Analysis of long-term prognosis of older patients after a first fall according to economic status

Accidental falls are sentinel events of poor outcomes and future healthcare needs in older individuals. Understanding the effect of socioeconomic status (SES) on these needs is important for healthcare planning. The study aimed to investigate the association between SES and outcomes in a cohort of older fallers.

A multicentre study was conducted including patients aged 65 years or older attending the emergency department (ED) of five Spanish hospitals after a first fall from September 1st, 2014, to August 31st, 2015. Sociodemographic features and past medical history were recorded. SES was evaluated using a proxy based on the mean income level at patients' zip code area. Outcomes after 5 years of the index fall included all-cause death, new fall-related visits to the ED, and fall-related fractures. Logistic regression was used to investigate the association between SES and outcomes.

The cohort included 716 patients (median age 79 years [IQR 72-85], 68% female). There were 439 patients (61.3%) with low and 277 (38.7%) with high SES. The group with low SES had significantly higher prevalence of depression (31.3% vs. 23%), polypharmacy (57.5% vs. 45.5%), or visual impairment (58.7% vs. 50.6%), whereas the percentage of patients with dependency (42.3% vs. 53.1%) or living alone (15.1% vs. 22.4%) was higher in the group with high SES. At the end of the 5-year follow-up, 250 patients (35.4%) died, 271 (49.3%) had a new fall-related visit, and 104 (20.6%) suffered a fall with fracture. None of these outcomes was associated with SES, irrespective of whether SES was considered as a dichotomous or a continuous variable.

There are significant clinical differences based on SES in older patients attending the ED after a first fall. However, living in areas with lower SES was not associated with long-term outcomes in the context of a universal healthcare system. Further research is necessary to understand the interplay between SES and prognosis in this population.