Emergency medical services screening of elderly falls in the home

Previous studies of injury prevention among the elderly have focused on care by community-based services for the elderly. The plan for this study was to determine whether emergency medical services (EMS) could be a valuable partner in an injury prevention program for the elderly. The purposes of the study were: 1) to determine whether it is feasible to gather injury prevention data prospectively, 2) to determine whether these data suggest the need for further intervention to aid the elderly, and 3) to determine whether retrospective chart data are comparable to prospectively gathered data for evaluating the elderly home environment.

Trained fire/EMS chiefs gathered prospective data from the homes of all elderly falls. Patients were included if they were 65 years of age or older. Demographics extracted from the chart were gender, age, and average income based on zip code information from the city office. A 29-question survey was developed based on a literature review. Results were obtained representing information in six categories: environment, appearance, health, violence, access to help, and repeat medical care utilization. Retrospective data were obtained from run reports and from a computerized EMS database. Proportions and 95% confidence intervals were used. A p-value < 0.05 was considered statistically significant.

There were 70 prospective elderly fall cases evaluated and 74 retrospective charts reviewed, each representing a two-to-four-month period. Prospectively, significant problems were found with the patient's environment in up to 53% of cases, appearance in up to 29%, health in up to 77%, abuse in up to 3%, access in up to 57%, and repeat use in 33-68%. Although there were no differences in the age, income, or percentage transported between the prospective and retrospectively obtained groups, a significantly higher percentage of females were entered prospectively. Retrospective chart review obtained reasonable amounts of data for only four of 29 questions.

Prospective analysis is easily gathered and identifies elderly injuries and patterns. A significant number of elderly patients whose homes were visited by EMS need help. Retrospective analysis gleans little injury prevention information.