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. 2023 Sep;71(9):2715-2725.
doi: 10.1111/jgs.18401. Epub 2023 May 24.

Sex differences in mortality of older adults with falls after emergency department consultation: FALL-ER registry

Òscar Miró  1   2 , Adriana Gil-Rodrigo  3   4 , Ana García-Martínez  1 , Sira Aguiló  1 , Xavier Alemany  1 , Christian H Nickel  5 , Javier Jacob  6 , Pere Llorens  3   4   7 , Pablo Herrero  8 , Victoria Torres-Machado  6 , Raquel Cenjor  8 , Blanca Coll-Vinent  1 , Gemma Martínez-Nadal  1 , Montserrat Lázaro Del Nogal  9 , Frank Peacock  10 , Francisco Javier Martín-Sánchez  11
Affiliations

Sex differences in mortality of older adults with falls after emergency department consultation: FALL-ER registry

Òscar Miró et al. J Am Geriatr Soc. 2023 Sep.

Abstract

Background: To investigate if sex is a risk factor for mortality in patients consulting at the emergency department (ED) for an unintentional fall.

Methods: This was a secondary analysis of the FALL-ER registry, a cohort of patients ≥65 years with an unintentional fall presenting to one of 5 Spanish EDs during 52 predefined days (one per week during one year). We collected 18 independent patient baseline and fall-related variables. Patients were followed for 6 months and all-cause mortality recorded. The association between biological sex and mortality was expressed as unadjusted and adjusted hazard ratios (HR) with the 95% confidence interval (95% CI), and subgroup analyses were performed by assessing the interaction of sex with all baseline and fall-related mortality risk variables.

Results: Of 1315 enrolled patients (median age 81 years), 411 were men (31%) and 904 women (69%). The 6-month mortality was higher in men (12.4% vs. 5.2%, HR = 2.48, 95% CI = 1.65-3.71), although age was similar between sexes. Men had more comorbidity, previous hospitalizations, loss of consciousness, and an intrinsic cause for falling. Women more frequently lived alone, with self-reported depression, and the fall results in a fracture and immobilization. Nonetheless, after adjustment for age and these eight divergent variables, older men aged 65 and over still showed a significantly higher mortality (HR = 2.19, 95% CI = 1.39-3.45), with the highest risk observed during the first month after ED presentation (HR = 4.18, 95% CI = 1.31-13.3). We found no interaction between sex and any patient-related or fall-related variables with respect to mortality (p > 0.05 in all comparisons).

Conclusions: Male sex is a risk factor for death following ED presentation for a fall in the older population adults aged 65 and over. The causes for this risk should be investigated in future studies.

Keywords: death; emergency; falls; gender equity; older.

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References

REFERENCES

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    1. Miró O, Brizzi BN, Aguiló S, et al. Profile of older patients attended in the emergency department after falls: a FALL-ER registry study of the magnitude of the problem and opportunities for improving hospital emergency care. Emergencias. 2018;30:231-240.
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