factors. MAIN OUTCOME MEASURES: Barthel Index (BI) was measured at baseline, discharge and 30, 90 and 180 days after the index fall. Absolute and relative BI changes were calculated. Absolute difference of ≥10 points between BI at baseline and at 180 days was considered a clinically significant functional decline. RESULTS: 452 patients (mean age 80⯱â¯8 years; 70.8% women) were included. Baseline BI was 79.3⯱â¯23.1 points. Compared with baseline, functional status was significantly lower at the 4 follow-up time points (-8.7% at discharge; and -6.9%, -7.9% and -9.5% at 30, 90 and 180 days; pâ¯<â¯0.001 for all comparisons in relation to baseline; pâ¯=â¯0.001 for change over time). One hundred and thirty-three (29.6%) patients had a clinically significant functional decline at 180 days. Age ≥85 years (ORâ¯=â¯2.24, 95%CI 1.23-4.08; pâ¯=â¯0.008), fall-related fracture (ORâ¯=â¯2.45, 95%CI 1.43-4.28; pâ¯=â¯0.001), hospitalization (ORâ¯=â¯1.91; 95%CI 1.11-3.29; pâ¯=â¯0.019) and post-fall syndrome (ORâ¯=â¯1.77, 95%CI 1.13-2.77; pâ¯=â¯0.013) were independently associated with 180-day clinically significant functional decline. CONCLUSION: Patients ≥65 years attending EDs after a fall experience a consistent and persistent negative impact on their functional status. Several factors may help identify patients at increased risk of functional impairment.
Assuntos
Acidentes por Quedas , Atividades Cotidianas , Nível de Saúde , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Feminino , Fraturas Ósseas/fisiopatologia , Hospitalização , Humanos , Masculino , Prognóstico , Sistema de Registros , Estudos Retrospectivos , Fatores de Risco , Fatores de TempoRESUMO
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