Ten-year mortality in older patients attending the emergency department after a fall

Maw Pin Tan; Shahrul Bahyah Kamaruzzaman; Mohd Idzwan Zakaria; Ai-Vyrn Chin; Philip Jun Hua Poi

doi:10.1111/ggi.12446

Ten-year mortality in older patients attending the emergency department after a fall

Geriatr Gerontol Int. 2016 Jan;16(1):111-7. doi: 10.1111/ggi.12446. Epub 2015 Jan 22.

Authors

Maw Pin Tan^{1

2}, Shahrul Bahyah Kamaruzzaman^{1

2}, Mohd Idzwan Zakaria^{2

3}, Ai-Vyrn Chin^{1

2}, Philip Jun Hua Poi^{1

2}

Affiliations

¹ Division of Geriatric Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
² Aging and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia.
³ Academic Unit of Trauma and Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.

PMID: 25613422
DOI: 10.1111/ggi.12446

Abstract

Aim: To determine the dependency scores, long-term mortality and factors associated with mortality in older people presenting to the emergency department (ED) with a fall.

Methods: Information on sociodemographics, dependency using the Barthel index and fall characteristics were collected from consecutive patients attending the ED over a 6-month period. Barthel score was reassessed at 12 months. Ten-year mortality data were obtained through the National Registry Department.

Results: A total of 198 participants, with a mean age (standard deviation) of 76.2 years (6.3 years) and 74% women, were recruited. Of these, 70% sustained falls indoors, while 49% of falls occurred between 06.00 to 12.00 hours. Total Barthel scores were significantly lower at 1-year follow up compared with baseline (median [interquartile range], 20 [2] vs 18 [5], P < 0.001). Age ≥75 years was significantly associated with mortality at 1, 3, 5 and 10 years (HR 3.12, 95% CI 1.48-6.56; HR 2.32, 95% CI 1.37-3.92; HR 1.87, 95% CI 1.21-2.88; and HR 2.25, 95% CI 1.60-3.17, respectively). Indoor falls (HR 2.54, 95% CI 1.07-6.06; HR 2.01, 95% CI 1.10-3.69), hospital admission (HR 2.16, 95% CI 1.14-4.10; HR 1.84, 95% CI 1.11-3.07) and Barthel ≤18 (HR 2.99, 95% CI 1.39-6.44; HR 2.47, 95% CI 1.40-4.33) were significantly associated with 1-year and 3-year mortality. Hospital admission (HR 1.94, 95% CI 1.24-3.01; HR 1.53, 95% CI 1.06-2.23) and Barthel ≤18 (HR 2.27, 95% CI 1.41-3.66; HR 1.85, 95% CI 1.27-2.68) remained significantly associated with increased mortality at 5 and 10 years.

Conclusion: Functional ability is significantly reduced at 1 year after an initial presentation to the ED with a fall. Mortality is increased at 1 and 3 years in fallers who experienced indoor falls. The excess mortality associated with hospital admission and lower disability scores is persistent at 5 and 10 years. The results of the present study are invaluable in prognostication and healthcare decision-making for this group of frail older patients.

Keywords: accidental falls; aged; disability; fractures; mortality.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Accidental Falls / mortality*
Activities of Daily Living
Age Factors
Aged
Aged, 80 and over
Emergency Service, Hospital*
Female
Follow-Up Studies
Hospitalization / statistics & numerical data
Humans
Malaysia / epidemiology
Male
Registries
Risk Factors
Socioeconomic Factors
Survival Rate
Time Factors