Falling Behind? Understanding Implementation Science in Future Emergency Department Management Strategies for Geriatric Fall Prevention

Recently published consensus guidelines for geriatric emergency departments (EDs)1 provide a significant milestone for the nascent subspecialty of geriatric emergency medicine, but real-world challenges reside between guidelines and bedside practice. In this issue of Academic Emergency Medicine, Tirrell et al.2 report a 1-year chart review of 350 randomly selected elderly patients presenting to an urban academic ED following falls. Their primary objective was to determine the extent to which the documented ED evaluation adhered to the Geriatric Emergency Department Guidelines1 and the American Geriatric Society (AGS) guidelines. Only two of the 16 fall-risk evaluation items recommended by the guidelines were reported over 80% of the time: fall location and cause of fall. Most (13 of 16) were reported fewer than 50% of the time, and nine of these fewer than 25% of the time. Four patient-level characteristics were significantly associated with better guideline adherence: older age, more comorbid conditions, residing in an assisted living facility, and admission to either an inpatient or an observation unit. While these findings offer reassurance that individuals deemed at higher risk were more likely to undergo more comprehensive evaluations for falls, there is clearly a missed opportunity to perform more complete risk assessments that may provide critical secondary prevention for falls in individuals at lower risk.