Predictors of Falls, Emergency Department Visits, and Hospitalizations in an Advanced Multiple Sclerosis Population

Objective: To determine the relationship between impairments in an advanced Multiple Sclerosis (MS) population seen within a tertiary rehabilitation clinic and rates of falls and health care usage. Background: Canada has the highest prevalence of MS in the world and it is expected to further increase. Health care costs associated with MS are also likely to increase. Persons living with advanced MS (defined as an EDSS > 4.0), and their health care needs tend to be under-studied. Design/Methods: A prospective cohort study in an MS Rehab Outpatient Clinic; only persons with an EDSS >4.0 were included in the analysis. Results: 285 persons with MS met inclusion criteria and had the following demographics: mean EDSS 6.79 (1.14 SD); 60% female; 55% Secondary Progressive (SPMS); 33% Primary Progressive (PPMS); 11% Relapsing and Remitting (RR mean age 53.5 (11.3SD) years; and mean 17.4 (9.4SD) years post diagnosis. Falls were experienced by 62% of patients with a mean of 8.5 (16.4SD) falls per year, 26% were admitted to the Emergency Department (ED) at least once in the year prior, and 16% were hospitalized. Persons with SPMS had the greatest rates of falls (mean 10.1 falls per year SD 19.7) and had multiple ED visits per year. There was a non-linear relationship between falls and EDSS with EDSS 6.0 – 7.5 having the greatest rates of falls. Falls significantly (p=0.005) predicted ED visits, and an ED visit increased the risk of admission to hospital by 5.2 times (95%CI 3.1 – 8.9, p Conclusions: Persons living with advanced MS have high levels of disease-related burden that increase their risk of falls and subsequent admission to ED and hospitalization. Attention to falls risk reduction must remain a focus of MS care, ideally before irreversible disability sets in. Disclosure: Dr. Bruno has received research support from Novartis. Dr. Srivastava has nothing to disclose. Dr. Langer has received personal compensation for consulting, serving on a scientific advisory board, speaking, or other activities with Novartis. Dr. Langer has received research support from Novartis. Dr. Bayley has nothing to disclose.