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Biography

Jiraporn has been graduated from Khonkaen University, Thailand as a medical doctor, with the Diploma in emergency medicine from Ramathibodi Hospital,
Mahidol University, Bangkok, Thailand. Later on she obtained her post graduation from Massachusetts General Hospital, Harvard Medical School, USA with subjects about the research in Geriatric Emergency Medicine. Presently she is working at the emergency department, Vajira Hospital, Navamindradhiraj University, Bangkok, Thailand. Since 2010, she has developed her specialist interest in improving the care of older patients. Her research focus is on acute care for older patients, delirium and falls.

Abstract

Objectives: Fall-related injuries are a leading cause of morbidity and mortality among older adults. We seek to describe the rate of and risk factors for recurrent falls, emergency department (ED) revisits, subsequent hospitalizations and death within 6 months after a fall-related ED presentation.
 
Methods: This was a secondary analysis of a retrospective cohort of elderly fall patients who presented to the ED from one urban teaching hospital. We included patients aged 65 and older who had an ED fall visit in 2012. We examined the frequency of adverse events (composite of recurrent falls, ED revisits, subsequent hospitalizations and death at 7 days, 30 days and 6 months) controlling for important covariates.
 
Results: Our study included 350 older adults. Adverse events steadily increased with time, from 7.7% at 7 days, 21.4% at 30-days and 50.3% at 6 months. Within 6 months, 22.6% had at least one recurrent fall, 42.6% revisited the ED, 31.1% had subsequent hospitalizations and 2.6% died. In multivariable logistic regression analysis, psychological and/or sedative drug use and noninsulin anti-diabetic drug use predicted recurrent falls, ED revisits, subsequent hospitalizations and adverse events.
 
Conclusions: Our study shows at the very least, there appears to be an association with a history of falls and the use of certain classes of medications with subsequent adverse events. Falls appear to be a marker of physical disability and future health care utilization. Therefore, patients presenting to the ED with falls should be assessed for underlying risk factors and targeted for
preventive interventions.