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Aleid A, Bin Shuiel HK, Alyabis NA, Alfaraj AH, Dahlan DJ, Alkhatib FM, Alotaibi MN, Almulhim KN, Al Mutair A. Predictors and Outcomes of Falls in Older Adults Presenting to the Emergency Room in Saudi Arabia: A Cross-Sectional Analysis. Cureus 2023; 15:e47122. [PMID: 38022272 PMCID: PMC10648449 DOI: 10.7759/cureus.47122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Saudi Arabia is witnessing a demographic shift characterized by a rising elderly population. Cases of fall in this demographic have emerged as a significant health concern, especially in emergency room (ER) settings. Despite this, there is limited research on the causes and outcomes of such incidents. This study intends to bridge the gap in understanding the factors leading to falls in elderly patients presenting to ERs and the subsequent outcomes. Such understanding is pivotal for the formulation of effective prevention strategies and enhanced healthcare services for the elderly. METHODS To achieve the study's objectives, we employed SPSS software for Windows, version 28.0 (IBM Corp., Armonk, NY) for data analysis. We collected demographic information, including age, gender, education, employment status, and location, to measure patient satisfaction with the quality and responsiveness of emergency care, using Likert scale responses via electronic survey conducted as a cross-sectional study from January 2023 to August 2023, summarizing it using descriptive statistics. We analyzed categorical variables by frequencies and percentages. Chi-square tests were utilized to examine differences in distribution across categories for fall factors, and a p-value below 0.05 was deemed significant. Through logistic regression, we pinpointed the predictors of falls among older adults, showcasing the strength and direction of these relationships. Adjusted odds ratios with 95% confidence intervals were documented. A perception survey was also conducted to evaluate ER patient satisfaction. RESULTS Our results shed light on various aspects of fall prevention and emergency care. There was a pronounced representation in age groups of 18-24 and 25-34 years, indicating the need for interventions tailored to different age groups. Patterns were identified where subjects engaged in limited physical activity and consumed alcohol infrequently. Mobility and balance problems were commonly found, stressing the need to address these issues. Chronic conditions such as hypertension and diabetes correlated with fall incidents. Additionally, sociodemographic factors like gender, education, and employment status played a role in influencing the risk of falls. Although age and location seemed to have a less pronounced effect, there exists an opportunity to enhance communication and patient participation in emergency care for improved experiences. CONCLUSION The findings from our study provide crucial insights into the prevention of falls and enhancement of emergency care for Saudi Arabia's elderly population. By revealing the intricate relationships between sociodemographic attributes, health indicators, chronic ailments, and incidents of falls, we emphasize the need for well-rounded interventions. There is a pressing requirement for comprehensive fall prevention initiatives tailored to specific risk groups. Additionally, improving ER services is integral to ensuring the safety and well-being of older adults. This research can serve as a foundational resource for healthcare professionals and policymakers to devise robust strategies to reduce fall-related injuries and elevate the quality of emergency care outcomes.
