Managing older adults with ground-level falls admitted to a trauma service: The effect of frailty

Bellal A Joseph, Viraj Pandit, Mazhar Khalil, Narong Kulvatunyou, Bardiya Zangbar, Randall S Friese, Martha J Mohler, Mindy J Fain, Peter M Rhee

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Objectives To determine whether frail elderly adults are at greater risk of fracture after a ground-level fall (GLF) than those who are not frail. Design Prospective observational study. Setting Level 1 trauma center. Participants All elderly (≥65) adults presenting after a GLF over 1 year (N = 110; mean age ± SD 79.5 ± 8.3, 54% male). Measurement A Frailty Index (FI) was calculated using 50 preadmission frailty variables. Participants with a FI of 0.25 or greater were considered to be frail. The primary outcome measure was a new fracture; 40.1% (n = 45) of participants presented with a new fracture. The secondary outcome was discharge to an institutional facility (rehabilitation center or skilled nursing facility). Multivariate logistic regression was performed. Results Forty-three (38.2%) participants were frail. The median Injury Severity Score was 14 (range 9-17), and the mean FI was 0.20 ± 0.12. Frail participants were more likely than those who were not frail to have fractures (odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.2-2.3, P =.01). Thirty-six (32.7%) participants were discharged to an institutional facility. Frail participants were more likely to be discharged to an institutional facility (OR = 1.42, 95% CI = 1.08-3.09, P =.03) after a GLF. Conclusion Frail individuals have a higher likelihood of fractures and discharge to an institutional facility after a GLF than those who are not frail. The FI may be used as an adjunct for decision-making when developing a discharge plan for an elderly adult after a GLF.

Original languageEnglish (US)
Pages (from-to)745-749
Number of pages5
JournalJournal of the American Geriatrics Society
Volume63
Issue number4
DOIs
StatePublished - Apr 1 2015

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Odds Ratio
Confidence Intervals
Skilled Nursing Facilities
Frail Elderly
Rehabilitation Centers
Injury Severity Score
Trauma Centers
Wounds and Injuries
Observational Studies
Decision Making
Logistic Models
Outcome Assessment (Health Care)
Prospective Studies

Keywords

  • discharge disposition
  • fractures
  • frailty
  • ground-level falls
  • outcomes

ASJC Scopus subject areas

  • Geriatrics and Gerontology

Cite this

Managing older adults with ground-level falls admitted to a trauma service : The effect of frailty. / Joseph, Bellal A; Pandit, Viraj; Khalil, Mazhar; Kulvatunyou, Narong; Zangbar, Bardiya; Friese, Randall S; Mohler, Martha J; Fain, Mindy J; Rhee, Peter M.

In: Journal of the American Geriatrics Society, Vol. 63, No. 4, 01.04.2015, p. 745-749.

Research output: Contribution to journalArticle

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abstract = "Objectives To determine whether frail elderly adults are at greater risk of fracture after a ground-level fall (GLF) than those who are not frail. Design Prospective observational study. Setting Level 1 trauma center. Participants All elderly (≥65) adults presenting after a GLF over 1 year (N = 110; mean age ± SD 79.5 ± 8.3, 54{\%} male). Measurement A Frailty Index (FI) was calculated using 50 preadmission frailty variables. Participants with a FI of 0.25 or greater were considered to be frail. The primary outcome measure was a new fracture; 40.1{\%} (n = 45) of participants presented with a new fracture. The secondary outcome was discharge to an institutional facility (rehabilitation center or skilled nursing facility). Multivariate logistic regression was performed. Results Forty-three (38.2{\%}) participants were frail. The median Injury Severity Score was 14 (range 9-17), and the mean FI was 0.20 ± 0.12. Frail participants were more likely than those who were not frail to have fractures (odds ratio (OR) = 1.8, 95{\%} confidence interval (CI) = 1.2-2.3, P =.01). Thirty-six (32.7{\%}) participants were discharged to an institutional facility. Frail participants were more likely to be discharged to an institutional facility (OR = 1.42, 95{\%} CI = 1.08-3.09, P =.03) after a GLF. Conclusion Frail individuals have a higher likelihood of fractures and discharge to an institutional facility after a GLF than those who are not frail. The FI may be used as an adjunct for decision-making when developing a discharge plan for an elderly adult after a GLF.",
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T1 - Managing older adults with ground-level falls admitted to a trauma service

T2 - The effect of frailty

AU - Joseph, Bellal A

AU - Pandit, Viraj

AU - Khalil, Mazhar

AU - Kulvatunyou, Narong

AU - Zangbar, Bardiya

AU - Friese, Randall S

AU - Mohler, Martha J

AU - Fain, Mindy J

AU - Rhee, Peter M

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N2 - Objectives To determine whether frail elderly adults are at greater risk of fracture after a ground-level fall (GLF) than those who are not frail. Design Prospective observational study. Setting Level 1 trauma center. Participants All elderly (≥65) adults presenting after a GLF over 1 year (N = 110; mean age ± SD 79.5 ± 8.3, 54% male). Measurement A Frailty Index (FI) was calculated using 50 preadmission frailty variables. Participants with a FI of 0.25 or greater were considered to be frail. The primary outcome measure was a new fracture; 40.1% (n = 45) of participants presented with a new fracture. The secondary outcome was discharge to an institutional facility (rehabilitation center or skilled nursing facility). Multivariate logistic regression was performed. Results Forty-three (38.2%) participants were frail. The median Injury Severity Score was 14 (range 9-17), and the mean FI was 0.20 ± 0.12. Frail participants were more likely than those who were not frail to have fractures (odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.2-2.3, P =.01). Thirty-six (32.7%) participants were discharged to an institutional facility. Frail participants were more likely to be discharged to an institutional facility (OR = 1.42, 95% CI = 1.08-3.09, P =.03) after a GLF. Conclusion Frail individuals have a higher likelihood of fractures and discharge to an institutional facility after a GLF than those who are not frail. The FI may be used as an adjunct for decision-making when developing a discharge plan for an elderly adult after a GLF.

AB - Objectives To determine whether frail elderly adults are at greater risk of fracture after a ground-level fall (GLF) than those who are not frail. Design Prospective observational study. Setting Level 1 trauma center. Participants All elderly (≥65) adults presenting after a GLF over 1 year (N = 110; mean age ± SD 79.5 ± 8.3, 54% male). Measurement A Frailty Index (FI) was calculated using 50 preadmission frailty variables. Participants with a FI of 0.25 or greater were considered to be frail. The primary outcome measure was a new fracture; 40.1% (n = 45) of participants presented with a new fracture. The secondary outcome was discharge to an institutional facility (rehabilitation center or skilled nursing facility). Multivariate logistic regression was performed. Results Forty-three (38.2%) participants were frail. The median Injury Severity Score was 14 (range 9-17), and the mean FI was 0.20 ± 0.12. Frail participants were more likely than those who were not frail to have fractures (odds ratio (OR) = 1.8, 95% confidence interval (CI) = 1.2-2.3, P =.01). Thirty-six (32.7%) participants were discharged to an institutional facility. Frail participants were more likely to be discharged to an institutional facility (OR = 1.42, 95% CI = 1.08-3.09, P =.03) after a GLF. Conclusion Frail individuals have a higher likelihood of fractures and discharge to an institutional facility after a GLF than those who are not frail. The FI may be used as an adjunct for decision-making when developing a discharge plan for an elderly adult after a GLF.

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KW - outcomes

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