Department of Health Management and Informatics & Disability, Aging, and Technology Cluster, University of Central Florida, Orlando, Florida, USA.
Department of Environmental and Occupational Health School of Public Health, & Center for Population Health and Aging, & Southwest Rural Health Research Center, Texas A&M University, College Station, Texas, USA.
J Aging Soc Policy. 2022 Jul 4;34(4):515-536. doi: 10.1080/08959420.2020.1740639. Epub 2020 Mar 21.
The growing population of older adults has attracted concern from policymakers due in part to the fact that they are at higher risk of costly and potentially injurious falls. Responding to this concern, this study investigated fall-related hospitalizations among those aged 65 and older. Hospitalizations rose from 49,299 to 58,931, with charges and costs (estimated based on charges) increasing from $2.5 billion to $3.6 billion and under $900 million to over $1.1 billion, respectively. The intraclass correlation coefficients from linear mixed-effect models (with charges and costs serving as dependent variables) indicated differences in hospitals accounted for nearly half or more of medical cost variation among older adults suffering a fall-related hospitalization. Nonmetropolitan residence, being aged 65-69 (versus older), and higher risk-of-mortality on admission indicated higher costs. Identifying trends of fall-related hospitalizations over time allows for key stakeholders to not only track the burden of falls among older adults but to also use this information to attract funding for fall prevention strategies from policy makers at various levels (e.g., locally, at the state). Further, identifying characteristics of individuals (e.g., age, race, sex) and places (e.g., rural areas) that carry a higher relative cost can serve to inform the targeted allocation of finite resources including local, state, or federal funding, but also existing evidence-based practices such as community and clinical interventions.
老年人口的增长引起了政策制定者的关注，部分原因是他们面临更高的高成本和潜在伤害性跌倒风险。为了应对这一担忧，本研究调查了 65 岁及以上人群与跌倒相关的住院情况。住院人数从 49299 人增加到 58931 人，费用和成本（基于收费估计）从 25 亿美元增加到 36 亿美元，从不足 9 亿美元增加到 11 亿多美元。线性混合效应模型的组内相关系数（以费用和成本为因变量）表明，医院之间的差异占老年跌倒相关住院患者医疗费用变化的近一半或更多。非大都市居住、年龄在 65-69 岁（而非更年长）以及入院时更高的死亡率表明成本更高。随着时间的推移，确定与跌倒相关的住院趋势不仅使利益相关者能够跟踪老年人跌倒的负担，还可以利用这些信息从各级政策制定者（如地方、州）为跌倒预防策略吸引资金。此外，确定个人（如年龄、种族、性别）和地点（如农村地区）的特征，这些特征的相对成本更高，可以为有限资源的有针对性分配提供信息，包括地方、州或联邦资金，以及现有的基于证据的实践，如社区和临床干预措施。