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Affiliation(s)
| | | | - Nouf A Alyabis
- Emergency Medicine, College of Medicine, Alfaisal University, Riyadh, SAU
| | - Anwar H Alfaraj
- Emergency Medicine, College of Medicine, Dar Al-Uloom University, Riyadh, SAU
| | - Dana J Dahlan
- Emergency Medicine, Batterjee Medical College, Jeddah, SAU
| | - Fawaz M Alkhatib
- Emergency Medicine, College of Medicine, Umm Al-Qura University, Makkah, SAU
| | - Muteb N Alotaibi
- Emergency Medicine, College of Medicine, Alfaisal University, Riyadh, SAU
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Yang C, Lang L, He Z, Hui J, Jiang J, Gao GY, Feng JF. Epidemiological Characteristics of Older Patients with Traumatic Brain Injury in China. J Neurotrauma 2022; 39:850-859. [PMID: 35171687 DOI: 10.1089/neu.2021.0275] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Increasing traumatic brain injury (TBI) among older adults constitutes a substantial socioeconomic burden, in step with the growing aging global population. Here, we aimed to investigate the profile of geriatric TBI in the CENTER-TBI China registry, a prospective observational study conducted in 56 centers of 22 provinces across China. Patients admitted to the hospital with a clinical diagnosis of TBI were enrolled in the study. Data on demographic characteristics, injury, clinical features, treatments, and survival at discharge were collected and assessed. The primary endpoint was survival state at discharge. We analyzed a total of 2415 patients aged ≥65 years, accounting for 18.34% of the overall population. The median age was 72 years (interquartile range [IQR]: 68-78), and 1588 (65.76%) were men. Incidental falls (n=1044, 43.23%) were the leading cause of TBI, followed by road traffic injuries (n=1034, 42.82%). Roads and homes were the main sites of injury. The median Glasgow Coma Scale (GCS) score was 13 (IQR: 9-15); 1397 (57.85%) patients had mild TBI (GCS 13-15), while 530 (21.95%) and 488 (20.21%) presented with moderate (GCS 9-12) and severe TBI (sTBI; GCS 3-8), respectively. A total of 546 (22.61%) patients underwent intracranial surgery. The overall in-hospital mortality rate was 8.24% (n=199), and most survivors were transferred home. This study revealed that the demographic patterns and injury mechanisms are changing among elderly patients with TBI in China. More attention should be given to the high incidence of geriatric TBI to improve prevention and management strategies.
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Affiliation(s)
- Chun Yang
- Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, People's Republic of China., Department of Neurosurgery, 160 Pujian Road, Shanghai, Shanghai, China, 200127;
| | - Lijian Lang
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, 71140, Neurosurgery, Shanghai, Shanghai, China;
| | - Zhenghui He
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, 71140, Neurosurgery, Shanghai, Shanghai, China;
| | - Jiyuan Hui
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, 71140, Neurosurgery, Shanghai, Shanghai, China;
| | - Jiyao Jiang
- Shanghai Jiao Tong University School of Medicine Affiliated Renji Hospital, 71140, Department of Neurosurgery, Shanghai, China.,Shanghai Institute of Head Trauma, Shanghai, China;
| | - Guo-Yi Gao
- Shanghai General Hospital, 12482, Department of Neurosurgery, Shanghai, China;
| | - Jun-Feng Feng
- Renji hospital, Shanghai Jiaotong University, Neurosurgery Department, No.1630, Dongfang Road, Shanghai, China, 200127;
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Shagerdi G, Ayatollahi H, Hemmat M. Emergency care for the elderly: A review of the application of health information technology. HEALTH POLICY AND TECHNOLOGY 2021. [DOI: 10.1016/j.hlpt.2021.100592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Rod JE, Oviedo-Trespalacios O, Senserrick T, King M. Older adult pedestrian trauma: A systematic review, meta-analysis, and GRADE assessment of injury health outcomes from an aggregate study sample of 1 million pedestrians. ACCIDENT; ANALYSIS AND PREVENTION 2021; 152:105970. [PMID: 33578216 DOI: 10.1016/j.aap.2021.105970] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 11/06/2020] [Accepted: 12/30/2020] [Indexed: 06/12/2023]
Abstract
This systematic review sought to assess older adult pedestrian injury severity, injury by anatomical location and incidence proportions, including comparisons to younger age groups when available and provide an analysis of the quality of the existing evidence. A structured search was conducted in PubMed, Embase, Scopus, CINAHL, PsycInfo, AMED, Web of Science, LILACS and TRID. STROBE was used to assess the reporting quality of the included studies. Random-effect model meta-analysis served to obtain pooled relative risk, incidence proportions and standardized mean differences for different outcomes due to pedestrian crashes comparing older and younger pedestrians, while meta-analyses could not be conducted for pedestrian falls. We screened 7460 records of which 60 studies (1,012,041 pedestrians) were included in the review. Injured pedestrians 60+ compared to those <60 were found to have a higher relative risk of severe injury (pooled relative risk RR 1.6, 95 % CI: 1.4-2.0 p < 0.001), critical care admission (pooled RR 1.5, 95 %CI: 1.3-1.8 p < 0.001), and fatality (pooled RR of 3.7, 95 % CI: 3.0-4.5 p < 0.001). Pedestrians 60+ also had higher incidence rates of pedestrian falls causing higher injury severity. GRADE was used to evaluate evidence quality, with the results suggesting that the overall quality of the evidence supporting these findings was low. Further research is needed to understand health risks associated with older pedestrian trauma and to develop effective risk management strategies.
