Community-dwelling seniors who present to the emergency department with a fall do not receive Guideline care and their fall risk profile worsens significantly: a 6-month prospective study

Salter, A. E., Khan, K. M., Donaldson, M. G., Davis, J. C., Buchanan, J., Abu-Laban, R. B., Cook, W. L., Lord, S. R. and McKay, H. A. (2006) Community-dwelling seniors who present to the emergency department with a fall do not receive Guideline care and their fall risk profile worsens significantly: a 6-month prospective study. Osteoporosis International, 17 5: 672-683. doi:10.1007/s00198-005-0032-7


Author Salter, A. E.
Khan, K. M.
Donaldson, M. G.
Davis, J. C.
Buchanan, J.
Abu-Laban, R. B.
Cook, W. L.
Lord, S. R.
McKay, H. A.
Title Community-dwelling seniors who present to the emergency department with a fall do not receive Guideline care and their fall risk profile worsens significantly: a 6-month prospective study
Journal name Osteoporosis International   Check publisher's open access policy
ISSN 0937-941X
Publication date 2006-05
Year available 2006
Sub-type Article (original research)
DOI 10.1007/s00198-005-0032-7
Volume 17
Issue 5
Start page 672
End page 683
Total pages 12
Place of publication London
Publisher Springer International
Language eng
Subject 1103 Clinical Sciences
Abstract Abstract Introduction: Fall risk is a major contributor to fracture risk; implementing fall reduction programmes remains a challenge for health professionals and policymakers. Materials and methods: We aimed to (1) ascertain whether the care received by 54 older adults after an emergency department (ED) fall presentation met internationally recommended ‘Guideline Care’, and (2) prospectively evaluate this cohort’s 6-month change in fall risk profile. Participants were men and women aged 70 years or older who were discharged back into the community after presenting to an urban university tertiarycare hospital emergency department with a fall-related complaint. American Geriatric Society (AGS) guideline care was documented by post-presentation emergency department chart examination, daily patient diary of falls submitted monthly, patient interview and physician reconciliation where needed. Both at study entry and at a 6-month followup, we measured participants physiological characteristics by Lord’s Physiological Profile Assessment (PPA), functional status, balance confidence, depression, physical activity and other factors. Results: We found that only 2 of 54 (3.7%) of the fallers who presented to the ED received care consistent with AGS Guidelines. Baseline physiological fall risk scores classified the study population at a 1.7 SD higher risk than a 65-year-old comparison group, and during the 6-month followup period the mean fall-risk score increased significantly (i.e. greater risk of falls) (1.7±1.6 versus 2.2±1.6, p=0.000; 29.5% greater risk of falls). Also, functional ability [100 (15) versus 95 (25), p=0.002], balance confidence [82.5 (44.4) versus 71.3 (58.7), p=0.000] and depression [0 (2) versus 0 (3), p=0.000] all worsened over 6 months. Within 6 months of the index ED visit, five participants had suffered six fallrelated fractures. Discussion: We conclude that this group of community-dwelling fallers, who presented for ED care with a clinical profile suggesting a high risk of further falls and fracture, did not receive Guideline care and worsened in their fall risk profile by 29.5%. This gap in care, at least in one centre, suggests further investigation into alternative approaches to delivering Guideline standard health service.
Keyword Fall risk .
Fracture risk .
Guideline care .
Seniors
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Excellence in Research Australia (ERA) - Collection
School of Human Movement and Nutrition Sciences Publications
 
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Created: Thu, 05 Mar 2009, 10:45:24 EST by Jason Parr on behalf of School of Human Movement and Nutrition Sciences