Management and outcome after a fall : a 6-month prospective study of 54 older men and women presenting to the emergency department
Bibliographic record
Abstract
Objective: To prospectively compare the care received by 54 older adults after an emergency department (ED) fall presentation with the recommended 'Guideline Care' as published by the American Geriatrics Society (AGS). Secondary objectives include a longitudinal description and change evaluation of this cohort's fall risk profile, functional status, balance confidence, prevalence of depression, physical activity and living arrangements. Design: 6-month prospective observational study. Participants and Setting: 54 men and women aged 70 years or older who were discharged back to the community after presenting to the Vancouver General Hospital ED with a fall-related complaint. Measurements: AGS Guideline care was documented by chart review and questionnaires. Physiological characteristics were measured by Lord's Physiological Profile Assessment (PPA). Functional status, balance confidence, depression, physical activity and other factors were measured by validated questionnaires. Results: This cohort of fallers who presented to the ED did not receive AGS Guideline Care; only two participants received care consistent with AGS guidelines. Baseline physiological fall-risk scores classified the population at 1.7 SD higher risk than a 65-yr old comparison group and the mean fall-risk score increased (i.e., greater risk of falls) (1.7 ± 1.6 vs. 2.2 ± 1.6, p < 0.000) during the 6-month followup period. Also, functional ability (100 (15) vs. 95 (25), p= 0.002), balance confidence (82.5 (44.4) vs. 71.3 (58.7), p < 0.000) and depression (0 (2) vs. 0 (3), p < 0.000) all worsened over 6 months. Within 6 months of the index ED visit, 5 participants had suffered 6 fall-related fractures. Summary & Conclusion: Medical care of older people who fall and are not admitted to hospital is inconsistent with the AGS Guidelines. This research is the first to prospectively highlight a gap in care of this high-risk group. As fallers who present to the ED constitute a population at high risk of future fracture, this thesis highlights the need for interventions that will address the gap in care that I have identified.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".