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Affiliation(s)
- J E Rod
- Centre for Accident Research and Road Safety Queensland (CARRS-Q), Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Centre for Future Mobility, Brisbane, Queensland, Australia.
| | - Oscar Oviedo-Trespalacios
- Centre for Accident Research and Road Safety Queensland (CARRS-Q), Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Centre for Future Mobility, Brisbane, Queensland, Australia
| | - Teresa Senserrick
- Centre for Accident Research and Road Safety Queensland (CARRS-Q), Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Centre for Future Mobility, Brisbane, Queensland, Australia
| | - Mark King
- Centre for Accident Research and Road Safety Queensland (CARRS-Q), Queensland University of Technology (QUT), Brisbane, Queensland, Australia; Queensland University of Technology (QUT), Centre for Future Mobility, Brisbane, Queensland, Australia
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Yaghmaei E, Ehwerhemuepha L, Feaster W, Gibbs D, Rakovski C. A multicenter mixed-effects model for inference and prediction of 72-h return visits to the emergency department for adult patients with trauma-related diagnoses. J Orthop Surg Res 2020; 15:331. [PMID: 32795327 PMCID: PMC7427714 DOI: 10.1186/s13018-020-01863-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 08/04/2020] [Indexed: 11/10/2022] Open
Abstract
Objective Emergency department (ED) return visits within 72 h may be a sign of poor quality of care and entail unnecessary use of healthcare resources. In this study, we compare the performance of two leading statistical and machine learning classification algorithms, and we use the best performing approach to identify novel risk factors of ED return visits. Methods We analyzed 3.2 million ED encounters with at least one diagnosis under “injury, poisoning and certain other consequences of external causes” and “external causes of morbidity.” These encounters included patients 18 years or older from across 128 emergency room facilities in the USA. For each encounter, we calculated the 72-h ED return status and retrieved 57 features from demographics, diagnoses, procedures, and medications administered during the process of administration of medical care. We implemented a mixed-effects model to assess the effects of the covariates while accounting for the hierarchical structure of the data. Additionally, we investigated the predictive accuracy of the extreme gradient boosting tree ensemble approach and compared the performance of the two methods. Results The mixed-effects model indicates that certain blunt force and non-blunt trauma inflates the risk of a return visit. Notably, patients with trauma to the head and patients with burns and corrosions have elevated risks. This is in addition to 11 other classes of both blunt force and non-blunt force traumas. In addition, prior healthcare resource utilization, patients who have had one or more prior return visits within the last 6 months, prior ED visits, and the number of hospitalizations within the 6 months are associated with increased risk of returning to the ED after discharge. On the one hand, the area under the receiver characteristic curve (AUROC) of the mixed-effects model was 0.710 (0.707, 0.712). On the other hand, the gradient boosting tree ensemble had a lower AUROC of 0.698 CI (0.696, 0.700) on the independent test model. Conclusions The proposed mixed-effects model achieved the highest known AUC and resulted in the identification of novel risk factors. The model outperformed one of the leading machine learning ensemble classifiers, the extreme gradient boosting tree in terms of model performance. The risk factors we identified can assist emergency departments to decrease the number of unplanned return visits within 72 h.
