Resumen de Managing Older Adults with Ground-Level Falls Admitted to a Trauma Service: The Effect of Frailty

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

• 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.