Characteristics and consequences of falls among older adult trauma patients: Considerations for injury prevention programs.

BACKGROUND/AIM: Health promotion and prevention is an important component of occupational therapy practice. Falls are one of the most common causes of ER visits among older adults and injurious falls requiring trauma care can have a significant impact on the health and quality of life of elders. The aim of this study was to compare characteristics and consequences of falls among older adult trauma patients across different age groups with an eye towards informing injury prevention programs. METHODS: A retrospective study using the trauma database from a level one trauma centre in the U.S. (N = 711) was conducted. We compared patient and fall characteristics across age groups and then used logistic regression to estimate odds ratios for hospital length of stay >4 days, discharge disposition, and injury severity (ISS >15). RESULTS: Associations between age group and fall height, location and alcohol use at the time of the fall were statistically significant (P < 0.0001). As compared to the reference group (85 and older), younger age groups had lower odds ratios for discharge to a facility for rehabilitation. CONCLUSION: Results highlight differences among age groups of fallers admitted for trauma care and can help to inform injury prevention programs related to outdoor and indoor falls.

Characterization of fall patients: Does age matter?

INTRODUCTION: Evaluating age-specific fall characteristics is important for prevention programs. The aim was to characterize fallers who presented to our trauma center. We hypothesized that fall characteristics and outcomes would vary with age. METHODS: Data were retrospectively collected from the trauma registry and electronic medical records during January 1st, 2014-December 31st, 2015. Data were analyzed by Chi-square test with Yates' continuity correction and one-way ANOVA with Bonferroni's multiple comparisons test. RESULTS: There were 1541 fallers, 814 (52.8%) were male. Ages ranged from 11 months to 100years. The admission rate was high at 86%, with an average hospital stay of 5.7days. Patients in the 0-18 and 19-45age groups spent significantly less time in the hospital (p<0.0001). Elderly patients had the highest average injury severity score (p<0.0001). However, the youngest patients required surgery more often (p=0.0004). The overall mortality rate was 3.6% and 52.8% were male. The mortality rate increased with age, from 0% for the 0-18 age group to 6.9% for patients ≥65years of age. Remarkably, fallers in the 19-45 and 46-64age groups predominantly died from ground level falls even though the average fall height in these groups was the highest (p<0.0001). More fallers in the 19-45 and 46-64age groups tested positive for alcohol/drug use (p<0.0001). Middle-aged and elderly patients were more likely to be discharged to a skilled nursing or rehabilitation facility compared to younger patients who were discharged home. CONCLUSIONS AND PRACTICAL APPLICATIONS: Fall characteristics and outcomes varied with age. Data on age-specific characteristics, outcomes, and risk factors of falls will help in developing targeted interventions and may lead to better approaches to treat patients.

Clinical and non-clinical factors that predict discharge disposition after a fall.

BACKGROUND: Falls can result in injuries that require rehabilitation and long-term care after hospital discharge. Identifying factors that contribute to prediction of discharge disposition is crucial for efficient resource utilization and reducing cost. Several factors may influence discharge location after hospitalization for a fall. The aim of this study was to examine clinical and non-clinical factors that may predict discharge disposition after a fall. We hypothesized that age, injury type, insurance type, and functional status would affect discharge location. METHODS: This two-year retrospective study was performed at an urban, adult level-1 trauma center. Fall patients who were discharged home or to a facility after hospital admission were included in the study. Data was obtained from the trauma registry and electronic medical records. Logistic regression modeling was used to assess independent predictors. RESULTS: A total of 1,121 fallers were included in the study. 621 (55.4%) were discharged home and 500 (44.6%) to inpatient rehabilitation (IRF)/skilled nursing facility (SNF). The median age was 64 years (IQR: 49-79) and 48.4% (543) were male. The median length of hospital stay was 5 days (IQR: 2.5-8). Increasing age (p < 0.001), length of stay in the ICU (p < 0.001), injury severity (p < 0.001), number of comorbidities (p = 0.038), having Medicare insurance (p = 0.025), having a fracture at any body region (p < 0.001), and ambulation status (p = 0.025) significantly increased the odds of being discharged to IRF/SNF compared to home. The removal of injury severity score and ICU length of stay from the "late/regular discharge" model, to create an "early discharge" model, decreased the accuracy of the prediction rate from 78.5% to 74.9% (p < 0.001). CONCLUSION: A combination of demographic, clinical, social, economic, and functional factors can together predict discharge disposition after a fall. The majority of these factors can be assessed early in the hospital stay, which may facilitate a timely discharge plan and shorter stays in the hospital.

Indoor and outdoor falls among older adult trauma patients: A comparison of patient characteristics, associated factors and outcomes.

AIM: The aim of the present study was to examine significant differences in patient characteristics, associated factors and outcomes for indoor versus outdoor falls among trauma patients. METHODS: A retrospective cross-sectional study using data from the trauma registry and electronic medical records at a level 1 trauma center in the USA was carried out. People aged 55 years or older, for whom fall location could be identified (n = 712), were included in the study. Demographic information, functional status before admission, comorbid conditions, activation level, Injury Severity Score, discharge disposition and injury type were included in the comparative analyses. Associated factors for falls and fractures in each location were also examined using logistic regression. RESULTS: Significant differences were found in patient characteristics between indoor and outdoor fallers. Significant differences in outcomes were found related to discharge disposition and injury type. Open wounds were more common among outdoor fallers (26.5%) as compared with indoor fallers (16.3%, P = 0.002). Although disorders of joints with difficulty walking were associated with fractures among both indoor (OR 7.20, CI 2.19-23.66) and outdoor fallers (OR 5.65, CI 1.27-25.06), sex was only associated with fractures among those who fell indoors (OR 1.69 CI 1.12-2.56). CONCLUSIONS: Significant differences exist in characteristics of indoor and outdoor fallers, and for discharge disposition and injury type for each fall location among patients admitted for trauma care. Factors associated with fractures differ between indoor and outdoor fallers. Results can help to inform targeted primary and secondary prevention initiatives. Geriatr Gerontol Int 2017; 17: 905-912.