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Affiliation(s)
- Ehsan Yaghmaei
- CHOC Children's, Orange, CA, 92868, USA.,Schmid College of Science & Technology, Chapman University, Orange, CA, USA
| | - Louis Ehwerhemuepha
- CHOC Children's, Orange, CA, 92868, USA. .,Schmid College of Science & Technology, Chapman University, Orange, CA, USA.
| | | | | | - Cyril Rakovski
- Schmid College of Science & Technology, Chapman University, Orange, CA, USA
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O' Keeffe A, O' Grady S, Cronin F, Dolan C, O' Hea A, O' Shea KL, Naughton C. Evaluation of an emergency department falls pathway for older people: A patient chart review. Int Emerg Nurs 2020; 51:100869. [PMID: 32354620 DOI: 10.1016/j.ienj.2020.100869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 10/24/2022]
Abstract
The number of older adults presenting to EDs following a fall continues to rise, yet falls management often ignores opportunities for secondary falls risk reduction. Advanced Nurse Practitioners (ANPs) in EDs have an important clinical leadership role in improving outcomes for this group of patients. AIM This study describes the development of an ANP led falls pathway in an ED to improve safe discharge. It evaluates compliance with the pathway and referrals to community falls prevention services. It also draws comparison with baseline practice as recorded in 2014. METHODS The Falls Pathway involves four steps: 1) screening at triage (3 questions), 2) risk stratification (low, medium, high), 3) risk assessment (lying and standing blood pressure (B/P), timed-up and go (TUG), 4-AT for delirium screening, polypharmacy), and 4) referral to community falls services. We undertook a 12-month chart review of all patients aged 65 years or older presenting following a fall to the ANP service in 2018. We compared data to a baseline audit in 2014; descriptive and Chi squared statistics were used to examine the data. RESULTS The 2018 audit involved 77 patients representing 27% of ANP caseload. A repeat fall occurred in 42% (32/77) of cases and 35% (22/77) reported a fear of falling. The Falls Pathway was initiated in nearly 80% (62/77) of patients and compliance with falls risk assessment ranged from 42% for lying and standing B/P to 75% for TUG. In 2014, a review of 59 patient charts showed 27% (16/59) experienced a repeat fall, but other risk factors such as fear of falling were not recorded. In 2018, the majority of patients (88%) discharged home were referred to community falls prevention services compared to 22% in 2014. CONCLUSION The Falls Pathway improved falls risk assessment in the ED, identified opportunities for risk reduction and optimised referral to community falls services. The pathway continues to be a valuable tool but requires resources for ongoing implementation among the wider ED team.
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Affiliation(s)
| | - Sile O' Grady
- Mercy University Hospital, Cork City, Co Cork, Ireland.
| | - Finola Cronin
- North Lee Community Health, Cork City, Co Cork, Ireland.
| | - Clodagh Dolan
- Mercy University Hospital, Cork City, Co Cork, Ireland.
| | - Ann O' Hea
- Mercy University Hospital, Cork City, Co Cork, Ireland.
| | - Katie Louise O' Shea
- School of Nursing and Midwifery, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork T12 AK54, Ireland.
| | - Corina Naughton
- UCC School of Nursing and Midwifery, Professor in Clinical Nursing in Older Person HealthCare, School of Nursing and Midwifery, College of Medicine and Health, Brookfield Health Sciences Complex, University College Cork, College Road, Cork T12 AK54, Ireland.
