Open Access Research article

Risk factors associated with visiting or not visiting the accident & emergency department after a fall

Alice C Scheffer1*, Pieter Boele van Hensbroek2, Nynke van Dijk3, Jan S K Luitse4, Johannes C Goslings3, René H Luigies5 and Sophia E de Rooij1

Author Affiliations

1 Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

2 Trauma Unit, Department of Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

3 Department of General Practice/Family Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

4 Department of Emergency Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

5 Independent Consultant, Rijswijk, the Netherlands

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BMC Health Services Research 2013, 13:286  doi:10.1186/1472-6963-13-286

Published: 26 July 2013

Abstract

Background

Little is known about the prevalence of modifiable risk factors of falling in elderly persons with a fall-history who do not visit the Accident and Emergency (A&E) Department after one or more falls. The objective of this study was to determine the prevalence of modifiable risk factors in a population that visited the A&E Department after a fall (A&E group) and in a community-dwelling population of elderly individuals with a fall history who did not visit the A&E Department after a fall (non-A&E group).

Methods

Two cohorts were included in this study. The first cohort included 547 individuals 65 years and older who were visited at home by a mobile fall prevention team. The participants in this cohort had fall histories but did not visit the A&E Department after a previous fall. These participants were age- and gender-matched to persons who visited the A&E Department for care after a fall. All participants were asked to complete the CAREFALL Triage Instrument.

Results

The mean number of modifiable risk factors in patients who did not visit the A&E Department was 2.9, compared to 3.8 in the group that visited the A&E Department (p<0.01). All risk factors were present in both groups but were more prevalent in the A&E group, except for the risk factors of balance and mobility (equally prevalent in both groups) and orthostatic hypotension (less prevalent in the A&E group). The risk factors of polypharmacy, absence of orthostatic hypotension, fear of falling, impaired vision, mood and high risk of osteoporosis were all independently associated with visiting the A&E Department.

Conclusion

All modifiable risk factors for falling were found to be shared between community-dwelling elderly individuals with a fall history who visited the A&E Department and those who did not visit the Department, although the prevalence of these factors was somewhat lower in the A&E group. Preventive strategies aimed both at patients presenting to the A&E Department after a fall and those not presenting after a fall could perhaps reduce the number of recurrent falls, the occurrence of injury and the frequency of visits to the A&E Department.

Keywords:
Older persons; Falls; Risk factors; A&E Department; Mobile fall prevention unit