Recurrent Falls After Emergency Department Discharge Are Common and Frequently Result in Hospitalization

Falls are a common cause of Emergency Department (ED) visits among older adults, and approximately half are discharged. However, little is known about the likelihood of recurrent falls leading to subsequent ED visits or hospitalization. The purpose of this study was to determine the rate of recurrent falls and admissions in older adults discharged from the ED after a fall and to explore predictors of recurrent ED visits and admissions.

We performed a retrospective cohort study of adults 65 and older presenting for a fall at a Level I Trauma ED in 2022 who were discharged. Adults admitted during the initial visit were excluded. The main outcome was a subsequent ED visit for a fall within 6 months. Hospital admission and in-hospital death were secondary outcomes. Multivariable logistic regression was used to identify predictors of recurrent falls. Logistic regression was performed using the forward stepwise measure.

Of 11,835 ED visits by patients ages 65 and older during 2022, there were 3308 (28%) visits for a fall, of which 1,545 (46.7%) were discharged home. Within 6 months, 225 patients (14.6%) returned for a recurrent fall, and 108 (48.0%) required admission. No in-hospital deaths occurred. Multivariate predictors of a second fall were age (OR 1.027; 95%CI 1.007-1.047), dementia (OR 1.98; 95%CI, 1.38-2.81), and female sex (OR 0.7; 95%CI, 0.51-0.97). Among patients with a second fall, multivariable predictors of a hospital admission were higher heart rate (OR 1.04; 95% CI 1.01–1.07), neurodegenerative disease (OR 3.52; 95% CI 1.86–6.67), atrial fibrillation (OR 3.07; 95% CI 1.50–6.27), hypertension (OR 2.32; 95% CI 1.21–4.44), and emphysema (OR 4.37; 95% CI 1.35–14.14). Admission was more frequently associated with fractures, particularly of the ribs, spine, and lower extremities.

Nearly 1 in 7 older adults discharged after an ED visit for a fall experienced a recurrent fall requiring ED care within 6 months, with almost half requiring hospitalization. The second falls were more severe and linked to disease burden. These findings identify ED discharge as a critical intervention point for risk stratification and fall prevention strategies in older adults.