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7
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van Schoor NM, Dennison E, Castell MV, Cooper C, Edwards MH, Maggi S, Pedersen NL, van der Pas S, Rijnhart JJM, Lips P, Deeg DJH. Clinical osteoarthritis of the hip and knee and fall risk: The role of low physical functioning and pain medication. Semin Arthritis Rheum 2020; 50:380-386. [PMID: 32199610 DOI: 10.1016/j.semarthrit.2020.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 02/13/2020] [Accepted: 02/13/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Several studies have found an increased fall risk in persons with osteoarthritis (OA). However, most prospective studies did not use a clinical definition of OA. In addition, it is not clear which factors explain this risk. Our objectives were: (1) to confirm the prospective association between clinical OA of the hip and knee and falls; (2) to examine the modifying effect of sex; and (3) to examine whether low physical performance, low physical activity and use of pain medication are mediating these relationships. METHODS Baseline and 1-year follow-up data from the European Project on OSteoArthritis (EPOSA) were used involving pre-harmonized data from five European population-based cohort studies (ages 65-85, n = 2535). Clinical OA was defined according to American College of Rheumatology (ACR) criteria. Falls were assessed using self-report. RESULTS Over the follow-up period, 27.7% of the participants fell once or more (defined as faller), and 9.8% fell twice or more (recurrent faller). After adjustment for confounding, clinical knee OA was associated with the risk of becoming a recurrent faller (relative risk=1.55; 95% confidence interval: 1.10-2.18), but not with the risk of becoming a faller. No associations between clinical hip OA and (recurrent) falls were observed after adjustment for confounding. Use of opioids and analgesics mediated the associations between clinical OA and (recurrent) falls, while physical performance and physical activity did not. CONCLUSION Individuals with clinical knee OA were at increased risk for recurrent falls. This relationship was mediated by pain medication, particularly opioids. The fall risk needs to be considered when discussing the risk benefit ratio of prescribing these medications.
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Affiliation(s)
- N M van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands.
| | - E Dennison
- University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - M V Castell
- Doctor Castroviejo Health Center, Northern Health Care Directorate of the Community of Madrid, Medicine Department, Family Medicine and Primary Care Division, School of Medicine, Autonoma University of Madrid, Hospital La Paz Institute for Health Research (IdiPAZ) Madrid, Spain
| | - C Cooper
- University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - M H Edwards
- University of Southampton, Southampton General Hospital, Southampton, United Kingdom
| | - S Maggi
- National Research Council, Neuroscience Institute, Padua, Italy
| | | | - S van der Pas
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands; University of Applied Sciences Leiden, Leiden, the Netherlands
| | - J J M Rijnhart
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
| | - P Lips
- Department of Internal Medicine, Endocrine Section, VU University Medical Center, Amsterdam, the Netherlands
| | - D J H Deeg
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, the Netherlands
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Judd MA. Commingled crypts: Comparative health among Byzantine monastics in the Levant. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2020; 172:70-86. [PMID: 31907930 DOI: 10.1002/ajpa.23993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 11/13/2019] [Accepted: 12/18/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Early Byzantine (A.D. 330-842) monastic rules stipulated that entrants relinquished familial connections, personal belongings and secular relationships to become part of the ascetic collective that continued in death, resulting in bioarchaeological marginalization, as was the case of the monastics excavated from the Chapel of Robebus at Mount Nebo, Jordan (ca. A.D. 491-640). It was hypothesized that compared to contemporary monastic groups, the Mount Nebo monastics experienced poorer health and gravitated to Mount Nebo, owing to its association with the Prophet Moses and proximity to the Dead Sea, Livias baths and Jordan River, all associated with curative benefits, especially for those suffering from leprosy. MATERIALS AND METHODS The commingled remains of 73 adult males from Mount Nebo and the articulated skeletons (n = 27) from the Sanctuary of Agios Lot at Deir 'Ain 'Abata (Jordan) were assessed for paleopathology, then compared with a contemporary commingled group from the Monastery of Saint Euthymius at Khan-el-Ahmar (Judean Desert) (n = 117). RESULTS No skeletal evidence of leprosy was observed among the groups. Most Mount Nebo individuals did not reach an older age, yet injuries, severe osteoarthritis, lower leg osteoperiostitis and antemortem tooth loss were common. The paleopathological profile was similar at Deir 'Ain 'Abata, but paleopathology was negligible at Khan-el-Ahmar. CONCLUSIONS The similar paleopathological profiles of the Jordanian monastic groups suggest that the proximity to the Dead Sea may have attracted monastics to both sites, in addition to spirituality, but leprosy was not a factor based on the skeletal evidence.
