PMID- 33047305 OWN - NLM STAT- MEDLINE DCOM- 20210917 LR - 20210917 IS - 1532-5415 (Electronic) IS - 0002-8614 (Linking) VI - 69 IP - 2 DP - 2021 Feb TI - The Cost of a Fall Among Older Adults Requiring Emergency Services. PG - 389-398 LID - 10.1111/jgs.16863 [doi] AB - BACKGROUND/OBJECTIVE: The cost of a fall among older adults requiring emergency services is unclear, especially beyond the acute care period. We evaluated medical expenditures (costs) to 1 year among community-dwelling older adults who fell and required ambulance transport, including acute versus post-acute periods, the primary drivers of cost, and comparison to baseline expenditures. DESIGN: Retrospective cohort analysis. SETTING: Forty-four emergency medical services agencies transporting to 51 emergency department in seven northwest counties from January 1, 2011, to December 31, 2011, with follow-up through December 31, 2012. PARTICIPANTS: We included 2,494 community-dwelling adults, 65 years and older, transported by ambulance after a fall with continuous fee-for-service Medicare coverage. MEASUREMENTS: The primary outcome was total Medicare expenditures to 1 year (2019 U.S. dollars), with separation by acute versus post-acute periods and by cost category. We included 48 variables in a standardized risk-adjustment model to generate adjusted cost estimates. RESULTS: The median age was 83 years, with 74% female, and 41.9% requiring admission during the index visit. The median total cost of a fall to 1 year was $26,143 (interquartile range (IQR) = $9,634-$68,086), including acute care median $1,957 (IQR = $1,298-$12,924) and post-acute median $20,560 (IQR = $5,673-$58,074). Baseline costs for the previous year were median $8,642 (IQR = $479-$10,948). Costs increased across all categories except outpatient, with the largest increase for inpatient costs (baseline median $0 vs postfall median $9,477). In multivariable analysis, the following were associated with higher costs: high baseline costs, older age, comorbidities, extremity fractures (lower extremity, pelvis, and humerus), noninjury diagnoses, and surgical interventions. Compared with baseline, costs increased for 74.6% of patients, with a median increase of $12,682 (IQR = -$185 to $51,189). CONCLUSION: Older adults who fall and require emergency services have increased healthcare expenditures compared with baseline, particularly during the post-acute period. Comorbidities, noninjury medical conditions, fracture type, and surgical interventions were independently associated with increased costs. CI - (c) 2020 The American Geriatrics Society. FAU - Newgard, Craig D AU - Newgard CD AD - Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, Portland, USA. FAU - Lin, Amber AU - Lin A AUID- ORCID: 0000-0001-5542-1425 AD - Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, Portland, USA. FAU - Caughey, Aaron B AU - Caughey AB AD - Department of Obstetrics and Gynecology, Oregon Health & Science University, Oregon, Portland, USA. FAU - Eckstrom, Elizabeth AU - Eckstrom E AD - Division of General Internal Medicine & Geriatrics, Department of Medicine, Oregon Health & Science University, Oregon, Portland, USA. FAU - Bulger, Eileen M AU - Bulger EM AD - Department of Surgery, University of Washington, Seattle, Washington, USA. FAU - Staudenmayer, Kristan AU - Staudenmayer K AD - Department of Surgery, Stanford University Medical Center, Palo Alto, California, USA. FAU - Maughan, Brandon AU - Maughan B AUID- ORCID: 0000-0002-5216-4707 AD - Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, Portland, USA. FAU - Malveau, Susan AU - Malveau S AD - Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, Portland, USA. FAU - Griffiths, Denise AU - Griffiths D AD - Department of Emergency Medicine, Center for Policy and Research in Emergency Medicine, Oregon Health & Science University, Oregon, Portland, USA. FAU - McConnell, K John AU - McConnell KJ AD - Department of Emergency Medicine, Center for Health Systems Effectiveness, Oregon Health & Science University, Oregon, Portland, USA. LA - eng GR - R01HS023796/HS/AHRQ HHS/United States PT - Journal Article PT - Research Support, U.S. Gov't, P.H.S. DEP - 20201012 PL - United States TA - J Am Geriatr Soc JT - Journal of the American Geriatrics Society JID - 7503062 SB - IM MH - *Accidental Falls/economics/statistics & numerical data MH - Aftercare/economics/methods MH - Aged, 80 and over MH - Chronic Disease/epidemiology MH - Comorbidity MH - Costs and Cost Analysis MH - *Emergency Medical Services/economics/methods/statistics & numerical data MH - Female MH - *Fractures, Bone/economics/etiology MH - Health Care Costs/statistics & numerical data MH - *Hospitalization/economics/statistics & numerical data MH - Humans MH - Independent Living/statistics & numerical data MH - Male MH - Medicare/statistics & numerical data MH - Transportation of Patients/statistics & numerical data MH - United States/epidemiology OTO - NOTNLM OT - cost OT - emergency medical services OT - fall OT - older adults EDAT- 2020/10/14 06:00 MHDA- 2021/09/18 06:00 CRDT- 2020/10/13 05:40 PHST- 2020/05/22 00:00 [received] PHST- 2020/08/10 00:00 [revised] PHST- 2020/09/09 00:00 [accepted] PHST- 2020/10/14 06:00 [pubmed] PHST- 2021/09/18 06:00 [medline] PHST- 2020/10/13 05:40 [entrez] AID - 10.1111/jgs.16863 [doi] PST - ppublish SO - J Am Geriatr Soc. 2021 Feb;69(2):389-398. doi: 10.1111/jgs.16863. Epub 2020 Oct 12.