title: Healthcare utilization of elderly persons hospitalized after a noninjurious fall in a Swiss academic medical center.
abstract: OBJECTIVE
  To determine the risk of hospital readmission, nursing home admission, and death, as well as health services utilization over a 6-month follow-up, in community-dwelling elderly persons hospitalized after a noninjurious fall.
  
  
  METHODS
  Prospective cohort study with 6-month follow-up.
  
  
  METHODS
  Swiss academic medical center.
  
  
  METHODS
  Six hundred ninety persons aged 75 and older hospitalized through the emergency department.
  
  
  METHODS
  Data on demographics and medical, physical, social, and mental status were collected upon admission. Follow-up data were collected from the state centralized billing system (hospital and nursing home admission) and proxies (death).
  
  
  RESULTS
  Seventy patients (10%) were hospitalized after a noninjurious fall. Fallers had shorter hospital stays (median 4 vs 8 days, P<.001) and were more frequently discharged to rehabilitation or respite care than nonfallers. During follow-up, fallers were more likely to be institutionalized (adjusted hazard ratio=1.82, 95% confidence interval=1.03-3.19, P=.04) independent of comorbidity and functional and mental status. Overall institutional costs (averaged per day of follow-up) were similar for both groups ($138.5 vs $148.7, P=.66), but fallers had lower hospital costs and significantly higher rehabilitation and long-term care costs ($55.5 vs $24.1, P<.001), even after adjustment for comorbidity, living situation, and functional and cognitive status.
  
  
  CONCLUSIONS
  Elderly patients hospitalized after a noninjurious fall were twice as likely to be institutionalized as those admitted for other medical conditions and had higher intermediate and long-term care services utilization during follow-up, independent of functional and health status. These results provide direction for interventions needed to delay or prevent institutionalization and reduce subsequent costs.
authors.affiliation: Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. Laurence.Seematter-Bagnoud@chuv.ch
authors.forename: Laurence
authors.initials: L
authors.lastname: Seematter-Bagnoud
authors.forename: Vincent
authors.initials: V
authors.lastname: Wietlisbach
authors.forename: Bertrand
authors.initials: B
authors.lastname: Yersin
authors.forename: Christophe J
authors.initials: CJ
authors.lastname: Büla
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D003695:Delivery of Health Care / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D017721:Hospital Costs; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000209:etiology