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Underreporting of Fall Injuries of Older Adults: Implications for Wellness Visit Fall Risk Screening
Author(s) -
Hoffman Geoffrey J.,
Ha Jinkyung,
Alexander Neil B.,
Langa Kenneth M.,
Tinetti Mary,
Min Lillian C.
Publication year - 2018
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/jgs.15360
Subject(s) - medicine , gerontology , logistic regression , occupational safety and health , injury prevention , poison control , ambulatory , health care , suicide prevention , ambulatory care , fall prevention , emergency medicine , pathology , economics , economic growth
Objectives To compare the accuracy of and factors affecting the accuracy of self‐reported fall‐related injuries (SFRIs) with those of administratively obtained FRIs (AFRIs). Design Retrospective observational study Setting United States Participants Fee‐for‐service Medicare beneficiaries aged 65 and older (N=47,215). Measurements We used 24‐month self‐report recall data from 2000–2012 Health and Retirement Study data to identify SFRIs and linked inpatient, outpatient, and ambulatory Medicare data to identify AFRIs. Sensitivity and specificity were assessed, with AFRIs defined using the University of California at Los Angeles/RAND algorithm as the criterion standard. Logistic regression models were used to identify sociodemographic and health predictors of sensitivity. Results Overall sensitivity and specificity were 28% and 92%. Sensitivity was greater for the oldest adults (38%), women (34%), those with more functional limitations (47%), and those with a prior fall (38%). In adjusted results, several participant factors (being female, being white, poor functional status, depression, prior falls) were modestly associated with better sensitivity and specificity. Injury severity (requiring hospital care) most substantively improved SFRI sensitivity (73%). Conclusion An overwhelming 72% of individuals who received Medicare‐reimbursed health care for FRIs failed to report a fall injury when asked. Future efforts to address underreporting in primary care of nonwhite and healthier older adults are critical to improve preventive efforts. Redesigned questions—for example, that address stigma of attributing injury to falling—may improve sensitivity.