Management of fall-related injuries in the elderly: a retrospective chart review of patients presenting to the emergency department of a community-based teaching hospital
- PMID: 20145749
- PMCID: PMC2788319
- DOI: 10.3138/physio.61.1.26
Management of fall-related injuries in the elderly: a retrospective chart review of patients presenting to the emergency department of a community-based teaching hospital
Abstract
Purpose: To identify current practice for elderly individuals who have sustained a fall-related injury and subsequently presented to the emergency department (ED) of a community-based hospital in Toronto, Ontario.
Methods: A retrospective longitudinal chart review was conducted for 300 persons, 65 years of age and older, who presented to the ED of a community-based teaching hospital with a fall from June 2004 through May 2005. Data were collected using a tool created by the investigators (based on information gathered through a literature review) to capture information related to risk factors for falling.
Results: Our study sample was demographically similar to elderly individuals in other fall-related studies. Most patients discharged directly from the ED did not receive multidisciplinary care. In the ED, all patients saw a nurse or physician, while only 1.3% (n = 4) saw a physical therapist, 3.0% (n = 9) saw an occupational therapist, and 5.3% (n = 16) saw a social worker. At discharge, 62% (n = 152) had no documented referral for follow-up care. Abilities related to falls in elderly individuals were not consistently assessed in the ED. Frequency of assessment for these abilities was as follows: (1) gait, 10.2%; (2) balance, 4.1%; (3) lower-extremity range of motion, 4.9%; (4) lower-extremity strength, 2.0%; (5) cognition, 26.1%; (6) vision, 2.0%; (7) ability to perform activities of daily living, 7.3%. In the 6 months following the index fall, 8.3% of patients returned to the ED of the same hospital because of a subsequent fall.
Conclusions: In the ED, fall-related risk factors were not consistently assessed or documented, and few patients received multidisciplinary management. Since elderly individuals who fall commonly present to the ED, the implementation of evidence-based strategies aimed at preventing repeat falls should be considered.
Objectif : Définir les modalités des soins fournis aux personnes âgées qui se sont présentées au service des urgences d'un hôpital communautaire de Toronto, en Ontario, après s'être blessées en tombant.
Méthode : On a procédé à l'analyse rétrospective longitudinale des dossiers de 300 personnes de 65 ans et plus qui s'étaient présentées, de juin 2004 à mai 2005, au service des urgences d'un hôpital communautaire universitaire après avoir fait une chute. La collecte des données s'est effectuée au moyen d'un outil mis au point par les enquêteurs (selon ce qu'a révélé une analyse documentaire), en vue de faire ressortir les facteurs de risque de chute.
Résultats : L'échantillon étudié s'apparentait, sur le plan démographique, à la population des personnes âgées prise en compte dans d'autres études sur le sujet. La plupart des patients qui ont été congédié directement du service des urgences n'ont pas eu accès à des soins multidisciplinaires. Tous ont pu consulter un médecin ou un membre du personnel infirmier, mais à peine 1,3 % (n = 4) ont vu un physiothérapeute, 3,0 % (n = 9), un ergothérapeute et 5,3 % (n = 16), un travailleur social. Au congé, 62 % des patients (n = 152) n'avaient reçu aucune demande de consultation écrite aux fins de suivi. Au service des urgences, les aptitudes jouant un rôle dans les chutes, plutôt que de faire l'objet d'une évaluation systématique, ont été mesurées à des fréquences diverses : (1) démarche = 10,2 %; (2) équilibre = 4,1 %; (3) amplitude de mouvement des membres inférieurs = 4,9 %; (4) force des membres inférieurs = 2,0 %; (5) cognition = 26,1 %; (6) vision = 2,0 %; (7) capacité de d'exécuter les activités de la vie quotidienne = 7,3 %. Au cours des 6 mois qui ont suivi la chute de référence, une autre chute a obligé 8,3 % des patients à se rendre de nouveau au service des urgences du même hôpital.
Conclusions : Les facteurs de risque de chute n'ont pas été systématiquement évalués et/ou documentés, et peu de patients ont bénéficié d'une prise en charge multidisciplinaire après s'être présentés au service des urgences. Comme il est fréquent que des personnes âgées se rendent au service des urgences après une chute, la mise en place de stratégies fondées sur des données probantes et destinées à prévenir les chutes à répétition devrait être envisagée.
Keywords: emergency department management; fall prevention; fall risk; fall-related injuries; falls in the elderly.
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