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Miró Ò, Gil-Rodrigo A, García-Martínez A, Aguiló S, Alemany X, Nickel CH, Jacob J, Llorens P, Herrero P, Torres-Machado V, Cenjor R, Coll-Vinent B, Martínez-Nadal G, Del Nogal ML, Peacock F, Martín-Sánchez FJ. Sex differences in mortality of older adults with falls after emergency department consultation: FALL-ER registry. J Am Geriatr Soc 2023; 71:2715-2725. [PMID: 37224385 DOI: 10.1111/jgs.18401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 04/07/2023] [Accepted: 04/19/2023] [Indexed: 05/26/2023]
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.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain
- University of Barcelona, Catalonia, Spain
| | - Adriana Gil-Rodrigo
- Emergency Department, Short Stay Unit and Hospitalization at Home, Dr. Balmis General University Hospital, Alicante, Spain
- Institute for Health and Biomedical Research, Alicante, Spain
| | | | - Sira Aguiló
- Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | - Xavier Alemany
- Emergency Department, Hospital Clínic, Barcelona, Catalonia, Spain
| | | | - Javier Jacob
- Emergency Department, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home, Dr. Balmis General University Hospital, Alicante, Spain
- Institute for Health and Biomedical Research, Alicante, Spain
- Miguel Hernández University, Elche, Alicante, Spain
| | - Pablo Herrero
- Emergency Department, Hospital Central de Asturias, Oviedo, Spain
| | - Victoria Torres-Machado
- Emergency Department, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Raquel Cenjor
- Emergency Department, Hospital Central de Asturias, Oviedo, Spain
| | | | | | | | - Frank Peacock
- Henry JN Taub Emergency Department, Baylor College of Medicine, Houston, Texas, USA
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Fernández Alonso C, Lázaro Del Nogal M, Quintela Jorge Ó, Santiago-Sáez AE. [Suspicion of chemical submission in older subjects attending a hospital emergency department]. Rev Esp Geriatr Gerontol 2020; 55:354-357. [PMID: 32718580 DOI: 10.1016/j.regg.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/30/2020] [Indexed: 06/11/2023]
Abstract
Chemical Submission (CS) is considered a danger to health and a form of violence. There are different forms of proactive CS (involuntary consumption of psychoactive substances) and opportunistic CS (voluntary consumption), with criminal intent, usually theft, submission, or sexual assault. The objective of this work is to describe the characteristics of cases of suspected CS in adults older than 65 years treated in the Emergency Department of the San Carlos Clinical Hospital and the results of the toxicological analysis performed by the INTCF in Madrid (April 1, 2015-2019). There were 12 (8%) cases of suspected CS, with a mean age of 75 (SD 8) years, of which 8 (66.7%) men, with two different profiles, all associated with theft, and in 3 (25%) possible sexual assault. In 9 (75%) cases, benzodiazepines and / or usual drugs were identified. CS is a problem to consider in Emergency Departments and is not exclusive to the young population.
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Affiliation(s)
- Cesáreo Fernández Alonso
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España; Comisión Contra la Violencia, Hospital Clínico San Carlos, Madrid, España.
