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Fig. 1
Changes in independence 6 months after a fall. Patients were classified in 4 categories according to the initial Katz scale: complete independence (6), partly dependent (4-5), very dependent (2-3), and completely dependent (0-1). Percent of patients in each category are represented as white bars (initial Katz score) and black bars (Katz score at 6 months). Absolute numbers of patients are indicated at the top of each bar.
Abstract
Background
Fall-related morbidity is a serious public health issue in older adults referred to emergency departments (EDs). Emergency physicians mostly focus on immediate injuries, whereas the specific assessment of functional consequences and opportunities for prevention remain scarce. The aim of this study was to determine the factors influencing 6-month independence.
Methods
We used a prospective observational study at the ED of a tertiary teaching hospital over a 6-month period. Uni- and multivariate assessments of factors related to loss of independence were examined.
Results
A total of 367 patients survived to 6 months, mean age was 86 years, and 79% were women. The population was initially healthy and independent. Because this independence reassured the medical staff, more than 42% percent were directly discharged home without any improvement of home facilities; only 63% had recovered their independence at the end of the follow-up. There were 111 patients were hospitalized for 30 days or more. Older patients, initial Katz score, and absence of immediate trauma consequences were associated with an increased risk for loss of independence.
Conclusions
Because prevention is an emerging role of ED, a multidisciplinary team should evaluate fallers and propose medical and environmental changes as required for those discharged after their ED visit.
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☆The study was funded by The Fondation Caisses d'Epargne pour la solidarité and supported by the French Fondation National de Gérontologie and the Assistance Publique des Hôpitaux de Paris.
