Fall Risk Identification Throughout the Continuum of Care for Elderly Trauma Patients: An Injury Prevention Initiative

Meaghan R Crawley; Alistair J Chapman; Amy Koestner; Steffen Pounders; Laura Krech; Matthew Lypka; Chelsea Fisk; Gaby Iskander

doi:10.1016/j.injury.2022.08.066

Fall Risk Identification Throughout the Continuum of Care for Elderly Trauma Patients: An Injury Prevention Initiative

Injury. 2022 Nov;53(11):3715-3722. doi: 10.1016/j.injury.2022.08.066. Epub 2022 Aug 31.

Authors

Meaghan R Crawley¹, Alistair J Chapman², Amy Koestner¹, Steffen Pounders³, Laura Krech⁴, Matthew Lypka⁵, Chelsea Fisk³, Gaby Iskander⁶

Affiliations

¹ Spectrum Health Butterworth Hospital, Trauma Services, 100 Michigan St. NE, Grand Rapids, MI 49503, USA.
² Spectrum Health Butterworth Hospital, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA; Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA.
³ Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA.
⁴ Spectrum Health Trauma Research Institute, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA. Electronic address: Laura.Krech@spectrumhealth.org.
⁵ Spectrum Health Office of Research and Education, Biostatistics Core, 15 Michigan St. NE, Grand Rapids, MI 49503, USA.
⁶ Spectrum Health Butterworth Hospital, Acute Care Surgery, 100 Michigan St. NE, Grand Rapids, MI 49503, USA.

PMID: 36075779
DOI: 10.1016/j.injury.2022.08.066

Abstract

Introduction: Falls are the second leading cause of trauma-related deaths worldwide. Identifying fall risk patients and initiating interventions reduces injuries and mortality, particularly in the elderly. The primary aim of this retrospective study was to identify missed opportunities for fall risk identification and intervention for geriatric trauma patients.

Patients and methods: In this retrospective observational cohort study, the trauma registry was queried to identify geriatric patients admitted for a fall over 36 months. The electronic medical record (EMR) was reviewed to evaluate patients' fall risk in the 12 months prior to the index fall admission. The EMR was also queried for repeat falls within 12 months after discharge, and to determine if fall prevention education was provided at discharge.

Results: 597 patients met inclusion criteria; 68.3% were female. 64.7% were at risk for falling in the year before admission. 2% had documented fall prevention education at discharge. 32% of patients fell again within a year of discharge and 19.4% were readmitted for a repeat fall. Patients at high risk for falls (on the Hester-Davis scale) were significantly more likely to be readmitted (p = 0.005) and expire within six months (p = 0.033) than moderate risk patients. Mortality at 12 months post-admission for all patients was 19.4%.

Conclusion: This large study demonstrated that geriatric trauma patients admitted for a fall were already at risk for falling in the 12 months prior to admission. This is a novel finding that presents a substantial prevention opportunity for healthcare systems. Education and implementation of proven techniques to prevent falls as soon as at-risk patients are identified has the potential to change the course for a patient who may not only fall, but also fall again. This proactive approach could significantly impact the fall epidemic in our elderly population.

Keywords: Fall prevention; Geriatric hip fracture; Geriatric trauma; Geriatric traumatic brain injury; Ground level fall.

Publication types

Observational Study

MeSH terms

Aged
Continuity of Patient Care*
Female
Hospitalization*
Humans
Male
Retrospective Studies
Risk Factors