Long-Term Outcomes of Ground-Level Falls in the Elderly

Details

• Personal Author:
  Ayoung-Chee P ; Ebel BE ; Mack CD ; Maier RV ; McCormick W ; McIntyre L
• Description:
  BACKGROUND: For older adults, even ground-level falls (GLFs) can result in multiple injuries and are associated with significant morbidity and mortality. Previous studies have focused on in-hospital outcomes and patients with isolated injuries. Our study examined outcomes following discharge for older adults who were hospitalized following a GLF. METHODS: A retrospective cohort study of patients older than 65 years admitted to a regional Level I trauma center, from 2005 to 2008, after a GLF was conducted. Hospital trauma registry data were linked to state hospital discharge data and the death certificate registry. Skilled nursing facilities (SNFs) were contacted to verify ultimate patient placement, with follow-up through December 2010. Kaplan-Meier and Cox proportional hazards models were used to analyze postdischarge mortality. RESULTS: There were 1,352 consecutive admissions; 48% had an Injury Severity Score (ISS) greater than 15, and 12% died during admission. Of the patients who survived hospitalization, 51% were discharged to an SNF, 33% to home without assistance, 6% to home with assistance, and 5% to inpatient rehabilitation facilities. Within 1 year of injury, 44.6% of the patients were readmitted. The 1-year mortality for the overall cohort was 33%; for patients who were discharged alive, the 1-year mortality was 24%. After adjusting for confounders, patients discharged to an SNF had a threefold greater risk of 1-year mortality (hazard ratio, 2.82; 95% confidence interval, 1.86-4.28), compared with patients discharged home with no assistance. Of the patients discharged to an SNF, 48% died by the end of the follow-up period (mean, 28.2 months), and 61% of these patients died while residing at an SNF. CONCLUSION: GLFs in the elderly result in severe injury, high rate of readmissions, and increased mortality, both in-hospital and after discharge. Overall, only one third of the patients were discharged home to independent living. Future efforts should examine whether improvements in the quality of posthospital care affect both mortality and functional outcomes. LEVEL OF EVIDENCE: Prognostic and epidemiologic study, level III. [Description provided by NIOSH]
• Subjects:
  Accidental Falls Accidents Aging Cohort Studies Delivery Of Health Care Morbidity Mortality Occupational Health Safety
• Keywords:
  Age Groups Author Keywords: Geriatric Trauma Cohort Studies Falls Medical Care Morbidity Rates Mortality Rates Outcomes Traumatic Injuries
• ISSN:
  2163-0755
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article
• Place as Subject:
  New York ; OSHA Region 10 ; OSHA Region 2 ; Washington
• CIO:
  National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health
• Location:
  North America
• Pages in Document:
  498-503
• Volume:
  76
• Issue:
  2
• NIOSHTIC Number:
  nn:20055416
• Citation:
  J Trauma Acute Care Surg 2014 Feb; 76(2):498-503
• Contact Point Address:
  Patricia Ayoung-Chee, MD, MPH, Department of Surgery, New York University School of Medicine, 550 First Ave, NB15N1, New York, NY 10016
• Email:
  Patricia.Ayoung-Chee@nyumc.org
• Federal Fiscal Year:
  2014
• Performing Organization:
  University of Washington
• Peer Reviewed:
  True
• Start Date:
  20050701
• Source Full Name:
  The Journal of Trauma and Acute Care Surgery
• End Date:
  20250630
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:31d366721c6b67d367df048ade48bda2a02a912f0785270e2806c221a8c35da92a4d5edff5c5b4d623ad343956a781741d9612b24270a61649838ec3e31bfcfc
• Download URL:
  https://stacks.cdc.gov/view/cdc/213275/cdc_213275_DS1.pdf
• File Type:
  [PDF - 266.12 KB ]