Outcomes of Physical and Occupational Therapy Evaluation in the Emergency Department for Older Adults With Falls: A Retrospective Multicenter Cohort.

OBJECTIVES

National guidelines recommend comprehensive assessment for older patients (age ≥ 65 years) presenting to the emergency department (ED) following a fall, including consulting physical therapy (PT) or occupational therapy (OT) when indicated. Our objective was to describe the utilization of therapists in the ED and their impact on patient care.

METHODS

This retrospective multicenter cohort study conducted at 5 EDs included older adults presenting for fall-related chief complaints between 2020 and 2022. Primary outcome was PT/OT consultations in the ED. Secondary outcomes were whether therapy consults were high-yield (defined as resulting in ≥ 1 prespecified outcomes) and results of geriatric screening assessments.

RESULTS

In total, 945 were included patients, and 28.1% (n = 266) had dementia. The median Charlson Comorbidity Index was 5 (IQR: 4-7). Geriatric screening assessment for fall risk, cognitive impairment, delirium, and functional impairment varied greatly between sites (0%-99%). A therapist was consulted for 16.1% (n = 152, range: 0.5%-39.5% between sites). PT was consulted for 11.7% (n = 111, range: 0.5%-21.0% between sites), and OT was consulted for 7.1% (n = 67, range: 1.0%-21.0% between sites). PT and OT consults were high-yield for 75.7% and 77.6% of patients, respectively: disposition recommendation (35.1%, n = 39; 31.3%, n = 21), home health therapy referral (35.1%, n = 39; 44.8%, n = 30), new durable medical equipment (21.6%, n = 24; 23.9%, n = 16), and symptom control (26.1%, n = 29; 7.5%, n = 5).

CONCLUSION

ED PT/OT consultations added to the care plan for most patients. There remains a care gap from guideline recommendations as most older adults in the ED for a fall are not receiving therapist consultation.