The epidemiology of elderly falls attended by emergency medical services in Victoria, Australia

Abstract

Background: With an increase in the proportion of older people in the community comes an increase in the demand on emergency medical services (EMS) by elderly patients who have fallen.

Objective: To describe the epidemiology of elderly falls patients attended by EMS in Victoria, Australia and identify predictors of transport and repeat falls.

Methods: A retrospective review included all elderly (age ≥ 65 years) falls patients attended by EMS between 2010 and 2017. Patient characteristics are described using descriptive statistics. Predictors of transport to hospital and repeat falls were identified using multivariable logistic regression analyses.

Results: Between 2010 and 2017 EMS attended 324,060 elderly falls patients, which represents 9.7% of EMS attended workload in Victoria. The median age of patients was 83 years (IQR: 76-88) and 60.2% were female. Comorbidities and medication use were common, while private residence (64.3%) and nursing home (20.0%) were common scene locations. Overall, 78.8% of falls events resulted in transport to hospital by EMS. Predictors of transport to hospital included female gender, one or more pre-existing medical conditions or current medications and meeting the pre-hospital trauma triage criteria or hospital major trauma criteria. To investigate predictors of repeat falls, the follow-up period was restricted to 12-months post initial fall, which resulted in 30,997 patients and 42,873 (13.2%) repeat fall incidents. The median number of days between the initial fall and a second fall was 98 (IQR: 27-206). Predictors of repeat falls included living at a nursing home, one or more pre-existing medical conditions and one or more current medications.

Conclusions: Older falls patients place significant demand on EMS resources in Victoria, Australia, accounting for 9.7% of EMS attendances. Despite high demand, just 3.8% of elderly falls patients received a 'lights and sirens' emergency transport response to hospital. Furthermore, a large number of falls incidents recorded during the study period were repeat falls. Access to alternative pathways of care like GP referral, allied and community health services may benefit this patient group. Development and enrolment into such programs may improve patient outcomes by minimising falls risk and decrease demand on EMS and hospital resources.

Keywords: Ambulance; Elderly; Fall; Injury; Pre-hospital; Repeat falls; Transport.