Sex differences in mortality of older adults with falls after emergency department consultation: FALL-ER registry - Miro, O.; Gil-Rodrigo, A.; Garcia-Martinez, A.; Aguilo, S.; Alemany, X.; Nickel, C. H.; Jacob, J.; Llorens, P.; Herrero, P.; Torres-Machado, V.; Cenjor, R.; Coll-Vinent, B.; et al. (J Am Geriatr Soc, 2023)
BACKGROUND: To investigate if sex is a risk factor for mortality in patients consulting at the emergency department (ED) for an unintentional fall. METHODS: This 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. RESULTS: Of 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). CONCLUSIONS: Male 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.
Keywords: journalArticle; *Emergency Service, Hospital; *Sex Characteristics; Aged; Aged, 80 and over; Female; Humans; Male; Registries; Risk Factors; death; emergency; falls; gender equity; older