确定社区急救服务预防跌倒的机会。

Tynan H Friend, Alexander J Ordoobadi, Zara Cooper, Ali Salim, Molly P Jarman
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引用次数: 0

摘要

背景:跌倒是美国老年人发病和死亡的主要原因。目前的预防跌倒干预措施依赖于医疗服务提供者的转介或住院病人的登记,需要病人的参与和独立。社区紧急医疗服务(CEMS)提供了一个独特的机会,可以快速识别有跌倒风险的老年人,并在家中提供积极的跌倒预防干预措施。我们描述了最有可能从这些干预措施中受益的老年人群的人口统计学和治疗特征:我们将 2019 年医疗成本与利用项目马萨诸塞州急诊科(ED)和州住院病人数据库与美国医院协会调查数据相链接,以查询 2019 年 7 月 1 日至 2019 年 12 月 31 日期间因跌倒相关伤害而在急诊科就诊的年龄≥55 岁的成年人的急诊科就诊和住院情况。单变量描述性统计评估了参与者的特征,双变量显著性检验比较了在出现跌倒前六个月内遇到和未遇到急救服务的老年人之间的诊断、处置和医院特征:2019年7月至12月,在马萨诸塞州急诊室就诊的66027名跌倒老年人中,有7942人(11%)在之前的6个月中曾遇到过急救服务,其中大部分包括伤害诊断(99%)。与以前未遇到过急救服务的老年人相比,以前遇到过急救服务的老年人通常健康状况较差(17%与10%患有多种或复杂的并发症,p < 0.001),社会经济地位较低(12%与8%处于最低社区收入四分位数,p < 0.001;10%与6%加入了医疗补助计划,p < 0.001):结论:在因跌倒受伤而到急诊室就诊的老年人中,有很大一部分在之前的几个月中曾遇到过急救服务。这些患者的健康状况和经济状况都会因跌倒而恶化,因此,他们是CEMS跌倒预防项目的受益人群。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Identifying opportunities for community EMS fall prevention.

Background: Falls are a leading cause of morbidity and mortality among older adults in the United States. Current fall prevention interventions rely on provider referral or enrollment during inpatient admissions and require engagement and independence of the patient. Community emergency medical services (CEMS) are a unique opportunity to rapidly identify older adults at risk for falls and provide proactive fall prevention interventions in the home. We describe the demographics and treatment characteristics of the older adult population most likely to benefit from these interventions.

Materials and methods: We linked 2019 Healthcare Cost and Utilization Project Massachusetts State Emergency Department (ED) and State Inpatient Databases with American Hospital Association survey data to query ED encounters and inpatient admissions for adults age ≥55 with ED encounters for fall-related injury between July 1, 2019 and December 31, 2019. Univariable descriptive statistics assessed participant characteristics and bivariable tests of significance compared diagnoses, disposition, and hospital characteristics between older adults with and without an EMS encounter in the six months prior to the presenting fall.

Results: Of 66,027 older adults who presented with a fall to a Massachusetts ED in July-December 2019, 7,942 (11%) had a prior encounter with EMS in the preceding six months, most of which included an injury diagnosis (99%). Compared to older adults without previous EMS encounters, those with previous EMS encounters were more often in poorer health (17% vs. 10% with multiple or complex comorbidities, p < 0.001) and of lower socioeconomic status (12% vs. 8% in lowest neighborhood income quartile, p < 0.001; 10% vs. 6% enrolled in Medicaid, p < 0.001) compared to those without a prior EMS encounter.

Conclusions: A significant proportion of older adults presenting to the ED with fall related injury have encounters with EMS in the preceding months. These participants are predisposed to poorer health and economic outcomes worsened by their fall and thus demonstrate a population that would benefit from CEMS fall prevention programs.

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