The Cost of a Fall Among Older Adults Requiring Emergency Services

Published on Feb 1, 2021in Journal of the American Geriatrics Society5.562
· DOI :10.1111/JGS.16863
Craig D. Newgard50
Estimated H-index: 50
(OHSU: Oregon Health & Science University),
Amber Lin11
Estimated H-index: 11
(OHSU: Oregon Health & Science University)
+ 7 AuthorsK. John McConnell30
Estimated H-index: 30
(OHSU: Oregon Health & Science University)
Sources
Abstract
Background/objective The cost of a fall among older adults requiring emergency services is unclear, especially beyond the acute care period. We evaluated medical expenditures (costs) to 1 year among community-dwelling older adults who fell and required ambulance transport, including acute versus post-acute periods, the primary drivers of cost, and comparison to baseline expenditures. Design Retrospective cohort analysis. Setting Forty-four emergency medical services agencies transporting to 51 emergency department in seven northwest counties from January 1, 2011, to December 31, 2011, with follow-up through December 31, 2012. Participants We included 2,494 community-dwelling adults, 65 years and older, transported by ambulance after a fall with continuous fee-for-service Medicare coverage. Measurements The primary outcome was total Medicare expenditures to 1 year (2019 U.S. dollars), with separation by acute versus post-acute periods and by cost category. We included 48 variables in a standardized risk-adjustment model to generate adjusted cost estimates. Results The median age was 83 years, with 74% female, and 41.9% requiring admission during the index visit. The median total cost of a fall to 1 year was 26,143 (interquartile range (IQR) = ,634-68,086), including acute care median ,957 (IQR = 1,298-2,924) and post-acute median 20,560 (IQR = ,673-58,074). Baseline costs for the previous year were median ,642 (IQR = 479-0,948). Costs increased across all categories except outpatient, with the largest increase for inpatient costs (baseline median 0 vs postfall median ,477). In multivariable analysis, the following were associated with higher costs: high baseline costs, older age, comorbidities, extremity fractures (lower extremity, pelvis, and humerus), noninjury diagnoses, and surgical interventions. Compared with baseline, costs increased for 74.6% of patients, with a median increase of 12,682 (IQR = -85 to $51,189). Conclusion Older adults who fall and require emergency services have increased healthcare expenditures compared with baseline, particularly during the post-acute period. Comorbidities, noninjury medical conditions, fracture type, and surgical interventions were independently associated with increased costs.
References41
Newest
#1Yvonne Johnston (Binghamton University)H-Index: 4
#2Gwen Bergen (CDC: Centers for Disease Control and Prevention)H-Index: 13
Last. Matthew Garnett (NYSDOH: New York State Department of Health)H-Index: 3
view all 8 authors...
BACKGROUND AND OBJECTIVES: Older adult falls pose a growing burden on the U.S. health care system. The Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative was developed as a multifactorial approach to fall prevention that includes screening for fall risk, assessing for modifiable risk factors, and prescribing evidence-based interventions to reduce fall risk. The purpose of this study was to determine the impact of a STEADI initiative ...
Source
#1Teresa Liu-Ambrose (UBC: University of British Columbia)H-Index: 63
#2Jennifer C. Davis (UBC: University of British Columbia)H-Index: 32
Last. Karim M. Khan (UBC: University of British Columbia)H-Index: 94
view all 8 authors...
Importance Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown. Objective To assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall. Design, Setting, and Participants A 12-month, single-blind, randomized clinical trial conducted from April 22, 2009, to June 5, 2018, among adults aged at least 70 years who had a fall within the ...
Source
#1John R. Montgomery (UM: University of Michigan)H-Index: 7
#2Anne H. Cain-Nielsen (UM: University of Michigan)H-Index: 9
Last. Mark R. Hemmila (UM: University of Michigan)H-Index: 42
view all 5 authors...
Source
#1Klaas A. HartholtH-Index: 21
#2Robin Lee (CDC: Centers for Disease Control and Prevention)H-Index: 13
Last. Ed F. van Beeck (Erasmus University Medical Center)H-Index: 30
view all 4 authors...
