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J Am Geriatr Soc. 2015 Apr;63(4):745-9. doi: 10.1111/jgs.13338. Epub 2015 Apr 6.

Managing older adults with ground-level falls admitted to a trauma service: the effect of frailty.

Author information

1
Division of Trauma, Critical Care, Emergency Surgery, and Burns, Department of Surgery, University of Arizona, Tucson, Arizona.

Abstract

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.

KEYWORDS:

discharge disposition; fractures; frailty; ground-level falls; outcomes

PMID:
25851948
DOI:
10.1111/jgs.13338
[Indexed for MEDLINE]

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