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.