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A Longitudinal Analysis of Total 3‐Year Healthcare Costs for Older Adults Who Experience a Fall Requiring Medical Care
Author(s) -
Bohl Alex A.,
Fishman Paul A.,
Ciol Marcia A.,
Williams Barbara,
LoGerfo James,
Phelan Elizabeth A.
Publication year - 2010
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2010.02816.x
Subject(s) - medicine , longitudinal study , cohort , comorbidity , demography , health care , falling (accident) , occupational safety and health , cohort study , generalized estimating equation , poison control , injury prevention , emergency medicine , gerontology , environmental health , statistics , mathematics , pathology , sociology , economics , economic growth
OBJECTIVES: To compare longitudinal changes in healthcare costs between fallers admitted to the hospital at the time of the fall (admitted), those not admitted to the hospital (nonadmitted), and nonfaller controls; test hypotheses related to differences in mean costs between and within these groups over time; and estimate the costs attributable to falling. DESIGN: Longitudinal cohort. SETTING: Group Health Cooperative of Puget Sound. PARTICIPANTS: Seven thousand nine hundred ninety‐three nonadmitted fallers, 976 admitted fallers, and 8,956 nonfallers aged 67 and older enrolled in an integrated healthcare delivery system. Fallers were identified according to fall‐related E‐Codes and International Classification of Diseases, Ninth Revision codes recorded between January 1, 2004, and December 31, 2006. Nonfallers were frequency matched on age group and sex. MEASUREMENTS: Quarterly costs during a 3‐year period were modeled using generalized estimating equations. Covariates included index age, sex, RxRisk (a comorbidity adjuster), fall status, time, and interactions between fall status and time. RESULTS: Cost differences between the faller cohorts and nonfallers were greatest in quarters closest to the fall (all P <.01) and persisted throughout the entire year of follow‐up. Although nonfaller costs increased with time, faller cohort costs increased more quickly (all P <.01). For admitted fallers, 92% of costs incurred in the quarter of the fall were estimated to be attributable to falling ($27,745 of $30,038, P <.001). CONCLUSION: Falls for which medical attention are sought resulted in higher costs than for nonfallers for up to 12 months after a fall, particularly for falls requiring hospitalization. Prevention efforts should focus on reducing fall‐related injuries requiring hospitalization because they produce the highest excess costs and have a higher likelihood of 1‐year mortality.