Bedside Assessment of Fall Risk in Emergency Department Elders

Falls are one of the most significant health risks to older Americans. In the U.S., 30-60% of community dwelling elders will fall each year.Studies have found rates of serious injury among elders who fall to range from 5-24%. Five percent of those who fall are hospitalized. Among elders, falls cause 2/3 of the deaths due to unintentional injury, the 6th leading cause of death in this age group. Additional major morbidity due to falls includes loss of independence as well as anxiety due to fear of falling. This results in limitation of function and often in a requirement for long-term care. Up to 40% of nursing home admissions are due to falls or fear of falling. Expenditures for fall-related injuries account for 6% of all medical expenditures in geriatric patients. Several interventions have been proven effective to reduce rates of fall. Implementation of these interventions requires physician appreciation of the risk for falls in individual patients. The emergency department (ED) may provide a location to identify patients at increased risk of falling. Unfortunately, successful ED based studies to identify and intervene on at-risk elders have been rare and not widely reproducible. The results of these previous ED studies demonstrate that a rapid, efficient, measurable assessment of balance is required if emergency physicians are to regularly consider such factors in their care plans and disposition decisions. Development of a single, simple screening test to identify ED elders at who fall may improve falls screening in the ED and prevent unnecessary morbidity and mortality by facilitating early identification and intervention.