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Xu D, Wang Y, Zhu S, Zhao M, Wang K. Relationship between fear of falling and quality of life in nursing home residents: The role of activity restriction. Geriatr Nurs 2024; 57:45-50. [PMID: 38520817 DOI: 10.1016/j.gerinurse.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 02/25/2024] [Accepted: 03/08/2024] [Indexed: 03/25/2024]
Abstract
This study investigates the mediating role of activity restriction in the relationship between the fear of falling and health outcomes. This was a cross-sectional study with convenience sampling of 316 nursing home residents. Generalized structural equation modeling was conducted to test the mediating role. The results showed that residents with fear of falling were more likely to restrict their activities and residents who often or always restricted activities reported lower levels of quality of life and higher levels of depression. Severe activity restriction accounted for 75 % of the total effect of fear of falling on quality of life and 69 % of the total effect of fear of falling on depression. Fall prevention efforts should focus on strategies or interventions to reduce residents' excessive fear of falling and promote activity engagement. Physical and social activities will not only prevent future falls but also improve residents' quality of life and mental health.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China; School of Nursing, Purdue University, West Lafayette, IN 47907 USA
| | - Yaqi Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Shanshan Zhu
- Geriatrics Department, Henan Provincial People's Hospital, Zhengzhou, Henan, China
| | - Meng Zhao
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China
| | - Kefang Wang
- School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, Shandong 250012, China.
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Drew JAR, Xu D. Trends in Fatal and Nonfatal Injuries Among Older Americans, 2004-2017. Am J Prev Med 2020; 59:3-11. [PMID: 32201184 PMCID: PMC7311304 DOI: 10.1016/j.amepre.2020.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION This study (1) provides annual population estimates of fatal and nonfatal injury incidence rates for older adults for 2004-2017; (2) determines if trends differ by whether the injury was fatal or nonfatal, a fall or nonfall injury, and for nonfatal injuries, minor or serious; and (3) investigates whether trends vary by age, sex, and race. METHODS This study used National Vital Statistics System and National Health Interview Survey data covering the population of adults aged ≥65 years for 2004-2017. Fatal injury incidence rates were estimated using negative binomial models; nonfatal injury incidence rates were estimated using Poisson models. All models compared overall risk and trend differences by year, age, sex, and race, and interactions between year and age, sex, and race. All analyses were conducted in 2019. RESULTS Fatal injury incidence was stable over time, but this apparent stability masked a 35% increase in fatal falls and a 17% decrease in fatal nonfall injuries. Increases in fall-related deaths were concentrated among those aged ≥85 years, men, and white older adults. The trend in fatal falls accelerated over time for those aged ≥85 years and white older adults. By contrast, there was a large increase in nonfatal injury incidence, occurring across all injury types. Nonfatal injury risk grew with age and was higher for women and white older adults, but trends did not vary by age, sex, or race. CONCLUSIONS Large increases in fatal and nonfatal injuries underscore the urgency of national implementation of fall prevention programs and expanding fall prevention efforts to more general injury prevention.
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Affiliation(s)
- Julia A Rivera Drew
- IPUMS and the Minnesota Population Center, University of Minnesota-Twin Cities, Minneapolis, Minnesota.
| | - Dongjuan Xu
- School of Nursing, Purdue University, West Lafayette, Indiana
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Carter MW, Yang BK, Davenport M, Kabel A. Increasing Rates of Opioid Misuse Among Older Adults Visiting Emergency Departments. Innov Aging 2019; 3:igz002. [PMID: 30863796 PMCID: PMC6404687 DOI: 10.1093/geroni/igz002] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE This study sought to investigate factors associated with opioid misuse-related emergency department (ED) visits among older adults and changes in outcomes associated with these visits, using multiple years of nationally representative data. METHODS A retrospective analysis of the Nationwide Emergency Department Sample was conducted. Study inclusion was limited to adults aged 65 years and older. Diagnostic codes were used to identify opioid misuse disorder; sampling weights were used to adjust standard estimates of the errors. Descriptive and multivariate procedures were used to describe risk and visit outcomes. RESULTS ED visits by older adults with opioid misuse identified in the ED increased sharply from 2006 to 2014, representing a nearly 220% increase over the study period. Opioid misuse was associated with an increased number of chronic conditions, greater injury risk, and higher rates of alcohol dependence and mental health diagnoses. CONCLUSION The steep increase in opioid misuse observed among older adult ED visits underscores the critical need for additional research to better understand the national scope and impact of opioid misuse on older adults, as well as to better inform policy responses to meet the needs of this particular age group.
