For Immediate Release October 7, 1997
CONTACT:
Laura Gore
(202) 728-0610, ext. 3006
ACEP Announces Major New Practice Guideline for Managing Elderly Patients Who Fall and Releases A Geriatric Study on Emergency Department Use And a National Survey on Elder Abuse
Washington, D.C.--The American College of Emergency Physicians today released a major new practice guideline for managing elderly patients who experience falls, the cause of death for 12 percent of those older than age 65. The guideline and the studies are presented in the October issue of Annals of Emergency Medicine, which joins 96 other journals this month to focus on aging as a global theme issue. This issue also contains a special historic article, "Passing the Torch: The Inheritance of Emergency Medicine," in celebration of the science journal's 25th anniversary, which culminates in December.
As the U.S. population grows older, an increasing proportion of emergency patients will be older citizens. Elderly people are the fastest growing age group in the United States, comprising 13 percent of the population in 1990. By 2050, it is estimated that older persons will be 25 percent of the population (assuming the same rate of growth), outnumbering children by the year 2020. Studies show that elderly patients use emergency medical services at twice the rate of other age groups.
Emergency Department Management of Elderly Persons who Fall
This article presents a major new practice guideline for managing people over age 65 who come to the emergency department for treatment after a fall. The comprehensive practice guideline contains charts of information about the causes of falls, drugs known to be associated with increased risk for falling, a list of the most important health measures for elderly people (which can be photocopied and distributed), and a reminder checklist of assessments and interventions for emergency health care providers. The goal of the guideline is to help emergency health care providers prevent future falls among the elderly by identifying their causes and implementing interventions that improve health and reduce the frequency of hospitalization and nursing home care.
The article explores the causes of falls among the elderly, stating they are a substantial problem for individuals over age 65, occurring in 32 percent of those aged 65 to 74, 35 percent of those aged 75 to 84, and 51 percent of those aged 85 and older. Falls more frequently occur in older women (42 percent of women ages 65 to 74 compared with 20 percent of men). More than two-thirds of those who fall will fall again in 6 months. For those who are hospitalized, the risk of death in the year following hospitalization ranges from 15 to 50 percent. Prevention of future falls is critical because subsequent falls may result in significant morbidity and mortality, and identifying the cause of a fall is critical to preventing future falls.
"A fall can be a sentinel event in the life of an older person, potentially marking the beginning of a serious decline in function or the symptom of a new or worsening medical condition," said Dr. Larry J. Baraff. "Identifying the cause of the fall and making appropriate interventions to improve function are as critical as treating injuries if future falls are to be prevented and quality of life and longevity are to be improved."
The practice guideline addresses the importance of regular exercise, especially after a fall when elderly people often reduce their physical activity because of fear of another fall. It also contains information about medical screenings elderly people should have, including those for vision, breast cancer, and prostate cancer.
The guideline was developed from an extensive literature review and an expert national panel of emergency physicians and geriatricians, supported by a grant to the John A. Hartford Foundation from the Society for Academic Emergency Medicine. It is adaptable to any health care setting. Evaluation of the practice guideline will be complete in 1997, and the results are scheduled to be available in early 1998. (Practice Guideline for the ED Management of Falls in Community-Dwelling Elderly Persons)
ED Use by Older Victims of Family Violence The study reviewed emergency department records to determine the nature and frequency of emergency department use by victims of elder abuse. Over a 7 year period, 182 physical elder abuse victims were identified, and 114 (62,6 percent) had been seen in an emergency department at least once during a 5-year period surrounding initial identification of abuse. These 114 individuals accounted for 628 visits; 30.6 percent of which resulted in hospital admission.
The patients in the study were primarily female (76.3 percent) and white (85.3 percent) with a mean age of 73.1 years. Adult sons were the abusers in 28.9 percent of cases, spouses in 26.8 percent of cases, and adult daughters in 21.6 percent of cases. Other abusers included grandchildren, other relatives, and friends. The most common weapon used was the body (punching, kicking, slapping) but knives, canes, furniture and pipes also were described (no firearms). Injury was the chief complaint(fractures, lacerations, contusions). No single overwhelming type or site of injury was noted.
The study concluded that elder abuse victims have substantial interactions with emergency departments that frequently result in hospital admissions and that strategies to identify elder abuse in less acute settings would improve quality of life and likely result in substantial savings in health care expenditures.
Elder Mistreatment: National Survey of Emergency Physicians This national survey is the first one to survey emergency physicians to determine the perceived magnitude of elder mistreatment, levels of physician awareness, and willingness to report suspected cases. It also sought to determine the barriers to reporting suspected cases of elder mistreatment and physician awareness of state elder abuse laws.
Fifty-two percent of the more than 700 surveys completed by members of the American College of Emergency Physicians described elder mistreatment as prevalent but less than spouse or child abuse. Ninety two percent of the physicians indicated their states did not have sufficient resources to meet the needs of elderly victims. Only 31 percent reported having a written protocol for reporting elder mistreatment. Physicians also were generally not familiar about applicable state laws and did not feel confident about identifying or reporting elderly victims of abuse or neglect.
Until recently, research on domestic violence has been focused mainly on spouse and child abuse, and little attention has been paid to the mistreatment of older people. The results of the survey highlight several areas of concern and the need for greater training and continuing medical education focuses related to elder abuse in the field of geriatric emergency medicine.
Other Articles
Crush Syndrome Sustained in the 1995 Kobe, Japan, Earthquake: Treatment and Outcome. This study assesses the treatment and outcome of eight patients with crush syndrome who were extricated within 1 to 18 hours from houses collapsed by a catastrophic earthquake.
Emergency Medicine in Bosnia and Herzegovina. This international report describes the medical care system in Bosnia and Herzegovina.
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