title: Risk factors associated with visiting or not visiting the accident & emergency department after a fall.
abstract: BACKGROUND
  Little is known about the prevalence of modifiable risk factors of falling in elderly persons with a fall-history who do not visit the Accident and Emergency (A&E) Department after one or more falls. The objective of this study was to determine the prevalence of modifiable risk factors in a population that visited the A&E Department after a fall (A&E group) and in a community-dwelling population of elderly individuals with a fall history who did not visit the A&E Department after a fall (non-A&E group).
  
  
  METHODS
  Two cohorts were included in this study. The first cohort included 547 individuals 65 years and older who were visited at home by a mobile fall prevention team. The participants in this cohort had fall histories but did not visit the A&E Department after a previous fall. These participants were age- and gender-matched to persons who visited the A&E Department for care after a fall. All participants were asked to complete the CAREFALL Triage Instrument.
  
  
  RESULTS
  The mean number of modifiable risk factors in patients who did not visit the A&E Department was 2.9, compared to 3.8 in the group that visited the A&E Department (p<0.01). All risk factors were present in both groups but were more prevalent in the A&E group, except for the risk factors of balance and mobility (equally prevalent in both groups) and orthostatic hypotension (less prevalent in the A&E group). The risk factors of polypharmacy, absence of orthostatic hypotension, fear of falling, impaired vision, mood and high risk of osteoporosis were all independently associated with visiting the A&E Department.
  
  
  CONCLUSIONS
  All modifiable risk factors for falling were found to be shared between community-dwelling elderly individuals with a fall history who visited the A&E Department and those who did not visit the Department, although the prevalence of these factors was somewhat lower in the A&E group. Preventive strategies aimed both at patients presenting to the A&E Department after a fall and those not presenting after a fall could perhaps reduce the number of recurrent falls, the occurrence of injury and the frequency of visits to the A&E Department.
authors.affiliation: Department of Internal Medicine, section of Geriatric Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. a.c.scheffer@amc.nl
authors.forename: Alice C
authors.initials: AC
authors.lastname: Scheffer
authors.forename: Pieter Boele
authors.initials: PB
authors.lastname: van Hensbroek
authors.forename: Nynke
authors.initials: N
authors.lastname: van Dijk
authors.forename: Jan S K
authors.initials: JS
authors.lastname: Luitse
authors.forename: Johannes C
authors.initials: JC
authors.lastname: Goslings
authors.forename: René H
authors.initials: RH
authors.lastname: Luigies
authors.forename: Sophia E
authors.initials: SE
authors.lastname: de Rooij
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D015985:Precipitating Factors; D012307:Risk Factors
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