title: Falls presenting to the accident and emergency department: types of presentation and risk factor profile.
abstract: The aim of this study was to evaluate the type and frequency of falls presenting to an inner city casualty department, and to identify modifiable risk factors in these patients. A prospective descriptive study evaluated those over 65 years presenting to an inner city casualty department with falls. Over a 4-week recruitment period, all consenting subjects completed a semi-structured questionnaire regarding their falls and cognitive status. Those with unexplained (UF) or recurrent falls (RF) underwent a more detailed assessment: history and examination, gait and balance assessment, visual acuity measurement and neurocardiovascular investigations (including orthostatic blood pressure, carotid sinus massage and head-up tilt testing). Of 200 patients with falls, 188 were interviewed; 29% could recall a reason for falling (accidental) and 30% had UF or RF. A cohort of 26 cognitively normal patients with UF and RF was fully investigated. In 23/26 patients risk factors for falls were found (median: three risk factors). These included: culprit medication (10), gait abnormalities (9) and carotid sinus hypersensitivity (19). Falls are a common presenting complaint yet a fall is readily explained in less than one-third of cases. Investigation of RF and UF has a high yield for possibly modifiable cardiac and non-cardiac risk factors. Targeted multi-disciplinary rapid assessment of patients attending the Accident and Emergency Department because of a fall might reduce the number of hospital admissions.
authors.affiliation: Cardiovascular Investigation Unit, Royal Victoria Infirmary, Newcastle-upon-Tyne.
authors.forename: A J
authors.initials: AJ
authors.lastname: Davies
authors.forename: R A
authors.initials: RA
authors.lastname: Kenny
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004739:England / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D015577:Geriatric Assessment / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D008297:Male; D009460:Neurologic Examination; D010343:Patient Admission / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D019462:Syncope, Vasovagal / Q000150:complications / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*