Long-term outcomes of ground-level falls in the elderly.
BACKGROUND
For older adults, even ground-level falls (GLFs) can result in multiple injuries and are associated with significant morbidity and mortality. Previous studies have focused on in-hospital outcomes and patients with isolated injuries. Our study examined outcomes following discharge for older adults who were hospitalized following a GLF.


METHODS
A retrospective cohort study of patients older than 65 years admitted to a regional Level I trauma center, from 2005 to 2008, after a GLF was conducted. Hospital trauma registry data were linked to state hospital discharge data and the death certificate registry. Skilled nursing facilities (SNFs) were contacted to verify ultimate patient placement, with follow-up through December 2010. Kaplan-Meier and Cox proportional hazards models were used to analyze postdischarge mortality.


RESULTS
There were 1,352 consecutive admissions; 48% had an Injury Severity Score (ISS) greater than 15, and 12% died during admission. Of the patients who survived hospitalization, 51% were discharged to an SNF, 33% to home without assistance, 6% to home with assistance, and 5% to inpatient rehabilitation facilities. Within 1 year of injury, 44.6% of the patients were readmitted. The 1-year mortality for the overall cohort was 33%; for patients who were discharged alive, the 1-year mortality was 24%. After adjusting for confounders, patients discharged to an SNF had a threefold greater risk of 1-year mortality (hazard ratio, 2.82; 95% confidence interval, 1.86-4.28), compared with patients discharged home with no assistance. Of the patients discharged to an SNF, 48% died by the end of the follow-up period (mean, 28.2 months), and 61% of these patients died while residing at an SNF.


CONCLUSIONS
GLFs in the elderly result in severe injury, high rate of readmissions, and increased mortality, both in-hospital and after discharge. Overall, only one third of the patients were discharged home to independent living. Future efforts should examine whether improvements in the quality of posthospital care affect both mortality and functional outcomes.


METHODS
Prognostic and epidemiologic study, level III.
From the Department of Surgery (P.A.-C.), New York University School of Medicine, New York, New York; Departments of Surgery (L.M., R.V.M.), Pediatrics (B.E.E.), and Epidemiology (B.E.E.), Division of Gerontology and Geriatric Medicine (W.M.), Department of Medicine, and Harborview Injury Prevention and Research Center (B.E.E.), University of Washington; and Group Health Research Institute (C.D.M.), Seattle, Washington.
Patricia
P
Ayoung-Chee
Lisa
L
McIntyre
Beth E
BE
Ebel
Christopher D
CD
Mack
Wayne
W
McCormick
Ronald V
RV
Maier
D000058:Accidental Falls / Q000401:mortality* / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D003266:Continuity of Patient Care; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009104:Multiple Trauma / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy; D010351:Patient Discharge / Q000706:statistics & numerical data; D010359:Patient Readmission / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome