One-Fifth to One-Third of Fall-Injured Seniors Return to the Emergency Department in 90 Days

8/31/2016

The Centers for Disease Control continue to list falls as the leading cause of injury-related emergency department visits, hospitalizations, and deaths for older Americans. Clinicians at the Ohio State University Wexner Medical Center also noticed that patients presenting to the emergency department (ED) for fall injuries seemed highly likely to return to the ED in the following weeks. Dr. Lauren Southerland and colleagues set out to measure and predict that phenomenon. The Journal of the American Geriatric Society published their results last April.¹ They followed 263 patients, age 65+, presenting to the emergency department for fall injuries.

Unfortunately, their suspicions were confirmed. Twenty-two percent of seniors who visit the emergency department after a fall return to the emergency department within 90 days. Eighty percent of these patients were assessed to have related injuries including fractures, head trauma, abrasions, lacerations, or contusions. Researchers performed multivariate analysis including types of injuries, comorbidities, and other factors. They concluded that minor head trauma proves to be the injury most strongly predicting ED recidivism within 90 days. One-third of patients age 65+ who present to the ED with minor head trauma subsequent to a fall return to the ED with another emergency within 90 days.

Dr. Southerland comments that these results suggest opportunities to better protect older patients. She recommends that these patients be referred to home health for observation and assessment, and home safety programs. When ER staff or the primary care physician refers these patients to Five Star Home Health, we can initiate observation and assessment plus a multidisciplinary rehabilitation program designed to protect general patient safety, prevent unnecessary emergent care, and improve patient mobility. Such programs may include:

Nursing observation & assessment
Medication reconciliation & adherence coaching
Gait training
Home safety evaluation
Optimization of daily activities by an occupational therapy

Upper extremity conditioning to help with use of hand rails and assistive devices
Chronic disease management when measures in an uncontrolled status can contribute to falls
Safe falling techniques

Five Star can also provide long-term in-home aide services for safe mobility assistance.

Leading California in Preventing Urgent Care

Medicare’s Home Health Compare shows that Five Star Home Health leads both state and nation in prevention of unplanned emergency room care during the home health episode. Compared to other home health agencies, the patients you refer to Five Star prove 22% less likely to require urgent care.

References

Southerland L, Stephens J, Robinson S, et al. Head trauma from falling increases subsequent emergency department visits more than other fall‐related injuries in older adults. J Am Geriatr Soc. 2016 Apr; 64 (4): 870-4.