Study finds major care gap for seniors visiting EDs after falls

A new multicenter study reveals a significant gap between recommended care and actual practice for older adults’ emergency department visits following falls. Researchers analyzed 945 patients aged 65 and older who presented with fall-related complaints at five hospitals — four located in the United States within the University of Pittsburgh Medical Center system and one in Australia affiliated with the University of New South Wales — between 2020 and 2022.

The study found that only 16% of elderly emergency patients received physical or occupational therapy evaluations, despite national guidelines recommending comprehensive assessments for this vulnerable population. This represents a substantial underutilization of therapy services that could potentially improve patient outcomes, according to the study authors.

However, when therapy consultations did occur, they proved highly effective. According to the research, 76% of physical therapy evaluations and 78% of occupational therapy evaluations resulted in meaningful changes to patient care plans. These changes included recommendations for different living arrangements, referrals for home health therapy, new medical equipment such as walkers or safety devices, and strategies for better symptom management.

The patient population studied demonstrated high medical complexity, with 28% having dementia and 67% requiring hospital admission. Among those screened for geriatric conditions like cognitive impairment, delirium, fall risk and functional problems, 74% tested positive for at least one issue.

Physical and occupational therapy consultation rates varied dramatically between hospitals, ranging from less than 1% to nearly 40% of eligible patients receiving therapy evaluations. This variation suggests inconsistent implementation of established care guidelines across different emergency departments.

The study authors concluded that ED therapy evaluations for older adults with falls are highly impactful when implemented but remain significantly underutilized in real-world clinical practice. The research was published in JACEP Open and involved hospitals in the United States and Australia.