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{ "pk": 15796, "title": "Falls in Older Adults Requiring Emergency Services: Mortality, Use of Healthcare Resources, and Prognostication to One Year", "subtitle": null, "abstract": "Introduction: Older adults who fall commonly require emergency services, but research on long-term outcomes and prognostication is sparse. We evaluated older adults transported by ambulance after a fall in the Northwestern United States (US) and longitudinally tracked subsequent healthcare use, transitions to skilled nursing, hospice, mortality, and prognostication to one year. Methods: This was a planned secondary analysis of a cohort study of community-dwelling older adults enrolled from January 1–December 31, 2011, with follow-up through December 31, 2012. We included all adults ≥ 65 years transported by 44 emergency medical services agencies in seven Northwest counties to 51 hospitals after a fall. We matched Medicare claims, state inpatient data, state trauma registry data, and death records. Outcomes included mortality, healthcare use, and new claims for skilled nursing and hospice to one year. Results: There were 3,159 older adults, with 147 (4.7%) deaths within 30 days and 665 (21.1%) deaths within one year. There was an initial spike in inpatient days, followed by increases in skilled nursing and hospice. We identified four predictors of mortality: respiratory diagnosis; serious brain injury; baseline disability; and Charlson Comorbidity Index ≥ 2. Having any of these predictors was 96.6% sensitive (95% confidence interval [CI]: 95.7, 97.5%) and 21.4% specific (95% CI: 19.9, 22.9%) for 30-day mortality, and 91.6% sensitive (95% CI: 89.5, 93.8%). and 23.8% specific (95% CI: 22.1, 25.5%) for one-year mortality.Conclusion: Community-dwelling older adults requiring ambulance transport after a fall have marked increases in healthcare use, institutionalized living, and mortality over the subsequent year. Most deaths occur following the acute care period and can be identified with high sensitivity at the time of the index visit, yet with low specificity. [West J Emerg Med. 2022;22(3)375–385.]", "language": "en", "license": { "name": "Creative Commons Attribution 4.0", "short_name": "CC BY 4.0", "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.", "url": "https://creativecommons.org/licenses/by/4.0" }, "keywords": [ { "word": "Emergency medical services, injury, longitudinal cohort, prognostication, geriatrics" } ], "section": "Geriatrics", "is_remote": true, "remote_url": "https://escholarship.org/uc/item/4zb98381", "frozenauthors": [ { "first_name": "Craig", "middle_name": "D.", "last_name": "Newgard", "name_suffix": "", "institution": "Oregon Health & Science University, Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Portland, Oregon", "department": "None" }, { "first_name": "Amber", "middle_name": "", "last_name": "Lin", "name_suffix": "", "institution": "Oregon Health & Science University, Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Portland, Oregon", "department": "None" }, { "first_name": "Aaron", "middle_name": "B.", "last_name": "Caughey", "name_suffix": "", "institution": "Oregon Health & Science University, Department of Obstetrics and Gynecology, Portland, Oregon", "department": "None" }, { "first_name": "K. John", "middle_name": "", "last_name": "McConnell", "name_suffix": "", "institution": "Oregon Health & Science University, Center for Health Systems Effectiveness, Department of Emergency Medicine, Portland, Oregon", "department": "None" }, { "first_name": "Eileen", "middle_name": "", "last_name": "Bulger", "name_suffix": "", "institution": "University of Washington, Department of Surgery, Seattle, Washington", "department": "None" }, { "first_name": "Susan", "middle_name": "", "last_name": "Malveau", "name_suffix": "", "institution": "Oregon Health & Science University, Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Portland, Oregon", "department": "None" }, { "first_name": "Kristan", "middle_name": "", "last_name": "Staudenmayer", "name_suffix": "", "institution": "Stanford University Medical Center, Department of Surgery, Palo Alto, California", "department": "None" }, { "first_name": "Denise", "middle_name": "", "last_name": "Griffiths", "name_suffix": "", "institution": "Oregon Health & Science University, Center for Policy and Research in Emergency Medicine, Department of Emergency Medicine, Portland, Oregon", "department": "None" }, { "first_name": "Elizabeth", "middle_name": "", "last_name": "Eckstrom", "name_suffix": "", "institution": "Oregon Health & Science University, Division of General Internal Medicine & Geriatrics, Portland, Oregon", "department": "None" } ], "date_submitted": "2021-08-03T17:51:21+01:00", "date_accepted": "2021-08-03T17:51:21+01:00", "date_published": "2022-05-14T08:00:00+01:00", "render_galley": null, "galleys": [ { "label": "", "type": "pdf", "path": "https://journalpub.escholarship.org/westjem/article/15796/galley/7914/download/" } ] }