Approximately 3.7 million Americans reach the age of 65 every year, and older adults are more prone to falling than younger adults, with the risk being twice as high for those aged 65 years and older (OR 2.84 [1.77-4.53]) according to Factora et al. (2021). Shockingly, more than one in four older adults falls each year, but only half of these individuals inform their healthcare provider. Falls are a leading cause of ED visits among older adults, with one older person visiting the ED every 11 seconds due to a fall, and an older adult dying from a fall every 20 minutes in the United States (NCOA, 2021; CDC STEADI, 2020). When an older adult falls and is brought to the ED, the medical team must determine the cause of the fall, as different fall causes necessitate different treatments. In 2018, 36 million older adults fell, leading to 8 million injuries, and 11% of these individuals visited the ED, with 31% requiring admission and 69% being discharged from the ED (CDC, 2018).
Screening for anticipated physiological falls, syncope, and accidental falls is critical for all ED patients, but it is especially important for known fallers who require individualized care planning based on the root cause of their fall. The HD Nursing ED Program, which aims to screen patients for fall risk, rather than requiring ER nurses to complete a fall risk assessment tool, is one example of best practice for fall prevention in the ED. HD’s emergency department fall risk program, eHDS, is a derivative of the Hester Davis Scale that was developed in collaboration with Kaiser Permanente Southern California Region and is the first ED fall risk screening tool to undergo full prospective psychometric evaluation in a multisite study. The final eHDS model, Behavior and Mobility, was validated by Kientz and Hester (2020) and has continued to perform well since its initial validation.
Preventing falls in the ED requires a scientific approach and rigorous research, which is precisely what the HD Nursing Program has demonstrated by establishing the psychometric properties to predict the likelihood of anticipated physiological falls. Dr. Hester, the entire HD Nursing Team, and Ms. Kientz and her colleagues are to be commended for their commitment, partnership, and dedication to creating a program that puts science and technology to work in the ED.
CDC STEADI (Stopping Elderly Accidents, Deaths and Injuries) (2020, July 9). Accessed November 22, 2022
Factora, R., Thomas, D., & Darowshi, A. (2021). Evaluation of falls in the elderly. BMJ Best Practice, https://bestpractice.bmj.com/topics/en-us/880
Kientz, S., Hester, A. (2020). Predictive model development and validation of the Emergency Hester Davis Scale© for fall risk screening. Nursing: Research and Reviews 10. 1-7.
National Council on Aging. Date Sept. 22: Fall Prevention Awareness Day. https://www.seniorfallsprevention.org/falls-prevention-awareness-day.html accessed June 5, 2021