Managing Older Adults with Ground‐Level Falls Admitted to a Trauma Service: The Effect of Frailty

Objectives To determine whether frail elderly adults are at greater risk of fracture after a ground‐level fall ( GLF ) than those who are not frail. Design Prospective observational study. Setting Level 1 trauma center. Participants All elderly (≥65) adults presenting after a GLF over 1 year (N = 110; mean age ±  SD 79.5 ± 8.3, 54% male). Measurement A Frailty Index ( FI ) was calculated using 50 preadmission frailty variables. Participants with a FI of 0.25 or greater were considered to be frail. The primary outcome measure was a new fracture; 40.1% (n = 45) of participants presented with a new fracture. The secondary outcome was discharge to an institutional facility (rehabilitation center or skilled nursing facility). Multivariate logistic regression was performed. Results Forty‐three (38.2%) participants were frail. The median Injury Severity Score was 14 (range 9–17), and the mean FI was 0.20 ± 0.12. Frail participants were more likely than those who were not frail to have fractures (odds ratio ( OR ) = 1.8, 95% confidence interval ( CI ) = 1.2–2.3, P  = .01). Thirty‐six (32.7%) participants were discharged to an institutional facility. Frail participants were more likely to be discharged to an institutional facility ( OR  = 1.42, 95% CI  = 1.08–3.09, P  = .03) after a GLF . Conclusion Frail individuals have a higher likelihood of fractures and discharge to an institutional facility after a GLF than those who are not frail. The FI may be used as an adjunct for decision‐making when developing a discharge plan for an elderly adult after a GLF .