School of Nursing, University of Texas Medical Branch, Galveston, TX, USA; Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA.
Sealy Center on Aging, University of Texas Medical Branch, Galveston, TX, USA; Department of Internal Medicine-Geriatrics and Palliative Medicine Division, University of Texas Medical Branch, Galveston, TX, USA.
Prev Med. 2022 Nov;164:107331. doi: 10.1016/j.ypmed.2022.107331. Epub 2022 Nov 9.
Fall-related injuries contribute to increased frailty, disability, and premature death in older adults (≥65 years). The US Centers for Medicare and Medicaid Services began reimbursing annual wellness visits (AWVs) in 2011. In the present study, we assessed the effect of AWV receipt in 2017 on fall and fracture prevention through December 31, 2018. Using Texas Medicare data for 2014-2018, we identified cohorts of Medicare beneficiaries ≥68 years, matched for the presence/absence of an AWV in 2017 by propensity score, and observed two outcomes: fracture as a primary diagnosis, and fall occurrences. Rates of each outcome were estimated using the Kaplan-Meier method. Of the 2017 beneficiaries, 32.2% received an AWV. For the 742,494 beneficiaries in the matched cohort, conditional Cox proportional hazards models revealed that receiving an AWV in 2017 was associated with reduced risks for future falls (3.9%) and fractures (4%). The effect of the AWV was stronger on fall reduction in rural residents (HR: 0.799; 95% CI: 0.679 to 0.941) and on fracture reduction in beneficiaries with ≥4 morbidities (HR: 0.918; 95% CI: 0.867 to 0.972). Receipt of an AWV in three consecutive years (2015-2017) further lowered the risk of future falls. We conclude that the risks for future falls/fractures are lower in older adults receiving AWVs. Our study underscores the need for expanded public education programs that raise awareness about AWVs and the potential for AWV data to inform fall prevention interventions and other health promotion practices.
与老年人（≥65 岁）相关的伤害会导致虚弱、残疾和过早死亡的风险增加。美国医疗保险和医疗补助服务中心于 2011 年开始报销年度健康访视（AWV）费用。在本研究中，我们评估了 2017 年接受 AWV 对 2018 年 12 月 31 日之前跌倒和骨折预防的影响。我们使用 2014-2018 年的德克萨斯州医疗保险数据，确定了≥68 岁的医疗保险受益人群队列，根据 2017 年是否接受 AWV 通过倾向评分进行匹配，并观察了两个结果：骨折作为主要诊断和跌倒发生。每个结果的发生率使用 Kaplan-Meier 方法进行估计。在 2017 年的受益人群中，32.2%接受了 AWV。在匹配队列的 742,494 名受益人群中，条件 Cox 比例风险模型显示，2017 年接受 AWV 与未来跌倒（3.9%）和骨折（4%）风险降低相关。AWV 对农村居民跌倒减少的效果更强（HR：0.799；95%CI：0.679 至 0.941），对患有≥4 种合并症的受益人群骨折减少的效果更强（HR：0.918；95%CI：0.867 至 0.972）。连续三年（2015-2017 年）接受 AWV 可进一步降低未来跌倒的风险。我们得出结论，接受 AWV 的老年人未来跌倒/骨折的风险较低。我们的研究强调需要扩大公共教育计划，提高对 AWV 的认识，以及利用 AWV 数据为跌倒预防干预措施和其他健康促进实践提供信息的潜力。
