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The aim of this study was to evaluate the type and frequency of falls presenting to an inner city casualty department, and to identify modifiable risk factors in these patients. A prospective descriptive study evaluated those over 65 years presenting to an inner city casualty department with falls. Over a 4-week recruitment period, all consenting subjects completed a semi-structured questionnaire regarding their falls and cognitive status. Those with unexplained (UF) or recurrent falls (RF) underwent a more detailed assessment: history and examination, gait and balance assessment, visual acuity measurement and neurocardiovascular investigations (including orthostatic blood pressure, carotid sinus massage and head-up tilt testing). Of 200 patients with falls, 188 were interviewed; 29% could recall a reason for falling (accidental) and 30% had UF or RF. A cohort of 26 cognitively normal patients with UF and RF was fully investigated. In 23/26 patients risk factors for falls were found (median: three risk factors). These included: culprit medication (10), gait abnormalities (9) and carotid sinus hypersensitivity (19). Falls are a common presenting complaint yet a fall is readily explained in less than one-third of cases. Investigation of RF and UF has a high yield for possibly modifiable cardiac and non-cardiac risk factors. Targeted multi-disciplinary rapid assessment of patients attending the Accident and Emergency Department because of a fall might reduce the number of hospital admissions.

Falls Presenting to the Accident and Emergency Department: Types of Presentation and Risk Factor Profile