Health care utilization and costs in a Medicare population by fall status.
OBJECTIVE
The economic impact of trauma in older persons is a matter of increasing concern to public health practitioners and planners, yet it is an issue that has not been widely studied. Available evidence does suggest, however, that falls are the costliest category of injury among older persons.


METHODS
This study used data from the Health Care Financing Administration and the Connecticut Long-Term Care Registry to isolate the effects of fall severity on hospital, nursing home, home health, and emergency room costs. Multivariate and logistic regression methods were used to control for the influence of a number of clinical and demographic factors believed to be independently related to health care costs. Health care costs of fallers were tracked for 1 year after the fall. The cost experience of this cohort was compared with nonfallers during the same time period.


RESULTS
The results provide strong evidence that falls are associated with increased health care costs, and that this relation increases monotonically with the frequency and severity of falls. Incurring one or more injurious falls was associated with increased annual hospital costs of $11,042 (1996), nursing home costs of $5,325, and total health care costs of $19,440. Incurring two or more noninjurious falls increased costs substantially as well.


CONCLUSIONS
The health care costs of falls are pervasive and substantial, and they increase with fall frequency and severity.
Program on Aging, Yale University School of Medicine, New Haven, CT 06520-8034, USA. John.Rizzo@Yale.edu
J A
JA
Rizzo
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R
Friedkin
C S
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Williams
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Nabors
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Acampora
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Tinetti
D000058:Accidental Falls / Q000191:economics*; D000368:Aged; D014487:Centers for Medicare and Medicaid Services, U.S.; D003237:Connecticut; D005260:Female; D005500:Follow-Up Studies; D017048:Health Care Costs / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006296:Health Services / Q000191:economics / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D015601:Injury Severity Score; D016015:Logistic Models; D008134:Long-Term Care / Q000191:economics; D008297:Male; D006278:Medicare / Q000191:economics / Q000706:statistics & numerical data*; D015999:Multivariate Analysis; D012042:Registries; D012959:Socioeconomic Factors; D014481:United States