Interdisciplinary assessment of elderly people presenting to A&E with a fall

INTRODUCTION:

Falls in elderly people are a major cause of mortality and carry with them substantial cost both to the individual and to health and allied services. There is no agreed approach to the management of falls within the UK but in view of their high prevalence, a clinically effective strategy is required, particularly if we are to achieve. The Health of the Nation target of a 33% reduction in deaths from home accidents in the over 65`s by the year 2005.

METHODOLOGY:

A randomised prospective controlled clinical study was undertaken to investigate the benefit of structured bidisciplinary (medical and OT) assessment of consecutive elderly patients (65 yrs and above) living in the community and presenting to A&E with a fall. Patients in the intervention group underwent a single detailed medical and occupational therapy assessment to identify remediable/modifiable risk factors for falls. Where further evaluation was required, the patient was referred to the relevant specialty . The primary endpoint was the number of subsequent falls in the lyr follow up period, identified by postal questionnaire.

RESULTS:

397 patients were randomised to intervention or control group. Of those undergoing the medical assessment (86% of intervention group), a primary attributable cause was assigned in 77,5% of cases. Only 15,6% of medical assessments and 10% of OT assessments required no further action/intervention. At 12 months there was a significant reduction in the number of falls in the intervention group (173 v 484, p<0.001). In addition, there was a significant difference in functional ability (Barthel score 18 5 v 17.3:p<0.01)

CONCLUSION:

Structured prospective interdisciplinary assessment and management of older people presenting to A&E with falls is of clear benefit in the prevention of subsequent falls and in the preservation of functional ability.