Heterogeneity of Health Profiles of Older People Presenting to an Accident and Emergency Department With a Fall

Summary 

Background

Falls account for considerable morbidity and mortality among older people. In Hong Kong, various falls prevention programs have been held in recent years, usually as tai chi exercises, for non-targeted groups of older people. We evaluated whether such a falls prevention approach addresses the needs of the elderly who presented to the accident and emergency (A&E) department with a fall.

Methods

Detailed determination of the profile of people aged 60 years and older presenting with a fall to the A&E of a regional hospital over a 1-year period was carried out. Information regarding their health profile including morbidity, comorbidities, medication use, self-perceived health status and body mass index were collected and used for comparison with the health profile of the general elderly population derived from two local large-scale surveys.

Results

A total of 807 elderly fallers completed the comprehensive assessment. Elderly fallers were found to be more frail than the general elderly population in terms of their health profile. Significantly higher proportions of fallers had multiple chronic diseases and took various medications. Fallers were also more likely to perceive their health as poor, and a significantly lower proportion of fallers had a normal body mass index.

Conclusion

Older people presenting with falls at the A&E have multiple health problems and varying degrees of frailty. A homogeneous management pathway may not be appropriate, but rather, the approach should be in the context of management of the frailty syndrome, requiring an individualized approach and taking into account the heterogeneity of their health profile.

Key Words:  accidental falls , comorbidity , frail elderly , prevention and control

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