SGEM#351: How to Stop Geriatrics from Free Fallin’

Date: November 16th, 2021 Reference:  Hammouda et al. Moving the Needle on Fall Prevention: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement. AEM November 2021 Guest Skeptic: Dr. Kirsty Challen (@KirstyChallen) is a Consultant in Emergency Medicine and Emergency Medicine Research Lead at Lancashire Teaching Hospitals Trust (North West England). She is Chair of the Royal College of Emergency Medicine Women in Emergency Medicine group and involved with the RCEM Public Health and Informatics groups. Kirsty is also the creator of the wonderful infographics called #PaperinaPic.  Case: Mid-shift, you realise that the next patient you are about to see is the third in a row aged over 70 who has fallen at home, and that this is her third attendance for a fall in the last two months. You wonder if any emergency department (ED)-based interventions would help her and people like her be safe. Background: We looked at geriatric falls on an SGEM Xtra in 2015. Back then we found that at one academic site older adults attending ED with falls didn't receive guideline-based assessment, risk stratification or management. Dr. Chris Carpenter In 2014 the SGEM looked at a systematic review by Dr. Chris Carpenter, which concluded that there wasn't a good tool to help us predict which ED patients are at risk of recurrent falls (SGEM #89). Close to three million adults aged 65 and over visit American EDs annually after a fall [1]. Falling is the most common cause of traumatic injury resulting in older adults presenting to the ED [2]. Approximately 20% of falls result in injuries, and falls are the leading cause of traumatic mortality in this age group [3-5]. The SAEM Geriatric Emergency Medicine Task Force recognized fall prevention as a priority over 10 years ago. There is the Geriatric Emergency care Applied Research (GEAR) network, which is trying to improve the emergency care of older adults and those with dementia and other cognitive impairments. GEAR looks to identify research gaps in geriatric emergency care support research and evaluation of these areas. GEAR 2.0 has recently been launched with funding opportunity in conjunction with EMF. There are three other GEAR 1.0 manuscripts which have been published: Delirium Prevention, Detection, and Treatment in Emergency Medicine Settings AEM 2020 Care Transitions and Social Needs AEM 2021 Research Priorities for Elder Abuse Screening and Intervention J Elder Abuse Negl 2021 Clinical Question: In older patients presenting to ED with falls do risk stratification or fall prevention interventions influence patient-centered or operational outcomes? Reference:  Hammouda et al. Moving the Needle on Fall Prevention: A Geriatric Emergency Care Applied Research (GEAR) Network Scoping Review and Consensus Statement. AEM November 2021 This publication presents two related but different scoping reviews so there are  two PICOs. PICO #1 Population: Systematic search that found 32 studies of fall prevention interventions for patients aged 60 or over who presented to ED with a fall. Exclusions: Abstracts repeating data already included in full, not original research. Intervention: Fall prevention interventions including multifactorial risk reduction, medication review, exercise training, models of care like Hospital-at-Home. Comparison: Standard of Care. Outcomes: Quality of care ED metrics, ED operational outcomes like length of stay, patient-centered outcomes like ED returns, further falls, fear of falling, functional decline, institutionalization. PICO #2 Population: Systematic search that found 17 studies of risk stratification and falls care plans in patients aged 60 or over in ED or pre-ED settings. Exclusions: As review 1. Intervention: Risk stratification and falls care plan. Comparison: No risk stratification and falls care plan.