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Predicting conveyance to the emergency department for older adults who fall

02 April 2022
Volume 14 · Issue 4



Falls are frequent in older adults and are associated with high mortality, morbidity and immobility. Many patients can be managed in the community, but some will require conveyance to the emergency department (ED).


This study aims to identify predictive characteristics of conveyance to the ED after a fall.


A cross-sectional study between December 2018 and September 2020 involved patients attended by a falls rapid response service. Eligible patients were aged ≥60 years with mental capacity, had experienced a fall and were living within the relevant geographical area.


426 patients were enrolled, with a mean age of 82.61 years (SD 8.4; range 60–99 years) and 60.7% were women. Predictive characteristics of conveyance were an injurious fall or pain (OR 8.25; 95% CI (4.89–14.50); P≤0.01) and having been lying for a long time (OR 1.6; 95% CI (1.00–2.56); P=0.04).


It is possible to identify predictors of conveyance to the ED; therefore, an undifferentiated approach towards dispatching the falls rapid response service to all older adults who fall is unwarranted.

The National Institute for Health Care Excellence (NICE, 2013) defines a fall as an unintentional or unexpected loss of balance resulting in coming to rest on the floor, on the ground or on an object below knee level. Falls are frequent in older adults, are the primary cause of injury in those aged 65 years and over, and are associated with high mortality, morbidity and immobility (Rubenstein, 2006; Darnell et al, 2012). Evidence suggests that 35% of those aged >65 years of age fall annually (Tinetti et al, 1988).

Ambulance services across the UK respond to about 300 000–400 000 emergency (999) calls for falls in older people each year (Close et al, 2002), many of which result in conveyance to the emergency department (ED). It has been estimated that the cost of falls accounts for 3% of total NHS expenditure (Scuffham and Chaplin, 2003).

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