Incidence and Factors of Functional Decline After Emergency Department Discharge in Older Adults With Falls

Falls are one of the leading causes of morbidity and functional decline in older adults. Even in cases without major injury requiring hospitalization, falls can lead to decreased independence and reduced quality of life. Functional decline, often measured as deterioration in activities of daily living (ADL), is associated with frailty, multimorbidity, polypharmacy, fear of falling, and reduced physical activity. Early identification of older patients at risk for functional decline after an emergency department (ED) visit is critical for designing timely interventions and improving patient outcomes.

This prospective cohort study will enroll 280 patients aged 65 years and older who present to the ED with a simple fall and are discharged without hospitalization. Baseline data will be collected at the time of ED visit, including demographic characteristics, comorbidities, medication use, frailty status (Clinical Frailty Scale), physical activity level (Physical Activity Scale for the Elderly, PASE), fall risk (MEFRAT), and fear of falling (Falls Efficacy Scale-International, FES-I). ADL status will be assessed at baseline and re-assessed at 7 and 30 days after discharge through online or telephone interviews.

The primary outcome is the incidence of decline in ADL within 30 days after ED discharge. Secondary analyses will examine associations between demographic, clinical, functional, and psychosocial factors and the risk of ADL decline, using logistic regression models.

The study is expected to provide valuable insights into the frequency and determinants of functional decline among older adults after ED discharge for falls. Identifying these risk factors will inform strategies for early recognition, follow-up care, and targeted interventions aimed at preventing functional decline and maintaining independence in older patients.

Inclusion criteria

• Age ≥ 65 years
• Presentation to the emergency department with a simple (non-injurious) fall
• Discharged from the ED without hospitalization
• Cognitively able to answer online or telephone follow-up interviews

Exclusion criteria

• Falls due to traumatic events other than simple falls
• Hospital admission required after the fall
• Presence of acute confusion, dementia, or other severe cognitive impairment
• Inability to access online or telephone follow-up during the 30-day study period