Maw Pin Tan1,2, Shahrul Bahyah Kamaruzzaman1,2, Mohd Idzwan Zakaria2,3, Ai-Vyrn Chin1,2, Philip Jun Hua Poi1,2. 1. Division of Geriatric Medicine, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia. 2. Aging and Age-Associated Disorders Research Group, University of Malaya, Kuala Lumpur, Malaysia. 3. Academic Unit of Trauma and Emergency Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Abstract
AIM: To determine the dependency scores, long-term mortality and factors associated with mortality in older people presenting to the emergency department (ED) with a fall. METHODS: Information on sociodemographics, dependency using the Barthel index and fall characteristics were collected from consecutive patients attending the ED over a 6-month period. Barthel score was reassessed at 12 months. Ten-year mortality data were obtained through the National Registry Department. RESULTS: A total of 198 participants, with a mean age (standard deviation) of 76.2 years (6.3 years) and 74% women, were recruited. Of these, 70% sustained falls indoors, while 49% of falls occurred between 06.00 to 12.00 hours. Total Barthel scores were significantly lower at 1-year follow up compared with baseline (median [interquartile range], 20 [2] vs 18 [5], P < 0.001). Age ≥75 years was significantly associated with mortality at 1, 3, 5 and 10 years (HR 3.12, 95% CI 1.48-6.56; HR 2.32, 95% CI 1.37-3.92; HR 1.87, 95% CI 1.21-2.88; and HR 2.25, 95% CI 1.60-3.17, respectively). Indoor falls (HR 2.54, 95% CI 1.07-6.06; HR 2.01, 95% CI 1.10-3.69), hospital admission (HR 2.16, 95% CI 1.14-4.10; HR 1.84, 95% CI 1.11-3.07) and Barthel ≤18 (HR 2.99, 95% CI 1.39-6.44; HR 2.47, 95% CI 1.40-4.33) were significantly associated with 1-year and 3-year mortality. Hospital admission (HR 1.94, 95% CI 1.24-3.01; HR 1.53, 95% CI 1.06-2.23) and Barthel ≤18 (HR 2.27, 95% CI 1.41-3.66; HR 1.85, 95% CI 1.27-2.68) remained significantly associated with increased mortality at 5 and 10 years. CONCLUSION: Functional ability is significantly reduced at 1 year after an initial presentation to the ED with a fall. Mortality is increased at 1 and 3 years in fallers who experienced indoor falls. The excess mortality associated with hospital admission and lower disability scores is persistent at 5 and 10 years. The results of the present study are invaluable in prognostication and healthcare decision-making for this group of frail older patients.
AIM: To determine the dependency scores, long-term mortality and factors associated with mortality in older people presenting to the emergency department (ED) with a fall. METHODS: Information on sociodemographics, dependency using the Barthel index and fall characteristics were collected from consecutive patients attending the ED over a 6-month period. Barthel score was reassessed at 12 months. Ten-year mortality data were obtained through the National Registry Department. RESULTS: A total of 198 participants, with a mean age (standard deviation) of 76.2 years (6.3 years) and 74% women, were recruited. Of these, 70% sustained falls indoors, while 49% of falls occurred between 06.00 to 12.00 hours. Total Barthel scores were significantly lower at 1-year follow up compared with baseline (median [interquartile range], 20 [2] vs 18 [5], P < 0.001). Age ≥75 years was significantly associated with mortality at 1, 3, 5 and 10 years (HR 3.12, 95% CI 1.48-6.56; HR 2.32, 95% CI 1.37-3.92; HR 1.87, 95% CI 1.21-2.88; and HR 2.25, 95% CI 1.60-3.17, respectively). Indoor falls (HR 2.54, 95% CI 1.07-6.06; HR 2.01, 95% CI 1.10-3.69), hospital admission (HR 2.16, 95% CI 1.14-4.10; HR 1.84, 95% CI 1.11-3.07) and Barthel ≤18 (HR 2.99, 95% CI 1.39-6.44; HR 2.47, 95% CI 1.40-4.33) were significantly associated with 1-year and 3-year mortality. Hospital admission (HR 1.94, 95% CI 1.24-3.01; HR 1.53, 95% CI 1.06-2.23) and Barthel ≤18 (HR 2.27, 95% CI 1.41-3.66; HR 1.85, 95% CI 1.27-2.68) remained significantly associated with increased mortality at 5 and 10 years. CONCLUSION: Functional ability is significantly reduced at 1 year after an initial presentation to the ED with a fall. Mortality is increased at 1 and 3 years in fallers who experienced indoor falls. The excess mortality associated with hospital admission and lower disability scores is persistent at 5 and 10 years. The results of the present study are invaluable in prognostication and healthcare decision-making for this group of frail older patients.
Authors: Omar Aziz; Jochen Klenk; Lars Schwickert; Lorenzo Chiari; Clemens Becker; Edward J Park; Greg Mori; Stephen N Robinovitch Journal: PLoS One Date: 2017-07-05 Impact factor: 3.240
Authors: Pey June Tan; Ee Ming Khoo; Karuthan Chinna; Nor I'zzati Saedon; Mohd Idzwan Zakaria; Ahmad Zulkarnain Ahmad Zahedi; Norlina Ramli; Nurliza Khalidin; Mazlina Mazlan; Kok Han Chee; Imran Zainal Abidin; Nemala Nalathamby; Sumaiyah Mat; Mohamad Hasif Jaafar; Hui Min Khor; Norfazilah Mohamad Khannas; Lokman Abdul Majid; Kit Mun Tan; Ai-Vyrn Chin; Shahrul Bahyah Kamaruzzaman; Philip Poi; Karen Morgan; Keith D Hill; Lynette MacKenzie; Maw Pin Tan Journal: PLoS One Date: 2018-08-03 Impact factor: 3.240