Preventive care in the emergency department: should emergency departments institute a falls prevention program for elder patients? A systematic review.
OBJECTIVE
To perform a systematic review of the emergency medicine literature to assess the appropriateness of an intervention to identify, counsel, and refer emergency department (ED) patients >64 years old who are at high risk for falls.


METHODS
The systematic review was facilitated through the use of a structured template, a companion explanatory piece, and a grading and methodological scoring system based on published criteria for critical appraisal. A reference librarian did two PubMed searches using the following: ED visits, patients >64 years old, falls, high risk, and effectiveness of intervention. Emergency Medical Abstracts, Science Citation Index, and the Cochrane Collaboration database were searched. Two team members reviewed the abstracts and selected pertinent articles. References were screened for additional pertinent articles.


RESULTS
Twenty-six articles were reviewed. None were ED-based primary or secondary falls prevention in older patients. One randomized controlled trial of an intervention to decrease subsequent falls in elder community-dwelling patients who presented with a fall showed a structured interdisciplinary approach significantly reducing the number of falls. Two ED-based studies showed it was possible to identify ED patients at risk for falls.


CONCLUSIONS
Based on one randomized controlled trial demonstrating a significant reduction in the risk of further falls, the burden of suffering caused by falls, and other studies demonstrating the value of interventions to reduce the risk of falling, the authors recommend that EDs conduct research to evaluate the effectiveness of clinical interventions to identify, counsel, and refer ED patients >64 years old who are at high risk for an unintentional fall.
Weigand
J V
JV
Department of Emergency Medicine, Summa Health System, Akron, OH, USA.
Gerson
L W
LW
D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged / Q000502:physiology*; D004632:Emergency Medical Services; D019317:Evidence-Based Medicine / Q000379:methods; D006801:Humans; D011315:Preventive Medicine; D012008:Recurrence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D000078329:Workforce