Hip Fracture-Related Emergency Department Visits, Hospitalizations and Deaths by Mechanism of Injury among Adults Aged 65 and Older, United States 2019.

OBJECTIVE: Describe rates of hip fracture-related emergency department (ED) visits, hospitalizations, and deaths among older adults (aged ≥65 years) in the United States. METHODS: Data from the 2019 Healthcare Cost and Utilization Project and National Vital Statistics System were used to calculate rates of hip fracture-related ED visits, hospitalizations, and deaths among older adults by select characteristics and mechanism of injury. RESULTS: In 2019, there were 318,797 ED visits, 290,130 hospitalizations, and 7731 deaths related to hip fractures among older adults. About 88% of ED visits and hospitalizations and approximately 83% of deaths related to hip fractures were caused by falls. Rates were highest among older adults living in rural areas and among those aged ≥85 years. DISCUSSION: Most hip fractures among older adults are fall-related. Healthcare providers can prevent falls among their older patients by screening for fall risk, assessing modifiable risk factors, and offering evidence-based interventions.

Differences in fall-related emergency departments visits with and without an Injury, 2018.

BACKGROUND: Falls, with or without an injury, often affect the health of older adults (65+). METHODS: We used the 2018 Healthcare Cost and Utilization Project to describe older adults' fall-related ED visits. We defined fall-related ED visits as those with a fall external cause of morbidity code and fall-injury related ED visits as those with an injury diagnosis code and a fall external cause of morbidity code. Percentages of fall-related and fall-injury related ED visits were analyzed by select characteristics. RESULTS: Over 86% of fall-related ED visits were fall-injury related. A higher percentage of females (87%) and rural (88%) older adults' fall-related ED visits were fall-injury related compared to males (85%) and urban older adults (86%). A higher percentage of fall-related ED visits without a coded injury (33%) were hospitalized compared to those with a coded injury (29%). CONCLUSION: The majority of fall-related ED visits included an injury diagnosis. PRACTICAL APPLICATIONS: Researchers can consider which method of measuring ED visits related to falls is most appropriate for their study. Limiting fall-related ED visits to only those where an injury diagnosis is also present may underestimate the number of fall-related ED visits but may be appropriate for researchers specifically interested in fall injuries.

Validation and comparison of fall screening tools for predicting future falls among older adults.

BACKGROUND: Falls are the leading cause of injuries among older adults in the United States (US). Falls are preventable and clinicians are advised to screen for fall risk yearly. There are many falls screening tools and not all have been validated for their ability to predict future falls. METHODS: We enrolled 1905 community-dwelling older adults into a 13-month study using a probability-based representative panel of the US population recruited from NORC at the University of Chicago's National Frame. Respondents completed a baseline survey, 11 monthly fall calendars, and a final survey. The baseline survey included six falls screening tools (the Stay Independent, Three Key Questions (3KQ), a modified American Geriatric/British Geriatric tool, the short Falls Efficacy-1[FES-I]) and two single screening questions ("I have fallen in the past year" and "How many times did you fall in the past 12 months?"). The baseline and final survey collected demographic and health information, including falls. Sensitivity, specificity, positive and negative likelihood ratios, and corresponding 95% confidence intervals were calculated in SAS using weighted proportions. RESULTS: There were 1563 respondents who completed the final survey (completion rate 82%). Sensitivity estimates ranged from 22.5% for the short FES-I to 68.7% for the 3KQ. Specificity estimates ranged from 57.9% for the 3KQ to 89.4% for the short FES-I. CONCLUSIONS: Falls screening tools have varying sensitivity and specificity for predicting the occurrence of a fall in the following 12 months.

Understanding Modifiable and Unmodifiable Older Adult Fall Risk Factors to Create Effective Prevention Strategies.

Each year, more than 1 in 4 older adults in the United States report a fall and 1 in 10 a fall injury. Using nationally representative data from the 2016 US Behavioral Risk Factor Surveillance System, we evaluated demographic, geographic, functional, and health characteristics associated with falls and fall injuries among adults aged 65 years and older. Analyses included descriptive statistics and multivariable logistic regression to produce crude and adjusted percentages by characteristic. Characteristics most strongly associated with increased fall risk in order of adjusted percentage were depression, difficulty doing errands alone, and difficulty dressing or bathing. Characteristics most strongly associated with fall injury risk in order of adjusted percentage were depression, difficulty dressing or bathing, and being a member of an unmarried couple. The diverse health and functional characteristics associated with increased falls and fall injuries confirm the importance of screening and assessing older adult patients to determine their individual unique risk factors. Health care providers can use tools and resources from the Centers for Disease Control and Prevention's STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to screen their older adult patients for fall risk, assess at-risk patients' modifiable risk factors, and intervene to reduce risk by prescribing evidence-based interventions.

National rates of non-fatal emergency department visits and hospitalisations due to fall-related injuries in older adults 2010-2014 and 2016: transitioning from ICD-9-CM to ICD-10-CM.

BACKGROUND: This study describes rates of non-fatal fall-injury emergency department (ED) visits and hospitalisations before and after the US 2015 transition from the 9th to 10th revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM to ICD-10-CM). METHODS: ED visit and hospitalisation data for adults aged 65+ years were obtained from the 2010-2016 Healthcare Cost and Utilisation Project. Differences in fall injury rates between 2010 and 2014 (before transition), and 2014 and 2016 (before and after transition) were analysed using t-tests. RESULTS: For ED visits, rates did not differ significantly between 2014 and 2016 (4288 vs 4318 per 100 000, respectively). Hospitalisation rates were lower in 2014 (1232 per 100 000) compared with 2016 (1281 per 100 000). CONCLUSION: Increased rates of fall-related hospitalisations could be an artefact of the transition or may reflect an increase in the rate of fall-related hospitalisations. Analyses of fall-related hospitalisations across the transition should be interpreted cautiously.

