Survey of Fall History and Fall Risk Factors in Ambulatory Geriatric Emergency Department Patients

OBJECTIVES: To determine the prevalence of and correlated risk factors for reported falls in the last year in an ambulatory population of elderly Emergency Department (ED) patients. METHODS: A convenience sampling, cross-sectional survey of community dwelling elderly patients presenting to an academic ED for any reason except a fall and discharged to home. History of fall within the past year and risk factors for falls previously described in community settings were elicited via a 10 minute standardized interview. A brief functional assessment observing ability to stand and sit, walk raising feet and turn 180 degrees was also performed. RESULTS: 263 patients were enrolled. The mean age was 76 years with 80% Caucasian and 64% female. 39% reported a fall and 15% fell more than once. Among fallers, 22% were injurious falls with fractures and contusions predominant. 44% demonstrated a borderline or abnormal functional assessment test. The risk factors most significantly correlated with having fallen within the past 12 months include dementia (OR 3.80), near falls (OR 3.40), abnormal functional assessment (OR 2.48), ED visits in last six months (OR 2.30), depression (OR 2.16) and non-drivers (OR 1.71). The presence of urinary incontinence, cane-assisted ambulation, objective auditory or visual deficits and diabetes were not significantly associated with reported falls. CONCLUSIONS: Several previously described fall risk factors are significantly associated with reported falls in elderly ED patients. Also, significant risk factors not previously described include non-driver status and recent ED utilization. The prospective evaluation of these identified risk factors will permit the development of an ED fall risk assessment tool.