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Affiliation(s)
- Mary W Carter
- Department of Health Sciences, College of Health Professions, Towson University, Maryland
| | - Bo Kyum Yang
- Department of Health Sciences, College of Health Professions, Towson University, Maryland
| | - Marsha Davenport
- Department of Health Sciences, College of Health Professions, Towson University, Maryland
| | - Allison Kabel
- Department of Health Sciences, College of Health Professions, Towson University, Maryland
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Xu D, Drew JAR. What Doesn't Kill You Doesn't Make You Stronger: The Long-Term Consequences of Nonfatal Injury for Older Adults. THE GERONTOLOGIST 2018; 58:759-767. [PMID: 28329865 DOI: 10.1093/geront/gnw252] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Indexed: 11/13/2022] Open
Abstract
Purposey The majority of research efforts centering on injury among older adults focus on fall-related injuries and short-term consequences of injury. Little is known about the long-term consequences of all-cause nonfatal injuries, including minor injuries. Using a recent, large, and nationally representative sample of the U.S. non-institutionalized civilian population, the current study examines whether older adults who sustained a nonfatal injury (serious and minor) have higher risk of long-term morbidity and mortality outcomes compared with noninjured seniors. Methods Linked National Health Interview Survey-Medical Expenditure Panel Survey (NHIS-MEPS) data were used to fit logistic and 2-part models to estimate associations between injury incidence and later injury, hospitalization incidence, and length of hospital stay during the 2.5 years following the NHIS interview among 16,109 older adults. Data from the linked National Health Interview Survey-National Death Index (NHIS-NDI) files were used to estimate a Cox proportional hazards model to examine the association between injury incidence and mortality for up to 11 years after the initial interview among 79,504 older adults. Results Relative to no injury, serious nonfatal injury was significantly associated with increased risk of another injury, hospitalization, and mortality. Minor injuries were significantly related to higher risk of later injury and mortality. Implications Because even minor injuries are strongly associated with increased risks of later injury and mortality, preventing injury among seniors may be an effective way to improve quality of life and reduce declines in functional capacity.
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Affiliation(s)
- Dongjuan Xu
- School of Nursing, Purdue University, West Lafayette, Indiana
| | - Julia A Rivera Drew
- Minnesota Population Center, University of Minnesota, Twin Cities, Minneapolis
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Howard B, Baca R, Bilger M, Cali S, Kotarski A, Parrett K, Skibinski K. Investigating Older Adults’ Expressed Needs Regarding Falls Prevention. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2018. [DOI: 10.1080/02703181.2018.1520380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Brenda Howard
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Ryan Baca
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Melissa Bilger
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Sarah Cali
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Abigail Kotarski
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Kiana Parrett
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
| | - Karena Skibinski
- Occupational Therapy, University of Indianapolis, Indianapolis, Indiana, USA
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Kim K, Beach J, Senthilselvan A, Yiannakoulias N, Svenson L, Kim H, Voaklander DC. Agricultural injuries among farm and non-farm children and adolescents in Alberta, Canada. Am J Ind Med 2018; 61:762-772. [PMID: 30003556 DOI: 10.1002/ajim.22872] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2018] [Indexed: 11/09/2022]
Abstract
BACKGROUND Understanding of the specific risk of agricultural injury sustained by different populations of children and adolescents is needed for effective safety intervention. OBJECTIVE To compare the rates and patterns of agricultural injury incidence (fatal and non-fatal injury) between farm and non-farm children less than 18 years of age in Alberta, Canada. METHODS A total of 115 378 children (five subgroups: two groups of farm children and three groups of non-farm children) in Alberta were followed from 1999 to 2010 to examine injury incidence using the linkage of three administrative health databases. A recurrent event survival analysis using Cox proportional hazards regression was carried out. RESULTS A total of 1 849 agricultural injury episodes (1 616 emergency department visits, 225 hospitalizations, and 8 deaths) were identified from 1999 to 2010. The age- and gender-adjusted rate (per 100 000 person years) of agricultural injury was 672.3 for rural-living farm children, 369.4 for urban-living farm children, 180.2 for rural non-First Nations (FN) children, 64.4 for rural FN children, and 23.7 for urban children in descending order. CONCLUSION Specific strategies for different children's populations to prevent agricultural injuries and to extend agricultural injury controls to non-farming populations are needed.