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Affiliation(s)
- Margaret A Judd
- Department of Anthropology, University of Pittsburgh, Pittsburgh, Pennsylvania
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9
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Sheikh S. Risk Factors Associated with Emergency Department Recidivism in the Older Adult. West J Emerg Med 2019; 20:931-938. [PMID: 31738721 PMCID: PMC6860386 DOI: 10.5811/westjem.2019.7.43073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/29/2019] [Accepted: 07/28/2019] [Indexed: 01/09/2023] Open
Abstract
Our objective was to review risk factors predictive of older adult recidivism in the emergency department. Certain risk factors and themes commonly occurred in the literature. These recurring factors included increasing age, male gender, certain diagnoses (abdominal pain, traumatic injuries, and respiratory complaints), psychosocial factors (depression, anxiety, poor social support, and limited health literacy), and poor general health (cognitive health and physical functioning). Many of the identified risk factors are not easily modifiable posing a significant challenge in the quest to develop and implement effective intervention strategies.
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Affiliation(s)
- Sophia Sheikh
- University of Florida-Jacksonville, Department of Emergency Medicine, Jacksonville, Florida
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10
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Teo DB, Wong HC, Yeo AW, Lai YW, Choo EL, Merchant RA. Characteristics of fall-related traumatic brain injury in older adults. Intern Med J 2019; 48:1048-1055. [PMID: 29573078 DOI: 10.1111/imj.13794] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 03/14/2018] [Accepted: 03/14/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Older adults admitted for falls and its complications, including traumatic brain injury (TBI), is increasing. Recent studies have shown that those with falls who presented to the emergency department (ED) had an increased frequency of ED revisits, especially those with head trauma. AIM To determine the characteristics and predictors of fall-related traumatic brain injury (FRTBI) in older adults. METHODS Retrospective medical chart review of 339 patients aged 65 years and older admitted for TBI in 2014 due to a fall. Characteristics analysed include demographics, fall circumstances, prior ED visits, polypharmacy, readmission, functional status and specialist outpatient clinic utilisation before and after FRTBI. RESULTS A total of 339 (37.4%) patients admitted due to FRTBI was 65 years old and older; 112 (33.0%) for subdural haemorrhage (SDH); 227 (67.0%) for head injury (HI), with a mean age of 80 years. A total of 46 (41.1%) patients with SDH and 107 (47.1%) with HI had a previous ED visit within the last year, while 22 (19.6%) of SDH and 49 (21.6%) of HI had hospitalisation 3 months prior to FRTBI. FRTBI was associated with significant decline in activities of daily living, polypharmacy and increased specialist outpatient clinic appointments (P < 0.001). Mortality was 11 (3.2%). Mild cognitive impairment or dementia was significantly associated with admissions for FRTBI, 3.31 (95% confidence interval 1.68-6.51, P = 0.001) using adjusted logistic regression. CONCLUSION FRTBI is associated with significant functional decline and increased resource utilisation with almost half of the patients having had prior ED visits or hospitalisation. Future studies should focus on falls risk assessment and interventions for high-risk older adults prior to discharge from ED and hospital, and its impact on readmissions due to FRTBI.
