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Managing Older Adults with Ground‐Level Falls Admitted to a Trauma Service: The Effect of Frailty
Author(s) -
Joseph Bellal,
Pandit Viraj,
Khalil Mazhar,
Kulvatunyou Narong,
Zangbar Bardiya,
Friese Randall S.,
Mohler M. Jane,
Fain Mindy J.,
Rhee Peter
Publication year - 2015
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.13338
Subject(s) - medicine , trauma center , confidence interval , odds ratio , logistic regression , physical therapy , prospective cohort study , observational study , poison control , rehabilitation , injury prevention , gerontology , emergency medicine , retrospective cohort study
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 .