Author(s): SCHMIDT, L., STUCKENSCHNEIDER, T., KWIECIEN, R., ZIESCHANG, T., Institution: GERIATRIC MEDICINE , Country: GERMANY, Abstract-ID: 1273

INTRODUCTION:
Severe falls among older individuals are a common cause of emergency department (ED) visits, often leading to long-term consequences that impact functional independence. Little is known about the characteristics of individuals who suffer functional decline after such falls, however, a reduced physical activity (PA) may serve as an early warning sign. To date, PA has mostly been investigated in older adults with a fall cross-sectionally. Thus, little is known about which moderators e.g., age, sex, cognitive function, and depressive symptoms, influence changes in PA and to what extent. Therefore, this study aims to investigate the association between clinically relevant moderators and changes in PA in older adults, who experienced a severe fall.
METHODS:
Participants were recruited from the SeFallED study following up on individuals aged 60 years or older, who presented to the ED after a severe fall without hospital admission [1]. Moderating factors were collected as part of a home-based geriatric assessment within 4 weeks after a fall (T1) and included: age, sex, BMI, cognitive function, depressive symptoms, concerns about falling, falls in the preceding 12 months, type of initial fall i.e., unrecovered or recovered, lower extremity function, gait speed, and hand grip strength. Participants’ activity was quantified by assessing sedentary time using a three-axial accelerometer (activPAL4, PAL Technologies Ltd., Glasgow, UK), worn for 7 consecutive days, at T1 and 6 months after the initial fall (T2). Association of moderating factors with changes in PA were calculated using Linear Mixed Model (LMM) in R (R Core Team, 2023 Version 4.3.2, 2023-10-31).
RESULTS:
The study enrolled 335 participants, among whom, so far, 208 individuals (mean age 75.6; 60–98 years; 134 females) contributed valid datasets up to a 6-month follow-up period, further data pending as follow-up continues. Preliminary results of LMM revealed a significant time effect for sedentary time with an increase of 150.1 minutes between T1 and T2 (95% CI: 111.3–188.9, p<0.001). Each fall in the preceding 12 months was significantly associated with an increase of 13.0 minutes in sedentary time (95% CI: 3.9 – 22.2, p=0.005).
CONCLUSION:
Preliminary findings indicate that a decline in PA six months after a severe fall associates with the frequency of falls during the 12 months preceding the ED visit. Hence, this emphasizes the importance of enquiring falls in the ED in individuals seeking care post-fall, as it could signal potential long-term adverse outcomes. Considering the emerging healthcare challenge, posed by falls and their consequences, it is crucial to optimize risk assessments. The assessment should be realistically feasible and sufficiently sensitive to enable the implementation of tailored interventions for those with the most pressing needs – identifying prior falls may help.
1. Stuckenschneider T, et al: Sentinel fall presenting to the emergency department (SeFallED) - protocol. BMC Geriatr 2022, 22(1):594.