| | - Montserrat Lázaro Del Nogal
- Servicio de Geriatría, Hospital Clínico San Carlos, Madrid, España; Comisión Contra la Violencia, Hospital Clínico San Carlos, Madrid, España
| | - Óscar Quintela Jorge
- Servicio de Química, Instituto Nacional de Toxicología y Ciencias Forenses (INTCF)
| | - Andres E Santiago-Sáez
- Servicio de Medicina Legal, Hospital Clínico San Carlos, Madrid, España; Comisión Contra la Violencia, Hospital Clínico San Carlos, Madrid, España
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Miró Ò, Brizzi BN, Aguiló S, Alemany X, Jacob J, Llorens P, Herrero Puente P, Torres Machado V, Cenjor R, Gil A, Rico V, Álvarez Carretero M, Cuccolini L, Martínez Nadal G, Fernández Pérez C, Lázaro Del Nogal M, Platts-Mills TF, Martín-Sánchez FJ. 180-Day functional decline among older patients attending an emergency department after a fall. Maturitas 2019; 129:50-56. [PMID: 31547913 DOI: 10.1016/j.maturitas.2019.08.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2018] [Revised: 05/12/2019] [Accepted: 08/14/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To determine functional changes and factors affecting 180-day functional prognosis among older patients attending a hospital emergency department (ED) after a fall. STUDY DESIGN Retrospective analysis from a prospective cohort study (FALL-ER Registry) spanning one year that included individuals aged ≥65 years attending four Spanish EDs after a fall. We collected 9 baseline and 6 fall-related factors. MAIN OUTCOME MEASURES Barthel Index (BI) was measured at baseline, discharge and 30, 90 and 180 days after the index fall. Absolute and relative BI changes were calculated. Absolute difference of ≥10 points between BI at baseline and at 180 days was considered a clinically significant functional decline. RESULTS 452 patients (mean age 80 ± 8 years; 70.8% women) were included. Baseline BI was 79.3 ± 23.1 points. Compared with baseline, functional status was significantly lower at the 4 follow-up time points (-8.7% at discharge; and -6.9%, -7.9% and -9.5% at 30, 90 and 180 days; p < 0.001 for all comparisons in relation to baseline; p = 0.001 for change over time). One hundred and thirty-three (29.6%) patients had a clinically significant functional decline at 180 days. Age ≥85 years (OR = 2.24, 95%CI 1.23-4.08; p = 0.008), fall-related fracture (OR = 2.45, 95%CI 1.43-4.28; p = 0.001), hospitalization (OR = 1.91; 95%CI 1.11-3.29; p = 0.019) and post-fall syndrome (OR = 1.77, 95%CI 1.13-2.77; p = 0.013) were independently associated with 180-day clinically significant functional decline. CONCLUSION Patients ≥65 years attending EDs after a fall experience a consistent and persistent negative impact on their functional status. Several factors may help identify patients at increased risk of functional impairment.
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Affiliation(s)
- Òscar Miró
- Emergency Department, Hospital Clínic, Barcelona, Spain; University of Barcelona, Spain
| | | | - Sira Aguiló
- Emergency Department, Hospital Clínic, Barcelona, Spain
| | | | - Javier Jacob
- Emergency Depatment, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Pere Llorens
- Emergency Department, Short Stay Unit and Hospitalization at Home, Hospital Universitario General de Alicante, Spain; Miguel Hernández University, Elche, Alicante, Spain
| | | | - Victoria Torres Machado
- Emergency Depatment, Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain
| | - Raquel Cenjor
- Emergency Department, Hospital Central de Asturias, Oviedo, Spain
| | - Adriana Gil
- Emergency Department, Short Stay Unit and Hospitalization at Home, Hospital Universitario General de Alicante, Spain
| | - Verònica Rico
- Emergency Department, Hospital Clínic, Barcelona, Spain
| | | | - Lucía Cuccolini
- Emergency Department, Hospital Clínico San Carlos, Madrid, Spain
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Miró Ò, Nayla Brizzi B, Aguiló S, Alemany X, Jacob J, Llorens P, Herrero Puente P, González Ramón B, Castro Jiménez V, Torres Machado V, Cenjor R, Gil A, Rico V, Martínez Nadal G, Lázaro Del Nogal M, Martín-Sánchez FJ. 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 2019; 30:231-240. [PMID: 30033696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVES To profile patients aged 65 years or older who are attended in a hospital emergency department after falls. To describe the falls, their severity, and factors relevant to recommended preventive measures. MATERIAL AND METHODS The FALL-ER is a multipurpose, multicenter prospective registry of a systematically described cohort of patients aged 65 years or older attended in 5 hospital emergency departments on 52 days of the same year. We collected data on 68 independent variables. Patients were classified according to whether they had received recommendations related to preventing falls in any of the following categories: exercise, education on fall prevention, referral to a specialist or changes in medication. RESULTS . A total of 1507 patients or carers were interviewed (93.6% of the 1610 patients in the registry). The cohort was of advanced age and had high rates of comorbidity, polypharmacy, and history of geriatric syndromes. The majority of falls occurred during the day and in the patients home. Half the falls were not witnessed. Forty-eight percent of the patients reported fear of falling, 22% had acute functional impairment, 16% were admitted, and 0.6% died in the hospital. Recommendations directed to preventing falls were received by 509 (33.8%) cases. Loss of hearing acuity, self-reported cognitive impairment, emergency first aid at the site of the fall, fear of falling again, acute functional impairment, and hospitalization were associated with a greater likelihood of receiving recommendations for preventing falls. Loss of visual acuity was associated with a lower likelihood of receiving recommendations. CONCLUSION Only a third of elderly patients attended in an emergency department after falls receive recommendations that target preventing further falls. Certain patient and fall characteristics are associated with a greater likelihood of receiving such recommendations.
