A longitudinal analysis of total 3-year healthcare costs for older adults who experience a fall requiring medical care.
OBJECTIVE
To compare longitudinal changes in healthcare costs between fallers admitted to the hospital at the time of the fall (admitted), those not admitted to the hospital (nonadmitted), and nonfaller controls; test hypotheses related to differences in mean costs between and within these groups over time; and estimate the costs attributable to falling.


METHODS
Longitudinal cohort.


METHODS
Group Health Cooperative of Puget Sound.


METHODS
Seven thousand nine hundred ninety-three nonadmitted fallers, 976 admitted fallers, and 8,956 nonfallers aged 67 and older enrolled in an integrated healthcare delivery system. Fallers were identified according to fall-related E-Codes and International Classification of Diseases, Ninth Revision codes recorded between January 1, 2004, and December 31, 2006. Nonfallers were frequency matched on age group and sex.


METHODS
Quarterly costs during a 3-year period were modeled using generalized estimating equations. Covariates included index age, sex, RxRisk (a comorbidity adjuster), fall status, time, and interactions between fall status and time.


RESULTS
Cost differences between the faller cohorts and nonfallers were greatest in quarters closest to the fall (all P<.01) and persisted throughout the entire year of follow-up. Although nonfaller costs increased with time, faller cohort costs increased more quickly (all P<.01). For admitted fallers, 92% of costs incurred in the quarter of the fall were estimated to be attributable to falling ($27,745 of $30,038, P<.001).


CONCLUSIONS
Falls for which medical attention are sought resulted in higher costs than for nonfallers for up to 12 months after a fall, particularly for falls requiring hospitalization. Prevention efforts should focus on reducing fall-related injuries requiring hospitalization because they produce the highest excess costs and have a higher likelihood of 1-year mortality.
Bohl
Alex A
AA
Health Promotion Research Center, University of Washington, Seattle, Washington 98105, USA. aabohl@u.washington.edu
Fishman
Paul A
PA
Ciol
Marcia A
MA
Williams
Barbara
B
Logerfo
James
J
Phelan
Elizabeth A
EA
D000058:Accidental Falls / Q000191:economics; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012680:Sensitivity and Specificity; D012737:Sex Factors; D013223:Statistics as Topic; D013995:Time; D014861:Washington