180-Day functional decline among older patients attending an emergency department after a fall
Por:
Miro, O, Brizzi, B, Aguilo, S, Alemany, X, Jacob, J, Llorens P, Puente, P, Machado, V, Cenjor, R, Gil, A, Rico, V, Carretero, M, Cuccolini, L, Nadal, G, Perez, C, del Nogal, M, Platts-Mills, T and Martin-Sanchez, F
Publicada:
1 nov 2019
Resumen:
Objectives: To determine functional changes and factors affecting 180-day functional prognosis among older patients attending a hospital emergency department (ED) after a fall.
Study design: Retrospective analysis from a prospective cohort study (FALL-ER Registry) spanning one year that included individuals aged >= 65 years attending four Spanish EDs after a fall. We collected 9 baseline and 6 fall-related factors.
Main outcome measures: Barthel Index (BI) was measured at baseline, discharge and 30, 90 and 180 days after the index fall. Absolute and relative BI changes were calculated. Absolute difference >= 10 of points between BI at baseline and at 180 days was considered a clinically significant functional decline.
Results: 452 patients (mean age 80 +/- 8 years; 70.8% women) were included. Baseline BI was 79.3 +/- 23.1 points. Compared with baseline, functional status was significantly lower at the 4 follow-up time points (-8.7% at discharge; and -6.9%, -7.9% and -9.5% at 30, 90 and 180 days; p < 0.001 for all comparisons in relation to baseline; p = 0.001 for change over time). One hundred and thirty-three (29.6%) patients had a clinically significant functional decline at 180 days. Age >= 85 years (OR = 2.24, 95%CI 1.23-4.08; p = 0.008), fall-related fracture (OR = 2.45, 95%CI 1.43-4.28; p = 0.001), hospitalization (OR = 1.91; 95%CI 1.11-3.29; p = 0.019) and post-fall syndrome (OR = 1.77, 95%CI 1.13-2.77; p = 0.013) were independently associated with 180-day clinically significant functional decline.
Conclusion: Patients >= 65 years attending EDs after a fall experience a consistent and persistent negative impact on their functional status. Several factors may help identify patients at increased risk of functional impairment.
Filiaciones:
Miro, O:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain
Univ Barcelona, Barcelona, Spain
Brizzi, B:
Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Aguilo, S:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain
Alemany, X:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain
Jacob, J:
Hosp Bellvitge Princeps Espanya, Emergency Dept, Madrid, Catalonia, Spain
Llorens P:
Hosp Univ Gen Alicante, Short Stay Unit, Emergency Dept, Alicante, Spain
Hosp Univ Gen Alicante, Hospitalizat Home, Alicante, Spain
Miguel Hemdndez Univ, Alicante, Spain
Puente, P:
Hosp Cent Asturias, Emergency Dept, Oviedo, Spain
Machado, V:
Hosp Bellvitge Princeps Espanya, Emergency Dept, Madrid, Catalonia, Spain
Cenjor, R:
Hosp Cent Asturias, Emergency Dept, Oviedo, Spain
:
Hosp Univ Gen Alicante, Short Stay Unit, Emergency Dept, Alicante, Spain
Hosp Univ Gen Alicante, Hospitalizat Home, Alicante, Spain
Rico, V:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain
Carretero, M:
Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Cuccolini, L:
Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Nadal, G:
Hosp Clin Barcelona, Emergency Dept, Barcelona, Spain
Perez, C:
Hosp Clin San Carlos, Prevent Dept, Madrid, Spain
del Nogal, M:
Hosp Clin San Carlos, Dept Geriatr, Madrid, Spain
Platts-Mills, T:
Univ N Carolina, Dept Emergency Med, Chapel Hill, NC 27515 USA
Martin-Sanchez, F:
Hosp Clin San Carlos, Emergency Dept, Madrid, Spain
Univ Complutense Madrid, Madrid, Spain
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