Assessing the prevalence of modifiable risk factors in older patients visiting an ED due to a fall using the CAREFALL Triage Instrument.
OBJECTIVE
Falls in older people are a common presenting complaint. Knowledge of modifiable risk factors may lead to a more tailored approach to prevent recurrent falls and/or fractures. We investigated prevalence of 8 modifiable risk factors for recurrent falling and/or a serious consequence of the fall among older patients visiting the emergency department after a fall with the Combined Amsterdam and Rotterdam Evaluation of Falls Triage Instrument (CTI), a self-administrated questionnaire that consists of questions concerning demographics, possible cause(s) of the fall, and questions relating to (modifiable) risk factors for falling.


METHODS
After treatment for their injuries, 1077 consecutive patients 65 years or older visiting the accident and emergency department due to a fall were evaluated by the CTI. The following were assessed: impaired vision, mobility disorder, fear of falling, mood disorder, high risk of osteoporosis, orthostatic hypotension, incontinence, and polypharmacy.


RESULTS
The percentage of respondents who returned the questionnaire was 59.3%. The mean (SD) age was 78.5 (7.5) years, and 57.8% experienced a fall with serious consequences. There were 60.9% of patients with a recurrent fall versus 51% with a first fall who experienced with a serious consequence (P = .025). Age and risk factors mobility disorder (odds ratio [OR], 1.9; 95% confidence interval [CI], 1.1-3.3), high risk of osteoporosis (OR, 2.0; 95% CI, 1.2-3.2), incontinence (OR, 1.7; 95% CI, 1.0-2.7), fear of falling (OR, 2.2; 95% CI, 1.3-3.7), and orthostatic hypotension (OR, 2.4; 95% CI, 1.4-4.2) were independently associated with a recurrent fall. Age and high risk of osteoporosis were the only risk factors predicting a serious consequence of a fall (OR, 4.6; 95% CI, 2.9-7.2).


CONCLUSIONS
Age and 5 modifiable risk factors assessed with the CTI were independently associated with a recurrent fall. Only high risk of osteoporosis was associated with a serious consequence.
van Nieuwenhuizen
Roos C
RC
Department of Traumatology, Academic Medical Center, Amsterdam, The Netherlands.
van Dijk
Nynke
N
van Breda
Fenna G
FG
Scheffer
Alice C
AC
Korevaar
Johanna C
JC
van der Cammen
Tischa J
TJ
Lips
Paul
P
Goslings
Johannes C
JC
de Rooij
Sophia E
SE
D000058:Accidental Falls / Q000517:prevention & control / Q000706:statistics & numerical data*; D000367:Age Factors; D000368:Aged; D016001:Confidence Intervals; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D050723:Fractures, Bone / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications; D016015:Logistic Models; D008297:Male; D019964:Mood Disorders / Q000150:complications; D016017:Odds Ratio; D010024:Osteoporosis / Q000150:complications; D019338:Polypharmacy; D004856:Postural Balance / Q000502:physiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000150:complications; D015354:Vision, Low / Q000150:complications