title: Ten-year mortality in older patients attending the emergency department after a fall.
abstract: OBJECTIVE
  To determine the dependency scores, long-term mortality and factors associated with mortality in older people presenting to the emergency department (ED) with a fall.
  
  
  METHODS
  Information on sociodemographics, dependency using the Barthel index and fall characteristics were collected from consecutive patients attending the ED over a 6-month period. Barthel score was reassessed at 12 months. Ten-year mortality data were obtained through the National Registry Department.
  
  
  RESULTS
  A total of 198 participants, with a mean age (standard deviation) of 76.2 years (6.3 years) and 74% women, were recruited. Of these, 70% sustained falls indoors, while 49% of falls occurred between 06.00 to 12.00 hours. Total Barthel scores were significantly lower at 1-year follow up compared with baseline (median [interquartile range], 20 [2] vs 18 [5], P < 0.001). Age ≥75 years was significantly associated with mortality at 1, 3, 5 and 10 years (HR 3.12, 95% CI 1.48-6.56; HR 2.32, 95% CI 1.37-3.92; HR 1.87, 95% CI 1.21-2.88; and HR 2.25, 95% CI 1.60-3.17, respectively). Indoor falls (HR 2.54, 95% CI 1.07-6.06; HR 2.01, 95% CI 1.10-3.69), hospital admission (HR 2.16, 95% CI 1.14-4.10; HR 1.84, 95% CI 1.11-3.07) and Barthel ≤18 (HR 2.99, 95% CI 1.39-6.44; HR 2.47, 95% CI 1.40-4.33) were significantly associated with 1-year and 3-year mortality. Hospital admission (HR 1.94, 95% CI 1.24-3.01; HR 1.53, 95% CI 1.06-2.23) and Barthel ≤18 (HR 2.27, 95% CI 1.41-3.66; HR 1.85, 95% CI 1.27-2.68) remained significantly associated with increased mortality at 5 and 10 years.
  
  
  CONCLUSIONS
  Functional ability is significantly reduced at 1 year after an initial presentation to the ED with a fall. Mortality is increased at 1 and 3 years in fallers who experienced indoor falls. The excess mortality associated with hospital admission and lower disability scores is persistent at 5 and 10 years. The results of the present study are invaluable in prognostication and healthcare decision-making for this group of frail older patients.
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Aging and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Maw Pin
authors.initials: MP
authors.lastname: Tan
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Aging and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Shahrul Bahyah
authors.initials: SB
authors.lastname: Kamaruzzaman
authors.affiliation: Aging and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia.|Academic Unit of Trauma and Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Mohd Idzwan
authors.initials: MI
authors.lastname: Zakaria
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Aging and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Ai-Vyrn
authors.initials: AV
authors.lastname: Chin
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.|Aging and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia.
authors.forename: Philip Jun Hua
authors.initials: PJ
authors.lastname: Poi
mesh_terms: D000058:Accidental Falls / Q000401:mortality*; D000203:Activities of Daily Living; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008297:Male; D012042:Registries; D012307:Risk Factors; D012959:Socioeconomic Factors; D015996:Survival Rate; D013997:Time Factors
keywords: accidental falls; aged; disability; fractures; mortality