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Affiliation(s)
- Kyungsu Kim
- Rural Development Administration (RDA), Jeonju, The Republic of Korea
| | - Jeremy Beach
- Department of Preventive Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Niko Yiannakoulias
- School of Geography and Earth Sciences, McMaster University, Hamilton, Ontario, Canada
| | | | - Hyocher Kim
- Rural Development Administration (RDA), Jeonju, The Republic of Korea
| | - Donald C Voaklander
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
- The Injury Prevention Center, Edmonton, Alberta, Canada
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Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical Costs of Fatal and Nonfatal Falls in Older Adults. J Am Geriatr Soc 2018; 66:693-698. [PMID: 29512120 PMCID: PMC6089380 DOI: 10.1111/jgs.15304] [Citation(s) in RCA: 700] [Impact Index Per Article: 116.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To estimate medical expenditures attributable to older adult falls using a methodology that can be updated annually to track these expenditures over time. DESIGN Population data from the National Vital Statistics System (NVSS) and cost estimates from the Web-based Injury Statistics Query and Reporting System (WISQARS) for fatal falls, quasi-experimental regression analysis of data from the Medicare Current Beneficiaries Survey (MCBS) for nonfatal falls. SETTING U.S. population aged 65 and older during 2015. PARTICIPANTS Fatal falls from the 2015 NVSS (N=28,486); respondents to the 2011 MCBS (N=3,460). MEASUREMENTS Total spending attributable to older adult falls in the United States in 2015, in dollars. RESULTS In 2015, the estimated medical costs attributable to fatal and nonfatal falls was approximately $50.0 billion. For nonfatal falls, Medicare paid approximately $28.9 billion, Medicaid $8.7 billion, and private and other payers $12.0 billion. Overall medical spending for fatal falls was estimated to be $754 million. CONCLUSION Older adult falls result in substantial medical costs. Measuring medical costs attributable to falls will provide vital information about the magnitude of the problem and the potential financial effect of effective prevention strategies.
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Affiliation(s)
- Curtis S. Florence
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control Atlanta, GA
| | - Gwen Bergen
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control Atlanta, GA
| | - Adam Atherly
- University of Colorado Denver - Anschutz Medical Campus, Denver, CO
| | - Elizabeth Burns
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control Atlanta, GA
| | - Judy Stevens
- Centers for Disease Control and Prevention, National Center for Injury Prevention and Control Atlanta, GA
| | - Cynthia Drake
- University of Colorado Denver - Anschutz Medical Campus, Denver, CO
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Hoffman GJ, Hays RD, Shapiro MF, Wallace SP, Ettner SL. The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs. Health Serv Res 2016; 52:1794-1816. [PMID: 27581952 DOI: 10.1111/1475-6773.12554] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To estimate expenditures for fall-related injuries (FRIs) among older Medicare beneficiaries. DATA SOURCES The 2007-2009 Medicare claims and 2008 Health and Retirement Study (HRS) data for 5,497 (228 FRI and 5,269 non-FRI) beneficiaries. STUDY DESIGN FRIs were indicated by inpatient/outpatient ICD-9 diagnostic codes for fractures, trauma, dislocations, and by e-codes. A pre-post comparison group design was used to estimate the differential change in pre-post expenditures for the FRI relative to the non-FRI cohort (FRI expenditures). Out-of-pocket (OOP) costs, service category total annual FRI-related Medicare expenditures, expenditures related to the type of initial FRI treatment (inpatient, ED, outpatient), and the risk of persistently high expenditures (4th quartile for each post-FRI quarter) were estimated. PRINCIPAL FINDINGS Estimated FRI expenditures were $9,389 (95 percent CI: $5,969-$12,808). Inpatient, physician/outpatient, skilled nursing facility, and home health comprised 31, 18, 39, and 12 percent of the total. OOP costs were $1,363.0 (95 percent CI: $889-$1,837). Expenditures for FRIs initially treated in inpatient/ED/outpatient settings were $21,424/$6,142/$8,622. The FRI cohort had a 64 percent increased risk of persistently high expenditures. Total Medicare expenditures were $13 billion (95 percent CI: $9-$18 billion). CONCLUSIONS FRIs are associated with substantial, persistent Medicare expenditures. Cost-effectiveness of multifactorial falls prevention programs should be assessed using these expenditure estimates.