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Affiliation(s)
- Desmond B Teo
- Divisions of Advanced Internal Medicine, University Medicine Cluster, National University Hospital, National University Healthcare System, Singapore, Singapore
| | - Hung C Wong
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ai W Yeo
- Department of Nursing, National University Hospital, National University Healthcare System, Singapore, Singapore
| | - Yi W Lai
- Dean's Office, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Ee L Choo
- Management Information, Corporate Planning and Development, National University Hospital, National University Healthcare System, Singapore, Singapore
| | - Reshma A Merchant
- Divisions of Geriatric Medicine, University Medicine Cluster, National University Hospital, National University Healthcare System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Hsia RY, Markowitz AJ, Lin F, Guo J, Madhok DY, Manley GT. Ten-year trends in traumatic brain injury: a retrospective cohort study of California emergency department and hospital revisits and readmissions. BMJ Open 2018; 8:e022297. [PMID: 30552250 PMCID: PMC6303631 DOI: 10.1136/bmjopen-2018-022297] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/21/2018] [Accepted: 10/05/2018] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To describe visits and visit rates of adults presenting to emergency departments (EDs) with a diagnosis of traumatic brain injury (TBI). TBI is a major cause of death and disability in the USA; yet, current literature is limited because few studies examine longer-term ED revisits and hospital readmission patterns of TBI patients across a broad spectrum of injury severity, which can help inform potential unmet healthcare needs. DESIGN We performed a retrospective cohort study. SETTING We analysed non-public patient-level data from California's Office of Statewide Health Planning and Development for years 2005 to 2014. PARTICIPANTS We identified 1.2 million adult patients aged ≥18 years presenting to California EDs and hospitals with an index diagnosis of TBI. PRIMARY AND SECONDARY OUTCOME MEASURES Our main outcomes included revisits, readmissions and mortality over time. We also examined demographics, mechanism and severity of injury and disposition at discharge. RESULTS We found a 57.7% increase in the number of TBI ED visits, representing a 40.5% increase in TBI visit rates over the 10-year period (346-487 per 100 000 residents). During this time, there was also a 33.8% decrease in the proportion of patients admitted to the hospital. Older, publicly insured and black populations had the highest visit rates, and falls were the most common mechanism of injury (45.5% of visits). Of all patients with an index TBI visit, 40.5% of them had a revisit during the first year, with 46.7% of them seeking care at a different hospital from their initial hospital or ED visit. Additionally, of revisits within the first year, 13.4% of them resulted in hospital readmission. CONCLUSIONS The large proportion of patients with TBI who are discharged directly from the ED, along with the high rates of revisits and readmissions, suggest a role for an established system for follow-up, treatment and care of TBI.
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Affiliation(s)
- Renee Y Hsia
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, California, USA
| | - Amy J Markowitz
- Brain and Spinal Injury Center (BASIC), University of California, San Francisco, San Francisco, California, USA
| | - Feng Lin
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California, USA
| | - Joanna Guo
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Debbie Y Madhok
- Department of Emergency Medicine, University of California, San Francisco, San Francisco, California, USA
| | - Geoffrey T Manley
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA
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12
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Characteristics and outcomes of older adults presented to Spanish emergency departments after a fall. Eur Geriatr Med 2018; 9:631-640. [PMID: 34654232 DOI: 10.1007/s41999-018-0103-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/27/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To study patient profile, fall-related characteristics and immediate outcomes according to age and to determine the effect of age in the outcomes among older patients presenting to ED after a fall. METHODS Cross-sectional analysis of the FALL-ER registry that included patients aged ≥ 65 years old that presented to five Spanish EDs after a fall. Patients were classified into three age categories, and demographic, comorbidity, chronic medication, fall-related characteristics, health care resources and immediate outcomes data were analysed. RESULTS We included 1610 patients, 541 (28%) aged 65-74, 647 (40.2%) aged 74-84 and 512 (31.8%) aged ≥ 85 years old. Indoor falls, with no witnesses, at night and due to non-identified causes were significantly more likely among the oldest old. Medications related to risk of falling and antithrombotic therapy significantly increased with age category. Physical, functional and psychological consequences and healthcare resource use increased significantly with age group. Age was independently associated with severe injury (adjusted OR 1.02; IC 95% 1.01-1.04), fear of falling (adjusted OR 1.02; IC 95% 1.01-1.04) and acute functional impairment (adjusted OR 1.02; IC 95% 1.00-1.04). CONCLUSIONS Indoor falls, with no witnesses, at night and due to non-identified causes were significantly more likely among the oldest old. The probability of presenting with severe injury, fear of falling and acute functional impairment increases with age.
