The Cost of a Fall Among Older Adults Requiring Emergency Services.
J Am Geriatr Soc
; 69(2): 389-398, 2021 02.
Article
en En
| MEDLINE
| ID: mdl-33047305
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) = $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.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Contexto en salud:
11_ODS3_cobertura_universal
/
1_ASSA2030
Problema de salud:
11_financial_arrangements
/
11_governance_arrangements
/
1_financiamento_saude
Asunto principal:
Accidentes por Caídas
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Servicios Médicos de Urgencia
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Fracturas Óseas
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Hospitalización
Tipo de estudio:
Etiology_studies
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Health_economic_evaluation
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Observational_studies
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Prognostic_studies
Límite:
Aged80
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Female
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Humans
/
Male
País/Región como asunto:
America do norte
Idioma:
En
Revista:
J Am Geriatr Soc
Año:
2021
Tipo del documento:
Article
País de afiliación:
Estados Unidos