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The Cost of a Fall Among Older Adults Requiring Emergency Services
Author(s) -
Newgard Craig D.,
Lin Amber,
Caughey Aaron B.,
Eckstrom Elizabeth,
Bulger Eileen M.,
Staudenmayer Kristan,
Maughan Brandon,
Malveau Susan,
Griffiths Denise,
McConnell K. John
Publication year - 2021
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.16863
Subject(s) - medicine , interquartile range , emergency department , emergency medicine , acute care , retrospective cohort study , cohort , demography , health care , psychiatry , sociology , economics , economic growth
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) = $9,634–$68,086), including acute care median $1,957 (IQR = $1,298–$12,924) and post‐acute median $20,560 (IQR = $5,673–$58,074). Baseline costs for the previous year were median $8,642 (IQR = $479–$10,948). Costs increased across all categories except outpatient, with the largest increase for inpatient costs (baseline median $0 vs postfall median $9,477). 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 = −$185 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.