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Affiliation(s)
- Òscar Miró
- Área de Urgencias, Hospital Clínic, Barcelona, España. Universitat de Barcelona, Barcelona, España
| | | | - Sira Aguiló
- Área de Urgencias, Hospital Clínic, Barcelona, España
| | | | - Javier Jacob
- Servicio de Urgencias. Hospital de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Pere Llorens
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital Universitario General de Alicante, España. Universidad Miguel Hernández, Elche, Alicante, España
| | - Pablo Herrero Puente
- Servicio de Urgencias. Hospital Central de Asturias, España. Instituto de Investigación Sanitaria del Principado de Asturias, Asturias, España
| | | | | | | | - Raquel Cenjor
- Servicio de Urgencias. Hospital Central de Asturias, España
| | - Adriana Gil
- Servicio de Urgencias, Corta Estancia y Hospitalización a Domicilio, Hospital Universitario General de Alicante, España
| | - Verònica Rico
- Área de Urgencias, Hospital Clínic, Barcelona, España
| | | | - Montserrat Lázaro Del Nogal
- Unidad de Caídas. Servicio de Geriatría del Hospital Clínico San Carlos. Madrid, España. Facultad de Medicina de la Universidad Complutense, Madrid, España
| | - Francisco Javier Martín-Sánchez
- Servicio de Urgencias, Hospital Clínico San Carlos, Madrid, España. Facultad de Medicina de la Universidad Complutense, Madrid, España. Instituto de Investigación Sanitaria Hospital Clínico San Carlos (IdISSC), Madrid, España
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Martín-Sánchez FJ, Nayla Brizzi B, Aguiló Mir S, Lázaro Del Nogal M. Author's reply. Emergencias 2019; 31:71-72. [PMID: 30656885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
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Duaso E, Casas A, Formiga F, Lázaro Del Nogal M, Salvà A, Marcellán T, Navarro C. [Falls and osteoporotic fractures prevention units: proposed Osteoporosis, Falls and Fractures Group of the Spanish Society of Geriatrics and Gerontology]. Rev Esp Geriatr Gerontol 2011; 46:268-274. [PMID: 21945012 DOI: 10.1016/j.regg.2011.05.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 05/19/2011] [Accepted: 05/26/2011] [Indexed: 05/31/2023]
Abstract
Since forming the Osteoporosis, Falls and Fractures Group of the Spanish Society (GOCF) of Geriatrics and Gerontology (SEGG) a review was performed of the epidemiology of falls, along with a description of measures that have shown a degree of effectiveness in prevention. We also present the proposal of a common basic model of action in fall prevention units, mainly addressed to the community. Finally, a consensus model falls register is presented, common to community level and institutional areas, with the objective of being useful and easy to fill in at any care level.
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Affiliation(s)
- Enric Duaso
- Servicio de Geriatría, Consorcio Sanitario de Igualada, Barcelona, España.
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