Trends in Geriatric Ground-Level Falls: Report from the National Trauma Data Bank.

INTRODUCTION: Ground-level falls (GLF) are typically reported as a minor mechanism of injury; however, they represent a significant portion of hospitalized geriatric trauma patients as they can result in multisystem injury in this subset of the population. Our study aimed to analyze trends in geriatric trauma falls on the national level. METHODS: We performed a 5-y (2011-2015) analysis of the American College of Surgeons National Trauma Data Bank (ACS-NTDB) and included all geriatric trauma patients (age ≥ 65 y) who presented with GLF. GLF was identified using ICD-9 E CODES. Our outcome measures were national incidence of GLF, and overall discharge disposition and trauma center level discharge disposition following GLF. We used Cochran Armitage test and multivariate regression analysis. RESULTS: We analyzed a total of 1,017,326 geriatric trauma patients, of which 39% had had a fall as a mechanism of injury. Among those who fell, mean age was 78 ± 7, 63% were females, and 85% were whites. The incidence of falls significantly increased over the study period, and was noted to be proportional to age, with a plateau beyond age 85 y old. The rate of discharge to SNF and/or Rehab significantly increased over the study period; however, discharge to home and mortality rates trended downwards over the study period. Discharge to SNF and/or Rehab was significantly lower among level I trauma centers compared to other level trauma centers. Conversely, discharge to home was higher in level I trauma centers compared to other level trauma centers. CONCLUSION: Around one in three elderly trauma patients were admitted following a GLF with an overall increased incidence of falls over time. Although overall mortality rates decreased, there was an increase in adverse discharge disposition and loss of functional independence over the study period, mostly among those admitted to non-level I trauma centers.

Health Care Providers' Negative Implicit Attitudes and Stereotypes of American Indians.

Research suggests that implicit biases held by health care providers may play a role in perpetuating health disparities. However, minimal work has examined the presence of providers' negative implicit attitudes and stereotypes of American Indians. The current work examined implicit attitudes and stereotypes toward American Indians among 111 health care providers using the Implicit Association Test. Results revealed evidence of negative implicit attitudes toward American Indians. In addition, results showed that providers implicitly stereotype American Indians as noncompliant. This effect was moderated by self-reports of cultural competency and implicit bias training experience such that those reporting cultural competency or implicit bias training reported lower implicit stereotyping than those reporting no cultural competency or implicit bias training. Moreover, medical students reported lower implicit stereotyping than medical residents and practicing physicians. Implications of providers' implicit biases on treatment of American Indian patients and implicit bias reduction research are discussed.