Sex differences in mortality of older adults with falls after emergency department consultation: FALL‐ER registry

Abstract

AbstractBackgroundTo investigate if sex is a risk factor for mortality in patients consulting at the emergency department (ED) for an unintentional fall.MethodsThis was a secondary analysis of the FALL‐ER registry, a cohort of patients ≥65 years with an unintentional fall presenting to one of 5 Spanish EDs during 52 predefined days (one per week during one year). We collected 18 independent patient baseline and fall‐related variables. Patients were followed for 6 months and all‐cause mortality recorded. The association between biological sex and mortality was expressed as unadjusted and adjusted hazard ratios (HR) with the 95% confidence interval (95% CI), and subgroup analyses were performed by assessing the interaction of sex with all baseline and fall‐related mortality risk variables.ResultsOf 1315 enrolled patients (median age 81 years), 411 were men (31%) and 904 women (69%). The 6‐month mortality was higher in men (12.4% vs. 5.2%, HR = 2.48, 95% CI = 1.65–3.71), although age was similar between sexes. Men had more comorbidity, previous hospitalizations, loss of consciousness, and an intrinsic cause for falling. Women more frequently lived alone, with self‐reported depression, and the fall results in a fracture and immobilization. Nonetheless, after adjustment for age and these eight divergent variables, older men aged 65 and over still showed a significantly higher mortality (HR = 2.19, 95% CI = 1.39–3.45), with the highest risk observed during the first month after ED presentation (HR = 4.18, 95% CI = 1.31–13.3). We found no interaction between sex and any patient‐related or fall‐related variables with respect to mortality (p > 0.05 in all comparisons).ConclusionsMale sex is a risk factor for death following ED presentation for a fall in the older population adults aged 65 and over. The causes for this risk should be investigated in future studies.