title: Managing older adults with ground-level falls admitted to a trauma service: the effect of frailty.
abstract: OBJECTIVE
  To determine whether frail elderly adults are at greater risk of fracture after a ground-level fall (GLF) than those who are not frail.
  
  
  METHODS
  Prospective observational study.
  
  
  METHODS
  Level 1 trauma center.
  
  
  METHODS
  All elderly (≥65) adults presenting after a GLF over 1 year (N = 110; mean age ± SD 79.5 ± 8.3, 54% male).
  
  
  METHODS
  A Frailty Index (FI) was calculated using 50 preadmission frailty variables. Participants with a FI of 0.25 or greater were considered to be frail. The primary outcome measure was a new fracture; 40.1% (n = 45) of participants presented with a new fracture. The secondary outcome was discharge to an institutional facility (rehabilitation center or skilled nursing facility). Multivariate logistic regression was performed.
  
  
  RESULTS
  Forty-three (38.2%) participants were frail. The median Injury Severity Score was 14 (range 9-17), and the mean FI was 0.20 ± 0.12. Frail participants were more likely than those who were not frail to have fractures (odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.2-2.3, P = .01). Thirty-six (32.7%) participants were discharged to an institutional facility. Frail participants were more likely to be discharged to an institutional facility (OR = 1.42, 95% CI = 1.08-3.09, P = .03) after a GLF.
  
  
  CONCLUSIONS
  Frail individuals have a higher likelihood of fractures and discharge to an institutional facility after a GLF than those who are not frail. The FI may be used as an adjunct for decision-making when developing a discharge plan for an elderly adult after a GLF.
authors: Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.
authors: Bellal
authors: B
authors: Joseph
authors: Viraj
authors: V
authors: Pandit
authors: Mazhar
authors: M
authors: Khalil
authors: Narong
authors: N
authors: Kulvatunyou
authors: Bardiya
authors: B
authors: Zangbar
authors: Randall S
authors: RS
authors: Friese
authors: M Jane
authors: MJ
authors: Mohler
authors: Mindy J
authors: MJ
authors: Fain
authors: Peter
authors: P
authors: Rhee
mesh_terms: D000058:Accidental Falls; D000368:Aged; D005260:Female; D050723:Fractures, Bone / Q000628:therapy*; D016330:Frail Elderly; D006801:Humans; D016015:Logistic Models; D008297:Male; D064887:Observational Studies as Topic; D010351:Patient Discharge; D011446:Prospective Studies; D014193:Trauma Centers; D015599:Trauma Severity Indices
keywords: discharge disposition; fractures; frailty; ground-level falls; outcomes