• A J Bell, J K Talbot-Stern, and A Hennessy.
• Department of Emergency Medicine, Royal Prince Alfred Hospital, Sydney, NSW.
• Med. J. Aust. 2000 Aug 21;173(4):179-82.

ObjectivesTo study older patients presenting to the emergency department after a fall--factors associated with the fall, injuries sustained and outcome.DesignA retrospective analysis using the Emergency Department Information System (EDIS), the Trauma Registry and the patient information database (CCIS), in addition to the patient's emergency and inpatient medical records.SettingEmergency department of a major inner city teaching hospital, 1 June-30 November 1997.PatientsAll patients over 65 years presenting to the emergency department (ED) after a fall, for whom complete medical records were available.ResultsOf 803 patients over 65 years presenting to the ED after a fall, complete records were available for 733 (91.3%) (283 men and 450 women). Extrinsic (accidental) causes were implicated in more than a third of falls (313 patients [42.7%]). A high proportion of the patients were living at home (520; 70.9%) and walking unaided (389; 53.1%). Although absolute numbers of women increased with age, men were as likely as women to present after a fall. Many patients had fallen before--39% of the men (111/283) and 24% of the women (110/450). In 78 patients (10.6%), alcohol misuse may have been a direct cause of the fall. The overall injury rate was 70.5% (517/733 patients), the most common injury being an isolated fracture (269/517 patients; 52.0%). In all, 419 patients (57.2%) were admitted to hospital, 48% (200/419) with a fracture and 52% (219/419) for investigation of the medical cause of the fall. The median length of hospital stay was 6 days (mean, 10.4 days; range, 1-129 days); 35% (146/419) of patients were in hospital for more than 10 days.ConclusionOlder patients presenting to the ED after a fall had high injury rates, high admission rates and often prolonged hospitalisation. About a third had fallen before. Patients at risk can be identified in the ED and referred to falls prevention programs.

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