Retrospective analysis of two English ambulance service records following calls to older adults who have fallen: AMBOFALL

Introduction

Approximately 700,000 (10%) of UK emergency ambulance calls are to older adults who have fallen each year. Therefore this study aimed to answer: Who are the population of older adults who fall and call an emergency ambulance, what is their presentation and what ambulance response do they receive?

Methods

12-months of anonymous retrospective electronic ambulance records from two regional English ambulance services were collected.

Population: Patients aged 65 and older who called an emergency ambulance, were categorised as a fall during call triage, and received an ambulance.

The population is described with proportions, then complete case analysis using logistic regression was undertaken.

Outcomes: Conveyance or referral to other health and social care.

Variables: Call category, location and timings; Patient demographics e.g. age, gender, ethnicity); Clinical observations; Medical and social history.

Results

Between 01/Apr/2023-31/Mar/2024 and after deduplication, 78,797 cases underwent analysis.

Patients recorded with cognitive impairment had significantly lower odds of being conveyed than those without cognitive impairment in their medical history when adjusted for other demographic, clinical and response variables (aOR 0.73, 95% CI 0.69–0.78).

Crews arriving during daytime hours make significantly more referrals than those attending out-of-hours (Evening: aOR 0.65, 95% CI 0.57–0.74; Night aOR 0.72, 95% CI 0.64–0.82).

Level of deprivation does not significantly impact conveyance (aOR 1.00, 95% CI 0.99–1.00), however increasing deprivation decreases odds of a referral when adjusted for other variables (aOR 0.98, 95% 0.97–1.00).

Conclusions

Cognitive impairment being recorded is a significant variable reducing conveyance, whilst deprivation and out-of-hours crew arrival reduces referrals being made. Implications to future practice are that out-of-hours options should be reviewed and extended to give crews greater opportunity for continuing care irrespective of when they attend. Care provision across regions, encompassing areas of deprivation should be reviewed to improve equity of care.