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. 2021 Jul 19;22(4):988-999.
doi: 10.5811/westjem.2021.2.49307.

Risk Factors of Fall-Related Emergency Department Visits by Fall Location of Older Adults in the US

Uma Kelekar  1 , Debasree Das Gupta  2 , Jewel Goodman Shepherd  3 , Anupam A Sule  4
Affiliations

Risk Factors of Fall-Related Emergency Department Visits by Fall Location of Older Adults in the US

Uma Kelekar et al. West J Emerg Med. .

Abstract

Introduction: Prior evidence indicates that predictors of older adult falls vary by indoor-outdoor location of the falls. While a subset of United States' studies reports this finding using primary data from a single geographic area, other secondary analyses of falls across the country do not distinguish between the two fall locations. Consequently, evidence at the national level on risk factors specific to indoor vs outdoor falls is lacking.

Methods: Using the 2017 Nationwide Emergency Department Sample (NEDS) data, we conducted a multivariable analysis of fall-related emergency department (ED) visits disaggregated by indoor vs outdoor fall locations of adults 65 years and older (N = 6,720,937) in the US.

Results: Results are compatible with findings from previous primary studies. While women (relative risk [RR] = 1.43, 95% confidence interval [CI], 1.42-1.44) were more likely to report indoor falls, men were more likely to present with an outdoor fall. Visits for indoor falls were highest among those 85 years and older (RR = 2.35, 95% CI, 2.33-2.37) with outdoor fall visits highest among those 84 years and younger. Additionally, the probabilities associated with an indoor fall in the presence of chronic conditions were consistently much higher when compared to an outdoor fall. We also found that residence in metropolitan areas increased the likelihood of an indoor elderly fall compared to higher outdoor fall visits from seniors in non-core rural areas, but both indoor and outdoor fall visits were higher among older adults in higher income ZIP codes.

Conclusion: Our findings highlight the contrasting risk profile for elderly ED patients who report indoor vs outdoor falls when compared to the elderly reporting no falls. In conjunction, we highlight implications from three perspectives: a population health standpoint for EDs working with their primary care and community care colleagues; an ED administrative vantage point; and from an individual emergency clinician's point of view.

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Conflict of interest statement

Conflicts of Interest: By the WestJEM article submission agreement, all authors are required to disclose all affiliations, funding sources and financial or management relationships that could be perceived as potential sources of bias. No author has professional or financial relationships with any companies that are relevant to this study. There are no conflicts of interest or sources of funding to declare.

Figures

Figure 1
Figure 1
Sample extraction and selection/exclusion criteria using the Nationwide Emergency Department Sample (NEDS) 2017. Note: Data extraction and statistical analysis were conducted by the study authors. *No falls = Jumping/diving, and slipping, tripping, stumbling without falling.
Figure 2
Figure 2
Indoor, outdoor, and other falls stratified by gender and age, NEDS* 2017. Rates of indoor, outdoor and “other” falls by gender and by age categories demonstrating a higher incidence of falls among women, advancing with age (for both gender). Note: We calculated the rate for each fall type by dividing the total number of falls in each age/gender category with the total number of population in that age/gender category. *NEDS, Nationwide Emergency Department Sample.
Figure 3
Figure 3
Probabilities of an indoor and outdoor fall in the presence of a chronic condition, NEDS 2017. Note: The complement of the probabilities for each chronic condition is the probability associated with no fall in the presence of the respective chronic condition.
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