Lack of patient and primary care physician follow-up in geriatric emergency department patients with head trauma from a fall

• Published in: The American journal of emergency medicine Vol. 75; pp. 29 - 32
• Main Authors: Shih, Richard D., Solano, Joshua J., Engstrom, Gabriella, Khazem, Maya, Clayton, Lisa M., Wells, Michael, Hughes, Patrick G., Posaw, Leila, Goldstein, Lara, Hennekens, Charles H., Ouslander, Joseph G., Alter, Scott M.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2024; Elsevier Limited
• Subjects: Aged; Craniocerebral Trauma - epidemiology; Data collection; Dementia; Education; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Fall prevention; Falls; Follow-up; Follow-Up Studies; Funding; Geriatric Assessment; Geriatric emergency medicine; Geriatric falls; Geriatric head trauma; Geriatrics; Head; Head injuries; Humans; Hypertension; Intervention; Observational studies; Older people; Patients; Physical therapy; Physicians, Primary Care; Prevention; Primary care; Prospective Studies; Risk assessment; Risk Factors; Trauma; Trauma centers; Writing; Florida; United States > US; Falls; Fall prevention; Geriatric head trauma; Geriatric emergency medicine; Geriatric falls; Follow-up
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2023.10.021

Falls are the leading cause of injuries in the US for older adults. Follow-up after an ED-related fall visit is essential to initiate preventive strategies in these patients who are at very high risk for recurrent falls. It is currently unclear how frequently follow-up occurs and whether preventive strategies are implemented. Our objective is to determine the rate of follow-up by older adults who sustain a fall related head injury resulting in an ED visit, the rate and type of risk assessment and adoption of preventive strategies. This 1-year prospective observational study was conducted at two South Florida hospitals. All older ED patients with an acute head injury due to a fall were identified. Telephone surveys were conducted 14 days after ED presentation asking about PCP follow-up and adoption of fall prevention strategies. Clinical and demographic characteristics were compared between patients with and without follow up. Of 4951 patients with a head injury from a fall, 1527 met inclusion criteria. 905 reported follow-up with their PCP. Of these, 72% reported receiving a fall assessment and 56% adopted a fall prevention strategy. Participants with PCP follow-up were significantly more likely to have a history of cancer or hypertension. Only 60% of ED patients with fall-related head injury follow-up with their PCP. Further, 72% received a fall assessment and only 56% adopted a fall prevention strategy. These data indicate an urgent need to promote PCP fall assessment and adoption of prevention strategies in these patients. •Older ED patients who have sustained a fall-related injury have a very high risk for recurrent fall and injury.•After the ED visit, the primary care follow-up is an opportunity to address recurrent fall risk and fall prevention.•Unfortunately, older ED head injury patients who are discharged often do not follow-up with a primary care physician.•When follow-up does occur, fall-risk assessment and fall prevention strategies are infrequently performed and adopted.