Elderly have three-times greater mortality after falls than younger patients

In the largest analysis of trauma patients experiencing ground-level falls, investigators discovered that about 4.5% of patients aged 70 years or older died after such a fall compared with 1.5% of nonelderly patients.

Using records in the National Trauma Data Bank, investigators from the University of Rochester Medical Center in New York identified, 57,302 patients who experienced ground-level falls between 2001 and 2005. The patients had a mean injury severity score of 8 ±5. The investigators found an overall mortality rate of 3.2%, according to the study abstract. However, there was a significantly higher mortality rate among the elderly patients studied, the investigators wrote.

“There is the potential to minimize what people see as a relatively trivial issue, such as slipping and falling on a wet tile floor,” Julius Cheng, MD, MPH, an investigator for the study, stated in a University of Rochester Medical Center press release. “Our research shows that falls from low levels shouldn’t be underestimated in terms of how bad they can be, especially in older patients.”

Additional findings

The pre-existing conditions some elderly adults have, such as heart disease, may make them more vulnerable to these unintentional falls.

“An 80-year-old often can’t tolerate and recover from trauma like a 20-year-old,” Cheng stated in the release.

The study also revealed that elderly patients who had low-level falls remained hospitalized or in the intensive care unit longer than younger patients. According to the release, 22% of elderly patients could function independently after discharge vs. 41% of non-elderly patients.

Paradigm shift

Cheng and his colleagues also identified a Glasgow Coma Scale score of less than 15 and age older than 70 years as major predictors of mortality following ground-level falls.

The findings call for a shift in thinking about the elderly, Cheng said.

“Instead of just treating falls as they happen, the focus should be on what we can do to help older people avoid them in the first place,” he stated in the release.

Reference:
Spaniolas K, Cheng JD, Gestring ML, et al. Trauma. 2010;69(4):821-825.

This retrospective review from the National Trauma Databank concludes that amongst patients admitted to trauma centers in the United States after a ground level fall, those over the age of 70 and those with a decrease in their Glasgow Coma Score are at significantly higher risk of dying during their initial hospitalization. This study identifies a vulnerable patient population who has previously not always received critical attention during initial evaluations. It also identifies an important mechanism of injury previously considered benign.

While it is not possible for most trauma centers or even local emergency departments to triage all ground-level fall victims as priority trauma patients, the identification of the smaller subgroup at highest risk for mortality makes the information valuable in developing initial screening and evaluation tools to mitigate risk.

—Andrew N. Pollak, MD
Orthopedics Today Editorial Board member
Baltimore, Md.

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