Physical therapy after a fall may help reduce emergency department revisits
Falls are the leading cause of illness and death among Americans aged 65 and older. In 2014, some 2.8 million older adults visited the emergency department (ED) for a fall-related injury. And over time, the ED visit rate for falls among older adults has grown to 68.8 per 1,000 older adults (as of 2010).
Older adults who visit the ED for a fall are at high risk for both revisiting the ED and dying. In fact, some estimates show that 25 percent of older adults visiting the ED for a fall returned for at least one additional fall-related visit. Fifteen percent of those older adults died within the following year.
Because so many older adults visit an ED due to falls, many experts see an opportunity for EDs to play a role in reducing future falls among older adults who are at high risk.
In a new study, published in the Journal of the American Geriatrics Society, researchers explored whether older adults who received physical therapy (PT) services while in the ED for a fall experienced fewer fall-related repeat visits to the ED.
The research team used Medicare claims data representing Medicare beneficiaries from across the country. The information examined differences in 30-day and 60-day ED repeat visit rates among older adults who visited the ED for a fall and who received PT services in the ED. The researchers compared that to older adults who did not receive PT services in the ED after a fall.
PT services in the ED can include getting information, a diagnosis, and a referral for follow-up PT care after discharge. The researchers reviewed records for people aged 65 and over who had visited the ED for a fall, excluding people who died during the 30-day and 60-day follow up period. Receiving PT services in the ED during an initial visit for a fall was linked to a lower chance of returning to the ED for another fall within 30 and 60 days.
Geriatric care experts have previously recommended that older adults who visit the ED should be screened for high fall risk and referred, when appropriate, to physical therapists or other members of the healthcare team. In fact, previous studies have shown that when older adults follow special PT or exercise routines after a fall, they can reduce the risk of future falls. In spite of these findings, PT assessments and referral services remain rare in the ED. Older adults who go to the ED for a fall rarely receive the kind of examination and referral for PT services they need, said the researchers.
The researchers also said that their results suggest that EDs could play an important role in lowering fall-related ED revisits. That role is primarily to connect people treated for a fall to appropriate follow-up care.
"In our sample, only 3.2 percent of older adults who had a fall-related ED visit received PT services during that visit," said the researchers.
This summary is from "Association Between Physical Therapy in the Emergency Department and Emergency Department Revisits for Older Adult Fallers: A Nationally-representative Analysis." It appears online ahead of print in the Journal of the American Geriatrics Society. The study authors are Adriane Lesser, MS; Juhi Israni, MS; Tyler Kent; and Kelly Ko, PhD, of West Health Institute, La Jolla, CA.
About the Health in Aging Foundation
This research summary was developed as a public education tool by the Health in Aging Foundation. The Foundation is a national non-profit established in 1999 by the American Geriatrics Society to bring the knowledge and expertise of geriatrics healthcare professionals to the public. We are committed to ensuring that people are empowered to advocate for high-quality care by providing them with trustworthy information and reliable resources. Last year, we reached nearly 1 million people with our resources through HealthinAging.org. We also help nurture current and future geriatrics leaders by supporting opportunities to attend educational events and increase exposure to principles of excellence on caring for older adults. For more information or to support the Foundation's work, visit http://www.HealthinAgingFoundation.org.
About the Journal of the American Geriatrics Society
Included in more than 9,000 library collections around the world, the Journal of the American Geriatrics Society (JAGS) highlights emerging insights on principles of aging, approaches to older patients, geriatric syndromes, geriatric psychiatry, and geriatric diseases and disorders. First published in 1953, JAGS is now one of the oldest and most impactful publications on gerontology and geriatrics, according to ISI Journal Citation Reports®. Visit wileyonlinelibrary.com/journal/JGS for more details.
About the American Geriatrics Society
Founded in 1942, the American Geriatrics Society (AGS) is a nationwide, not-for-profit society of geriatrics healthcare professionals that has–for 75 years–worked to improve the health, independence, and quality of life of older people. Its nearly 6,000 members include geriatricians, geriatric nurses, social workers, family practitioners, physician assistants, pharmacists, and internists. The Society provides leadership to healthcare professionals, policymakers, and the public by implementing and advocating for programs in patient care, research, professional and public education, and public policy. For more information, visit AmericanGeriatrics.org.
Daniel E. Trucil