Insights into indoor and outdoor falls among older trauma patients

Among patients admitted to hospitals for trauma care, there are significant differences in outcomes, patient characteristics, discharge disposition, types of injuries, and the factors associated with fractures depending upon whether the fall occurred indoors or outdoors, according to researchers from New York University’s Steinhardt School of Culture, Education and Human Development, Greenwich Village, NY. The findings were published online in the journal Geriatrics and Gerontology International.

“Falls are one of the most common causes of emergency room visits for older adults and are the number one cause of traumatic injuries for this population,” said study author Tracy Chippendale, BS, MA, PhD, assistant professor of occupational therapy at NYU Steinhardt.

For this retrospective, cross-sectional study, Dr. Chippendale and colleagues collected data from the trauma registry and electronic medical records for 712 people aged 55 years and older who fell either indoors or outdoors before presenting at the hospital from the Trauma Center at Jamaica Hospital, New York City. They recorded demographic information, health condition, and injury specifics.

They found that those who fell outdoors were more likely to be younger, male, and less likely to have diabetes, dementia, and congestive heart failure compared with those who fell indoors. Outcomes and injuries were also different according to the location of the falls, with outdoor fallers as likely to sustain severe injuries and long stays in the hospital as indoor fallers. Indoor fallers, however, were more likely to undergo transfers to rehabilitation facilities from the hospital rather than return home.

According to researchers, this finding could be due to the fact that indoor fallers were older, on average, and therefore, recovery would be longer.

As far as injuries, outdoor fallers were more likely to sustain unspecified head injuries and open wounds (26.5% vs 16.3% in indoor fallers; P=0.002), while indoor fallers were more likely to sustain sprains. Fractures in indoor fallers were associated with older age, female sex (OR: 1.69, CI: 1.12-2.56), and dementia; in both groups fractures were associated with joint disorders (OR: 7.20, CI: 2.19-23.66 for indoor; OR: 5.65, CI: 1.27-25.06). Finally, in both groups of fallers, the use of alcohol at the time of the fall was negatively associated with fractures.

Dr. Chippendale and colleagues noted that these findings may be useful in the development of targeted initiatives for older people that are aimed at lowering the risk of falls.

“Given the difference in characteristics between indoor and outdoor fallers, targeted prevention programs are warranted to address the needs of these two groups,” said Dr. Chippendale.

“Since outdoor fallers are more likely to be younger and less likely to go to a rehabilitation or skilled nursing center—where fall prevention training often occurs—after being discharged from the hospital, we need to think about the location where fall prevention initiatives are offered. One possibility would be primary care clinics,” she concluded.