After a fall, four in ten older adults returned to the emergency department within a year

Design

Systematic review and random-effects meta-analysis of observational studies

Population

19 studies of adults ≥65 presenting to the ED after a fall

Primary outcome

Cumulative ED revisits and hospital readmissions within 1 year

Effect

ED revisit 15.0% at 30 days, 41.3% at 12 months; readmission 10.4% at 30 days

A meta-analysis pooled 19 observational studies of adults aged 65 or over presenting to the emergency department (ED) after a fall, and estimated how many came back.

Cumulative ED revisits were 3.9% within 3 days, 8.8% within 7 days and 15.0% within 30 days, rising to 37.5% at 6 months and 41.3% at 12 months. Hospital readmission was 10.4% at 30 days and about 30% by 6 to 12 months. Heterogeneity between studies was substantial, and some time points rested on a single study.

The fall is often treated as an injury to be imaged and discharged. These figures suggest it is better read as a marker of frailty and ongoing need. The study does not show that follow-up prevents revisits, but it makes a strong case for using the ED visit to start a falls assessment rather than end the episode.

• Ask why the patient fell: syncope, medications, postural hypotension, vision, cognition
• Review sedatives, antihypertensives and anticholinergics before discharge
• Check gait with a simple test such as timed up-and-go
• Refer to a falls service, physiotherapy or the GP with a specific request
• Tell the family the risk of a return visit is high in the first month

Why it matters

One in seven older fallers is back in the ED within a month, so the first visit is the moment to act.

Don't overread it

These are pooled observational proportions with high heterogeneity; they do not show that any intervention reduces revisits.

The statistics, in plain English

A meta-analysis of proportions averages how often something happened across studies, not the effect of a treatment. High heterogeneity means the studies' rates differed a lot, depending on setting and population, so a local rate may be quite different. The 6- and 12-month figures lean on fewer studies and are less certain.

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