title: [Quality of care provided to elderly fallers in the emergency room].
abstract: BACKGROUND
  recurrent falls are a major public health problem associated with high morbidity and mortality as well as increased dependence. Multifactorial intervention has been shown to reduce recurrence by 20% (Profet study). The French Health Authority (Haute autorité de santé or HAS) recommends since 2009 a systematic screening for and assessment of risk factors as well as the implementation of preventive measures.
  
  
  OBJECTIVE
  to examine whether the management of falls in older patients discharged home from the emergency department is consistent with the HAS guidelines.
  
  
  METHODS
  descriptive retrospective analysis of 1238 medical records of patients over 75 years, who consulted for falls from April to October 2010 in the emergency department of in 13 centers in the North-Alps region. The study is part of a program to improve the quality of care led by the French Network of North-Alps Emergency Departments (Réseau nord alpin des urgences, RENAU).
  
  
  RESULTS
  Screening of risk factors for falls was documented in varying rates: electrocardiogram 29%, cognitive impairment 25%, functional assessment 16%, walking difficulties 11%, postural hypotension 5%. A comprehensive geriatric assessment was undertaken for 3.8% of the patients.
  
  
  CONCLUSIONS
  risk factors for falls are insufficiently documented in elderly patients discharged home from the emergency room after a fall-related visit. Completeness rates are similar to those found in previous studies. A standardized protocol for older fallers, specifically adapted to the work routine in the emergency department could be useful. The RENAU has proposed an algorithm to streamline the orientation of older fallers and promote the use of geriatric network.
authors: Service de gériatrie, Centre hospitalier de Chambéry, France.
authors: Sandrine
authors: S
authors: Cabillic
authors: Clinique universitaire de médecine gériatrique. CHU de Grenoble, La Tronche, France, Université Joseph Fourier, Grenoble, France.
authors: Van Mo
authors: VM
authors: Dang
authors: Service des urgences, Renau, Centre hospitalier d'Annecy, Pringy, France.
authors: Cécile
authors: C
authors: Ricard
authors: Service des urgences, Renau, Centre hospitalier d'Annecy, Pringy, France.
authors: Françoise
authors: F
authors: Picot
authors: Service des urgences, Renau, Centre hospitalier d'Annecy, Pringy, France.
authors: François-Xavier
authors: FX
authors: Ageron
authors: Clinique universitaire de médecine gériatrique. CHU de Grenoble, La Tronche, France, Université Joseph Fourier, Grenoble, France.
authors: Pascal
authors: P
authors: Couturier
mesh_terms: D000058:Accidental Falls / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003663:Decision Trees; D004185:Disability Evaluation; D004636:Emergency Service, Hospital / Q000592:standards*; D005260:Female; D005602:France; D019983:Guideline Adherence; D006785:Hospitals, University; D006801:Humans; D008297:Male; D010351:Patient Discharge; D058996:Quality Improvement; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies; D018570:Risk Assessment; D055502:Secondary Prevention; D014947:Wounds and Injuries / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*
keywords: accidental falls; aged; emergency medicine; practice guideline