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Arnaud M, Pariente A, Bezin J, Bégaud B, Salvo F. Risk of Serious Trauma with Glucose-Lowering Drugs in Older Persons: A Nested Case-Control Study. J Am Geriatr Soc 2018; 66:2086-2091. [DOI: 10.1111/jgs.15515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Mickael Arnaud
- Pharmacoepidemiology Team, Bordeaux Population Health Research Center, Inserm; University of Bordeaux; Bordeaux France
| | - Antoine Pariente
- Pharmacoepidemiology Team, Bordeaux Population Health Research Center, Inserm; University of Bordeaux; Bordeaux France
- Service de Pharmacologie Médicale; Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
| | - Julien Bezin
- Pharmacoepidemiology Team, Bordeaux Population Health Research Center, Inserm; University of Bordeaux; Bordeaux France
- Service de Pharmacologie Médicale; Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
| | - Bernard Bégaud
- Pharmacoepidemiology Team, Bordeaux Population Health Research Center, Inserm; University of Bordeaux; Bordeaux France
- Service de Pharmacologie Médicale; Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
| | - Francesco Salvo
- Pharmacoepidemiology Team, Bordeaux Population Health Research Center, Inserm; University of Bordeaux; Bordeaux France
- Service de Pharmacologie Médicale; Centre Hospitalier Universitaire de Bordeaux; Bordeaux France
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Turgut K, Sarihan ME, Colak C, Güven T, Gür A, Gürbüz S. Falls from height: A retrospective analysis. World J Emerg Med 2018; 9:46-50. [PMID: 29290895 DOI: 10.5847/wjem.j.1920-8642.2018.01.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Emergency services manage trauma patients frequently and falls from height comprise the main cause of emergency service admissions. In this study, we aimed to analyse the demographic characteristics of falls from height and their relationship to the mortality. METHODS A total of 460 patients, who admitted to the Emergency Department of Inonu University between November 2011 and November 2014 with a history of fall from height, were examined retrospectively. Demographic parameters, fall characteristics and their effect to mortality were evaluated statistically. RESULTS The study comprised of 292 (63.5%) men and 168 (36.5%) women patients. The mean age of all patients was 27±24.99 years. Twenty-six (5.6%) patients died and the majority of them were in ≥62 years old group. The highest percentage of falls was at 0-5 years age group (28.3%). People fell mainly from 1.1-4 metres(m) level (46.1%). The causes of falls were ordered as unintentional (92.2%), workplace (8.1%) and suicidal (1.7%). Skin and soft tissue injuries (37.4%) were the main traumatic lesions. CONCLUSION Age, fall height, fall place, lineer skull fracture, subarachnoidal hemorrhage, cervical fracture, thoracic vertebra fracture and trauma scores had statistically significant effect on mortality. The casualties died because of subarachnoid hemorrhage mostly.
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Affiliation(s)
- Kasim Turgut
- Department of Emergency Medicine, Education and Research Hospital, Adiyaman University, Adiyaman, Turkey
| | - Mehmet Ediz Sarihan
- Department of Emergency Medicine, School of Medicine, Inonu University, Malatya, Turkey
| | - Cemil Colak
- Department of Biostatistics and Medical Informatics, School of Medicine, Inonu University, Malatya, Turkey
| | - Taner Güven
- Department of Emergency Medicine, School of Medicine, Inonu University, Malatya, Turkey
| | - Ali Gür
- Department of Emergency Medicine, School of Medicine, Inonu University, Malatya, Turkey
| | - Sükrü Gürbüz
- Department of Emergency Medicine, School of Medicine, Inonu University, Malatya, Turkey
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