Source
#1Craig D. Newgard (OHSU: Oregon Health & Science University)H-Index: 50
#2Amber Lin (OHSU: Oregon Health & Science University)H-Index: 11
Last. Elizabeth Eckstrom (OHSU: Oregon Health & Science University)H-Index: 20
view all 11 authors...
Abstract Introduction/Objective: Little is known about the long-term outcomes of injured older adults cared for in trauma systems. We sought to describe mortality and causes of death over time, and the independent association of injury severity, comorbidities, and other factors on 12-month mortality among injured older adults transported by emergency medical services (EMS). Materials and Methods: This was a population-based cohort study of injured adults ≥ 65 years in the United States transport...
Source
#1Kevin A. Schulman (Stanford University)H-Index: 95
#2Arnold Milstein (Stanford University)H-Index: 33
Source
#1Ayoade Adeyemi (Smith & Nephew)H-Index: 3
#2Gary Delhougne (Smith & Nephew)H-Index: 4
Background: There is limited information on current cost estimates associated with intertrochanteric hip fractures in the United States. The purpose of the present study was to estimate the incidence and economic burden of both intertrochanteric and all hip fracture types in the Medicare patient population to the U.S. health-care system. Methods: This retrospective database analysis of the 2014 Medicare database involved Standard Analytic File (SAF) 5% sample claims and total enrollment files. P...
Source
#1Craig D. Newgard (OHSU: Oregon Health & Science University)H-Index: 50
#2Susan Malveau (OHSU: Oregon Health & Science University)H-Index: 10
Last. Amber Lin (OHSU: Oregon Health & Science University)H-Index: 11
view all 5 authors...
OBJECTIVE: The objective was to describe and validate construction of a population-based, longitudinal cohort of injured older adults from 9-1-1 call to 1-year follow-up using existing data sources, probabilistic linkage, and multiple imputation. METHODS: This was a descriptive cohort study conducted in seven counties in Oregon and Washington from January 1, 2011, through December 31, 2011, with follow-up through December 31, 2012. The primary cohort included all injured adults ≥ 65 years served...
Source
#1Judy A. Stevens (CDC: Centers for Disease Control and Prevention)H-Index: 35
#2Robin Lee (CDC: Centers for Disease Control and Prevention)H-Index: 13
Introduction Falls often cause severe injuries and are one of the most costly health conditions among older adults. Yet, many falls are preventable. The number of preventable medically treated falls and associated costs averted were estimated by applying evidence-based fall interventions in clinical settings. Methods A review of peer-reviewed literature was conducted in 2017 using literature published between 1994 and 2017, the authors estimated the prevalence of seven fall risk factors and the ...
Source
#1Curtis S. Florence (CDC: Centers for Disease Control and Prevention)H-Index: 23
#2Gwen Bergen (CDC: Centers for Disease Control and Prevention)H-Index: 13
Last. Cynthia Drake (University of Colorado Denver)H-Index: 4
view all 6 authors...
Objectives To estimate medical expenditures attributable to older adult falls using a methodology that can be updated annually to track these expenditures over time. Design Population data from the National Vital Statistics System (NVSS) and cost estimates from the Web-based Injury Statistics Query and Reporting System (WISQARS) for fatal falls, quasi-experimental regression analysis of data from the Medicare Current Beneficiaries Survey (MCBS) for nonfatal falls. Setting U.S. population aged 65...
Source
Cited By1
Newest
#1Daniel K. Nishijima (UC Davis: University of California, Davis)H-Index: 24
#2Zhuo Yang (Emory University)H-Index: 11
Last. Craig D. Newgard (OHSU: Oregon Health & Science University)H-Index: 50
view all 3 authors...
Abstract null null Background null A pediatric field triage strategy that meets the national policy benchmark of ≥95% sensitivity would likely improve health outcomes but increase heath care costs. Our objective was to compare the cost-effectiveness of current pediatric field triage practices to an alternative field triage strategy that meets the national policy benchmark of ≥95% sensitivity. null null null Study design null We developed a decision-analysis Markov model to compare the outcomes a...
Source
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