Differences in Evaluating Fall Risk by Primary Care Provider Type.

This study assessed differences in clinical fall risk assessment of older adults (65+) and clinical resources used by primary care providers (PCP). We used Porter Novelli's 2016 DocStyles survey to examine clinical behavior data from PCPs (n=1128). Compared to other practitioners, nurse practitioners (NP) reported a higher percentage of their patients were older adults. The majority of NPs reported screening for falls risk routinely, but most did not use standardized fall-risk assessments to assess risk factors. There were also differences in the types of clinical resources used by NPs and other PCPs to evaluate the safety profile of medications.

Primary care providers' discussion of fall prevention approaches with their older adult patients-DocStyles, 2014.

Falls are the leading cause of fatal and non-fatal injuries among older adults. The American and British Geriatric Societies recommend a fall risk assessment to identify risk factors and guide interventions to prevent these falls. This study describes the self-reported discussion of fall prevention approaches used by primary care providers (PCPs)-family practitioners, internists and nurse practitioners-who treat older adults. Results are described overall and by PCP type. We analyzed a sample of 1210 U.S. PCPs who participated in the 2014 DocStyles survey. PCPs reported on their recommendation of fall prevention approaches including general exercise, Tai Chi, medication adjustments, home safety modifications, vitamin D supplements, assistive devices, alarm systems, and referral to physical therapy, foot specialist, or vision specialist. Frequencies and adjusted odds ratios for fall prevention approaches were assessed by provider and practice characteristics. Self-reported discussion of any fall prevention approaches was 89.3%. Controlling for provider and practice characteristics, there were significant differences for some approaches by provider type. Family practitioners were more likely to suggest home modification [adjusted Odds Ratio: 1.8 (1.3-2.4)], exercise [aOR: 2.0 (1.5-2.5)], and Tai Chi [aOR: 1.5 (1.0-2.2)] than internists. Nurse practitioners were more likely to suggest home modification [aOR: 2.1 (1.3-3.4)] and less likely to suggest vitamin D [aOR: 0.6 (0.4-1.0)] than internists. Fall prevention suggestions vary by type of PCP. Dissemination of geriatric guidelines should include all PCPs who routinely see older adults.

The direct costs of fatal and non-fatal falls among older adults - United States.

INTRODUCTION: This study sought to estimate the incidence, average cost, and total direct medical costs for fatal and non-fatal fall injuries in hospital, ED, and out-patient settings among U.S. adults aged 65 or older in 2012, by sex and age group and to report total direct medical costs for falls inflated to 2015 dollars. METHOD: Incidence data came from the 2012 National Vital Statistics System, 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 2012 Health Care Utilization Program National Emergency Department Sample, and 2007 Medical Expenditure Panel Survey. Costs for fatal falls were derived from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System; costs for non-fatal falls were based on claims from the 1998/1999 Medicare fee-for-service 5% Standard Analytical Files. Costs were inflated to 2015 estimates using the health care component of the Personal Consumption Expenditure index. RESULTS: In 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries. Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015. Fall incidence as well as total cost increased with age and were higher among women. CONCLUSION: Medically treated falls among older adults, especially among older women, are associated with substantial economic costs. PRACTICAL APPLICATION: Widely implementing evidence-based interventions for fall prevention is essential to decrease the incidence and healthcare costs associated with these injuries.

Falls and Fall Injuries Among Adults Aged ≥65 Years - United States, 2014.

Falls are the leading cause of fatal and nonfatal injuries among adults aged ≥65 years (older adults). During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized.* To estimate the numbers, percentages, and rates of falls and fall injuries among older adults by selected characteristics and state, CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. In 2014, 28.7% of older adults reported falling; the estimated 29.0 million falls resulted in 7.0 million injuries. Known effective strategies for reducing the number of older adult falls include a multifactorial clinical approach (e.g., gait and balance assessment, strength and balance exercises, and medication review). Health care providers can play an important role in fall prevention by screening older adults for fall risk, reviewing and managing medications linked to falls, and recommending vitamin D supplements to improve bone, muscle, and nerve health and reduce the risk for falls.

Stressful life events experienced by women in the year before their infants' births--United States, 2000-2010.

Epidemiologic studies suggest that prenatal stress is associated with preterm birth, low birth weight, and peripartum anxiety and depressive symptoms. The most recent population-based study, assessing trends in stress experienced in the year before an infant's birth, used 1990-1995 data from 11 states participating in the Pregnancy Risk Assessment Monitoring System (PRAMS). That study found that 64% of women surveyed reported experiencing at least one stressful life event (SLE), although the prevalence declined slightly over the study period. PRAMS data for 2000-2010 were used to examine more recent trends and to determine if the prevalence of SLEs has continued to decrease in the past decade. Additionally, 2010 data were used to determine the extent that maternal demographics and state of residence are associated with SLEs. This report describes the results of those analyses, which found that most women in the sample reported experiencing ≥1 SLEs in the year before their infant's birth, although the prevalence of experiencing SLEs decreased during 2000-2010. In 2010, based on data from 27 states, 70.2% of women reported ≥1 SLEs. The mean number of SLEs was 1.81, ranging from 1.41 in New York City to 2.26 in Oklahoma. SLEs were most frequently financial. Prevalence of SLEs varied by PRAMS reporting site and maternal demographics. Younger, less educated, unmarried, and Medicaid-covered women had the highest prevalence of SLEs. Public health practitioners and clinicians can use the information on trends and risk factors for SLEs to determine the likelihood that pregnant women might benefit from screening for stressors during pregnancy.