Evaluation of mortality and morbditiy due to falling as a trauma in patients older than sixtyfive years old by using barthel index and injury severity score (İSS)

Introduction: Population of Turkey and world is getting older.²,³ Elders are %12?24 of all emergency room presentations.? Falls are common and a significant public health problem, especially for the older patients, despite the preventive programs.?¯¹³ Disability, both the cause and the consequence of a fall, is measured by some scales. Barthel index is one of them. ISS is an anatomic scoring system that evaluates injury due to anatomical changes.We aimed to assess falling risk factors, relation of functional dependence level with injury severity, mortality and morbidity due to falling in the older patients presented to ER because of a fall.Material and Method: This prospective observational clinical study has been carried out between 01.07.2011 to 31.12.2011 in Gazi University, Faculty of Medicine, Department of Emergency Medicine. Patients were asked about falling risk factors, asessed by SIS for cognition, by ED-DSI about depression, by BI for dependence level and by ISS for injury severity and relation of functional dependence level with injury severity is evaluated.Results: Falls have constituted 2652 (10%) of all ER presentations. 233 (8%) of them were over the age of 65. Patients in the SIS + group were significantly older and dependent than the patients in the SIS ? group. (Mann-Whitney U test respectively p=0.011, p=0.003). Patients admitted to the hospital were significantly older and had higher ISS than discharged patients.(Mann-Whitney U test respectively p<0.001, p=0.003). Women were significantly more depressive, osteoporotic and widowed than men (Pearson ?² respectively p=0.028, p=0.002, p<0.001). The ISS of the patients who attended to ER between 12-18 pm. was significantly higher than the patients who attended to ER between 18-00 pm. (Bonferroni correction Mann Whitney U test p=0.011). Patients older than 80 were significantly dependent (p=0,004 Kruskall-Wallis) and cognitively disfunctioned than the patients aged between 65 and 70 (p=0,001 Pearson ?² test). Patients who fell at home were older than the patients who fell outside (p=0,019 Mann-Whitney U). There was a weak negative correlation between the number of comorbidity and BI (Spearman?s ?= ? 0.238, p=0.043, ?²=0.056). There was a weak positive correlation between the age and ISS (Spearman?s ?=0.231, p=0.05, ?²=0.053). There wasn?t a correlation between BI and ISS (Spearman?s test p=0,662).Conclusion: There isn?t a significant relation between the dependence level and injury severity of patients. However injury severity, dependence level and cognitive disfunction increases with the age.