Indoor and Outdoor Falls Among Older Adult Trauma Patients: A Comparison of Patient Characteristics and Outcomes

BACKGROUND AND PURPOSE: The number of older adults receiving emergency department care has increased by more than 20% since 2001, and falls are the most common cause of trauma admissions (Carpenter, 2013). Previous studies revealed differences in factors related to indoor versus outdoor falls (Kelsey, Proctor-Gray, Hannan, & Li, 2012; Li et al., 2006). Risk factors for serious injury are also impacted by fall location (Duckheim et al., 2013). Further research to illuminate differences in characteristics of indoor and outdoor fallers and factors associated with falls and fractures in each fall location will enable researchers and occupational therapy practitioners to effectively design programs and target individuals most at risk. The purpose of this study was to examine significant differences in patient characteristics, associated factors, and outcomes for indoor versus outdoor falls among trauma patients.

METHOD: A retrospective cross-sectional study was conducted using data from the trauma registry and electronic medical records at a Level I trauma center in the United States. People age 55 yr or older for whom fall location could be identified (n = 712) were included in the study. Demographic information, functional status prior to admission, comorbid conditions, activation level, injury severity score, discharge disposition, and injury type were included in the comparative analyses. Associated factors for falls and fractures in each location were also examined using logistic regression.

RESULTS: Significant differences were found in patient characteristics between indoor and outdoor fallers in relation to age, gender, prior level of function, and presence of some chronic diseases including diabetes, dementia, and congestive heart failure (p < .05). Significant differences in outcomes were found related to discharge disposition (p < .0001) and injury type. Open wounds were more common among outdoor fallers (26.5%) than indoor fallers (16.3%, p = .002), and unspecified head injuries were more common among outdoor fallers (p < .05). Although joint disorders with difficulty walking were associated with fractures among both indoor fallers (OR = 7.20, 95% confidence interval [CI] [2.19, 23.66]) and outdoor fallers (OR = 5.65, 95% CI [1.27, 25.06]), gender was associated with fractures only among those who fell indoors (OR = 1.69, 95% CI [1.12, 2.56]).

CONCLUSION: Significant differences exist in characteristics of indoor and outdoor fallers and for discharge disposition and injury type for each fall location among patients admitted for trauma care. Factors associated with fractures differed between indoor and outdoor fallers. Consistent with the American Occupational Therapy Foundation’s research priorities, results can help inform targeted primary and secondary injury prevention initiatives among adults in late midlife and older adulthood.

References

Carpenter, C. R. (2013). Deteriorating functional status in older adults after emergency department evaluation of minor trauma—Opportunities and pragmatic challenges. Journal of the American Geriatrics Society, 61, 1806–1807. https://doi.org/10.1111/jgs.12478

Duckheim, R. L., Proctor-Gray, E., Hannan, M. T., Leveille, S. G., Lipsitz, L. A., & Li, W. (2013). Sex differences in circumstances and consequences of outdoor and indoor falls in older adults in the Mobilize Boston cohort study. BMC Geriatrics, 13, 133. https://doi.org/10.1186/1471-2318-13-133

Kelsey, J. L., Proctor-Gray, E., Hannan, M. T., & Li, W. (2012). Heterogeneity of falls among older adults: Implications for public health prevention. American Journal of Public Health, 102, 2149–2156. https://doi.org/10.2105/AJPH.2012.300677

Li, W., Keegan, T. H. M., Sternfeld, B., Sidney, S., Quesenberry, C. P., & Kelsey, J. L. (2006). Outdoor falls among middle-aged and older adults: A neglected public health problem. American Journal of Public Health, 96, 1192–1199. https://doi.org/10.2105/AJPH.2005.083055