Improving Care for Ground-Level Falls in Assisted Living
Authors: Matthew E. Growdon, Sharon K. Inouye
Journal: Annals of Internal Medicine (2017)

Editorials6 February 2018Improving Care for Ground-Level Falls in Assisted LivingMatthew E. Growdon, MD, MPH and Sharon K. Inouye, MD, MPHMatthew E. Growdon, MD, MPHBrigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (M.E.G.)Search for more papers by this author and Sharon K. Inouye, MD, MPHHarvard Medical School and Hebrew SeniorLife, Boston, Massachusetts (S.K.I.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M17-2968 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Suppose an 86-year-old woman in an assisted living facility falls from the standing position. Per facility policy, emergency medical services are activated. An advanced practice paramedic assesses the patient and notes normal vital signs, a simple skin tear, the absence of hip pain, and that she receives warfarin for atrial fibrillation. He contacts the patient's primary care physician by telephone, and they discuss the patient's disposition: a bandage to the injury now and a visit with the primary care physician the next morning to complete a fall evaluation and wound check. In the end, the patient is not transported to ...References1. Williams JG, Bachman MW, Lyons MD, Currie BB, Brown LH, Jones AW, et al. Improving decisions about transport to the emergency department for assisted living residents who fall. Ann Intern Med. 2018;168:179-86. LinkGoogle Scholar2. Williams JG, Bachman MW, Jones AW, Myers JB, Kronhaus AK, Miller DL, et al. Retrospective validation of a protocol to limit unnecessary transport of assisted-living residents who fall. Prehosp Emerg Care. 2015;19:68-78. [PMID: 25075443] CrossrefMedlineGoogle Scholar3. Centers for Disease Control and Prevention. Leading Causes of Nonfatal Injury Reports, 2000-2015. Updated 19 February 2017. Accessed at https://webappa.cdc.gov/sasweb/ncipc/nfilead.html on 1 November 2017. Google Scholar4. DeGrauw X, Annest JL, Stevens JA, Xu L, Coronado V. Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older, United States, 2006–2011. J Safety Res. 2016;56:105-9. [PMID: 26875172] doi:10.1016/j.jsr.2015.11.002 CrossrefMedlineGoogle Scholar5. Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults—United States. J Safety Res. 2016;58:99-103. [PMID: 27620939] doi:10.1016/j.jsr.2016.05.001 CrossrefMedlineGoogle Scholar6. Platts-Mills TF, Owens ST, McBride JM. A modern-day purgatory: older adults in the emergency department with nonoperative injuries. J Am Geriatr Soc. 2014;62:525-8. [PMID: 24617946] doi:10.1111/jgs.12699 CrossrefMedlineGoogle Scholar7. Snooks HA, Anthony R, Chatters R, Dale J, Fothergill R, Gaze S, et al. Support and Assessment for Fall Emergency Referrals (SAFER) 2: a cluster randomised trial and systematic review of clinical effectiveness and cost-effectiveness of new protocols for emergency ambulance paramedics to assess older people following a fall with referral to community-based care when appropriate. Health Technol Assess. 2017;21:1-218. [PMID: 28397649] doi:10.3310/hta21130 CrossrefMedlineGoogle Scholar8. Ticona L, Schulman KA. Extreme home makeover—the role of intensive home health care. N Engl J Med. 2016;375:1707-1709. [PMID: 27806216] CrossrefMedlineGoogle Scholar9. Centers for Medicare & Medicaid Services. Comprehensive Primary Care Plus. Updated 24 October 2017. Accessed at https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus on 1 November 2017. Google Scholar10. Institute for Healthcare Improvement. IHI Triple Aim Initiative. Accessed at www.ihi.org/engage/initiatives/TripleAim/Pages/default.aspx on 1 November 2017. Google Scholar Author, Article, and Disclosure InformationAffiliations: Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (M.E.G.)Harvard Medical School and Hebrew SeniorLife, Boston, Massachusetts (S.K.I.)Grant Support: By grants R24AG054259 and K07AG041835 from the National Institute on Aging (Dr. Inouye). Dr. Inouye holds the Milton and Shirley F. Levy Family Chair at Hebrew SeniorLife and Harvard Medical School in Boston, Massachusetts. The funding sources had no role in the design, conduct, or reporting of this editorial.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-2968.Corresponding Author: Sharon K. Inouye, MD, MPH, Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02459; e-mail, [email protected]harvard.edu.Current Author Addresses: Dr. Growdon: Brigham and Women's Hospital, Internal Medicine Residency Office, 75 Francis Street, Boston, MA 02115.Dr. Inouye: Aging Brain Center, Institute for Aging Research, Hebrew SeniorLife, 1200 Centre Street, Boston, MA 02459.This article was published at Annals.org on 12 December 2017. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoImproving Decisions About Transport to the Emergency Department for Assisted Living Residents Who Fall Jefferson G. Williams , Michael W. Bachman , Michael D. Lyons , Benjamin B. Currie , Lawrence H. Brown , A. Wooten Jones , Jose G. Cabanas , Alan K. Kronhaus , and J. Brent Myers Metrics Cited byThe Impact of a Randomized Controlled Trial Testing the Implementation of Function-Focused Care in Assisted Living on Resident Falls, Hospitalizations, and Nursing Home Transfers 6 February 2018Volume 168, Issue 3Page: 225-226KeywordsAgingAllied health care professionalsElderlyEmergency departmentEmergency medical servicesFallsHealth careHealth care facilitiesPatientsPrimary care physicians ePublished: 12 December 2017 Issue Published: 6 February 2018 Copyright & PermissionsCopyright © 2017 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...