OBJECTIVE: Falls in older adults correlate with heightened morbidity and mortality. Assessing fall risk in the emergency department (ED) not only aids in identifying candidates for prevention interventions but may also offer insights into overall mortality risk. We sought to examine the link between fall risk and 30-day mortality in older ED adults.
METHODS: Observational cohort study of adults aged = 75years who presented to an academic ED and who were assessed for fall risk using the Memorial Emergency Department Fall Risk Assessment Tool (MEDFRAT), a validated, ED-specific screening tool. The fall risk was classified as low (0-2 points), moderate (3-4 points), or high (=5) risk. The primary outcome was 30-day mortality. Hazard ratios (HR) with 95% confidence intervals (CIs) were calculated.
RESULTS: A total of 941 patients whose fall risk was assessed in the ED were included in the study. Median age was 83.7 years; 45.6% were male, 75.6% lived in private residences, and 62.7% were admitted. Mortality at 30 days among the high fall risk group was four times that of the low fall risk group (11.8% vs 3.1%; HR 4.00, 95% CI 2.18 to 7.34, p < 0.001). Moderate fall risk individuals had nearly double the mortality rate of the low-risk group (6.0% vs 3.1%), but the difference was not statistically significant (HR 1.98, 95% CI 0.91 to 4.32, p = 0.087).
CONCLUSION: ED fall risk assessments are linked to 30-day mortality. Screening may facilitate the stratification of older adults at risk for health deterioration.
| Discipline Area | Score |
|---|---|
| Physician |  |
Physician rater
No surprises here. The risk factors used to determine fall risk (confusion, altered gait, need for a mobility assistance device, history of falls, sedation, difficulty with elimination) are obviously going to be tied to higher mortality. Frail elderly people fall more and are at higher risk for mortality. Although there may be some value in identifying those at risk for falls to try to intervene (although this study cannot tell us whether or not there is a patient benefit), formally tying this risk to mortality doesn't seem useful.
Physician rater
The study tackles a significant concern in elderly care by establishing an association between fall risk evaluations in the ED and 30-day mortality, highlighting the importance of early detection and preventive measures.
Physician rater
Falls are a symptom of underlying medical problems and the high-falls risk group seems to be, not surprisingly, generally medically sicker with more pre-existing medical conditions than the other 2 groups. This probably explains their higher risk for falling. Unfortunately, the study fails to describe data on cause of death in patients in each group.
, McMaster University