Profile of older patients attended in the emergency department after falls: a FALL-ER registry study of the magnitude of the problem and opportunities for improving hospital emergency care

To profile patients aged 65 years or older who are attended in a hospital emergency department after falls. To describe the falls, their severity, and factors relevant to recommended preventive measures.The FALL-ER is a multipurpose, multicenter prospective registry of a systematically described cohort of patients aged 65 years or older attended in 5 hospital emergency departments on 52 days of the same year. We collected data on 68 independent variables. Patients were classified according to whether they had received recommendations related to preventing falls in any of the following categories: exercise, education on fall prevention, referral to a specialist or changes in medication.. A total of 1507 patients or carers were interviewed (93.6% of the 1610 patients in the registry). The cohort was of advanced age and had high rates of comorbidity, polypharmacy, and history of geriatric syndromes. The majority of falls occurred during the day and in the patients home. Half the falls were not witnessed. Forty-eight percent of the patients reported fear of falling, 22% had acute functional impairment, 16% were admitted, and 0.6% died in the hospital. Recommendations directed to preventing falls were received by 509 (33.8%) cases. Loss of hearing acuity, self-reported cognitive impairment, emergency first aid at the site of the fall, fear of falling again, acute functional impairment, and hospitalization were associated with a greater likelihood of receiving recommendations for preventing falls. Loss of visual acuity was associated with a lower likelihood of receiving recommendations.Only a third of elderly patients attended in an emergency department after falls receive recommendations that target preventing further falls. Certain patient and fall characteristics are associated with a greater likelihood of receiving such recommendations.Estudiar el perfil de los pacientes de 65 años o más atendidos por una caída en los servicios de urgencias (SU), las características de las caídas, y el grado y los factores asociados con la realización de recomendaciones para prevenir las caídas (RPC).FALL-ER es un registro de cohortes multipropósito, prospectivo y multicéntrico, con muestreo sistemático, que incluyó todos los pacientes de 65 años o más atendidos por caída en 5 SU durante 52 días en un año. Se recogieron 68 variables independientes. Los pacientes se clasificaron en función de recibir o no RPC (cualquiera de las siguientes: ejercicio, educación sobre prevención de las caídas, derivación a especialista o modificación de fármacos relacionados con las caídas).Se analizaron 1.507 (93,6%) del total de 1.610 pacientes. Los pacientes tenían una edad muy avanzada y alto grado de comorbilidad, polifarmacia y síndromes geriátricos previos. La caída suele suceder de día, en domicilio y en la mitad de casos sin testigo. Un 48% refirió miedo a caerse, un 22% presentó deterioro funcional agudo, un 16% ingresó y un 0,6% falleció. Se realizaron RPC en 509 (33,8%) casos. La disminución de la agudeza auditiva, deterioro cognitivo autorreferido, atención médica en el lugar de la caída, miedo a volver a caerse, deterioro funcional agudo y hospitalización se asociaron con mayor probabilidad de RPC, y la disminución de la agudeza visual con menor probabilidad.Solo tres de cada diez pacientes ancianos atendidos por una caída en urgencias recibe RPC posteriores, aunque existen ciertas características relacionadas con el paciente y la caída que se asocian a una mayor probabilidad de recibirlas.