Evaluation of older adult patients with falls in the emergency department: discordance with national guidelines

Objectives: The objective was to examine whether the emergency department (ED) evaluation of older adult fallers is concordant with the Geriatric Emergency Department Guidelines.

Methods: This study was a chart review of randomly selected older adult ED fall patients from one urban academic teaching hospital. Patients 65 years and older who had ED fall visits in 2012 and who had primary care physicians within our hospital network during the past 3 years were included. Transferred patients were excluded. The data collection instrument was adapted from ED fall evaluation recommendations.

Results: There were 350 patients in this study. The mean (±SD) patient age was 80.1 (±8.8) years, 124 (35%) were male, 327 (93%) were white, and 298 (85%) were community dwelling. The range with which history and physical examination findings were concordant with fall guidelines was 1% to 85%. Cause and location of fall were the two most frequently reported history items (85 and 81%, respectively), while asking about baseline vision was only reported 1% of the time. Evaluating for sensory deficits and muscle strength were the two most frequently reported physical examinations (63 and 48%, respectively), while balance was evaluated with the lowest frequency (1%). Patients who received more guideline-recommended evaluations were older with more comorbid conditions and were transferred to an observation unit or admitted to the hospital more frequently. Overall, more than half of these elderly patients (56%) were discharged from the ED to their place of preadmission residence.

Conclusions: The current ED evaluation of older adult fallers is discordant with general and ED-specific fall guidelines. Future studies are warranted to investigate ways to successfully implement fall evaluation guidelines.