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Objective Post-fall syndrome (PFS) is a severe complication of falls in older adults. PFS is considered to be a medical emergency in geriatric patients, given the risk of a decompensatory “domino effect” and mortality. Unfortunately, there is currently no consensus on how to detect patients at risk of PFS. The primary objective of the present study was to profile patients suffering from PFS. The secondary objective was to study the prognosis of patients with PFS after their discharge from an aftercare and rehabilitation department (ARD). Material/Patients and methods We prospectively surveyed patients hospitalized in the geriatric ARD at Lille University Hospital (Lille, France) after a fall. Cases (i.e. patients meeting the criteria for PFS: the simultaneous presence of a postural disorder, a gait disorder and a psychobehavioural disorder) were compared with controls (i.e. patients free of PFS). Results Seventy-two patients were included (females: 74%). The median [interquartile range] age was 85.5 [81; 90]. Thirty-four patients (47%) had PFS. The symptoms most frequent significantly associated with PFS were retropulsion in stance, and anxiety about movement. Cases and controls did not differ significantly with regard to other signs (little step walking, axial akinesia, oppositional hypertonia, etc.). Patients with PFS were more likely to present with vascular dementia ( P = 0.0166) and osteoporosis ( P = 0.0458), and were less likely to be taking drugs associated with falls ( P = 0.0003). Initial functional assessments (according to both the Mini Motor Test and the Timed Up-and-Go test) showed that functional abilities were more severely impaired in the patients suffering from PFS. Nevertheless, the same functional assessment on discharge did not reveal a significant difference between the two groups. Likewise, there were no intergroup differences in mortality or institutionalization on discharge from the ARD. Discussion/Conclusion The imperative development of a precise, consensual definition of PFS is now justified by the gravity of this syndrome and the potential for functional recovery. Continuation of this ongoing study may highlight prognostic factors associated with the status of patients with PFS 6 months after discharge from the ARD. [ABSTRACT FROM AUTHOR]

Opinion/feedback Private practice-hospital patient pathways for elderly people with falls or at risk of falls: a study in Lille (northern France). About a third of the over-65 population will fall at least once a year. In France, falls are responsible for more than 9000 deaths among the over-65s and constitute a frequent reason for admission to long-stay care establishments [1] . Many different factors are involved in falls, which prompts the need for multidisciplinary assessments. For the last 15 years, Lille University Medical Centre (Lille, northern France) has been running multidisciplinary assessments at its day hospital for elderly people who have fallen or are at risk of falling. The patients’ medical, rehabilitational and retraining needs are identified during their admission to the day hospital. In 2013, the day hospital and the Lille urban area's existing private-practice care networks (e.g. physiotherapy) were completed by a number of innovative care systems: a care network for fall prevention and home-based rehabilitation (“ESPRAD Chute”), patient education workshops on falls, and a day hospital for follow-up care and geriatric retraining (“HDJ SSR Gériatrique”). The ESPRAD Chute network is based on nurse-led homecare and provides the patient with 15 home-based therapy sessions that complement surgery-based care. Patient education is based on 12 weekly sessions for elderly fallers. The HDJ SSR Gériatrie day hospital provides multidisciplinary rehabilitation for fallers or people at risk of falls and who require intensive rehabilitation and retraining. The interface between the day hospital and existing care structures enabled us to create private practice-hospital pathways for the multidisciplinary management of elderly people at risk of falls. We present our experience of these patient pathways and the associated care systems. [ABSTRACT FROM AUTHOR]