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Affiliation(s)
- Geoffrey J Hoffman
- Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI
| | - Ron D Hays
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Martin F Shapiro
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA.,Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Steven P Wallace
- Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, UCLA, Los Angeles, CA
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Kim SB, Zingmond DS, Keeler EB, Jennings LA, Wenger NS, Reuben DB, Ganz DA. Development of an algorithm to identify fall-related injuries and costs in Medicare data. Inj Epidemiol 2016; 3:1. [PMID: 27747538 PMCID: PMC4701758 DOI: 10.1186/s40621-015-0066-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identifying fall-related injuries and costs using healthcare claims data is cost-effective and easier to implement than using medical records or patient self-report to track falls. We developed a comprehensive four-step algorithm for identifying episodes of care for fall-related injuries and associated costs, using fee-for-service Medicare and Medicare Advantage health plan claims data for 2,011 patients from 5 medical groups between 2005 and 2009. METHODS First, as a preparatory step, we identified care received in acute inpatient and skilled nursing facility settings, in addition to emergency department visits. Second, based on diagnosis and procedure codes, we identified all fall-related claim records. Third, with these records, we identified six types of encounters for fall-related injuries, with different levels of injury and care. In the final step, we used these encounters to identify episodes of care for fall-related injuries. RESULTS To illustrate the algorithm, we present a representative example of a fall episode and examine descriptive statistics of injuries and costs for such episodes. Altogether, we found that the results support the use of our algorithm for identifying episodes of care for fall-related injuries. When we decomposed an episode, we found that the details present a realistic and coherent story of fall-related injuries and healthcare services. Variation of episode characteristics across medical groups supported the use of a complex algorithm approach, and descriptive statistics on the proportion, duration, and cost of episodes by healthcare services and injuries verified that our results are consistent with other studies. CONCLUSIONS This algorithm can be used to identify and analyze various types of fall-related outcomes including episodes of care, injuries, and associated costs. Furthermore, the algorithm can be applied and adopted in other fall-related studies with relative ease.
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Affiliation(s)
- Sung-Bou Kim
- Pardee RAND Graduate School, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - David S Zingmond
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA, 90095, USA
| | - Emmett B Keeler
- RAND Health, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - Lee A Jennings
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA, 90095, USA
| | - Neil S Wenger
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA, 90095, USA.,RAND Health, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
| | - David B Reuben
- Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA, 90095, USA
| | - David A Ganz
- RAND Health, RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA. .,Multicampus Program in Geriatric Medicine and Gerontology, David Geffen School of Medicine at UCLA, Center for Health Sciences, Los Angeles, CA, 90095, USA. .,Geriatric Research, Education and Clinical Center, and Center for the Study of Healthcare Innovation, Implementation and Policy, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Blvd (11G), Los Angeles, CA, 90073, USA.
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Nguyen H, Ivers R, Jan S, Martiniuk A, Segal L, Pham C. Cost and impoverishment 1 year after hospitalisation due to injuries: a cohort study in Thái Bình, Vietnam. Inj Prev 2015; 22:33-9. [PMID: 26070866 DOI: 10.1136/injuryprev-2014-041493] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 05/23/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Evidence on the economic impact on individuals and their families following an injury in Vietnam is limited. This study examines the costs and the risk of impoverishment due to hospitalised injuries at 12 months following hospital discharge and associated factors. METHOD Employing a prospective cohort design, 892 people hospitalised for injury were recruited from Thái Bình General Hospital in Vietnam in 2010 and followed up for 12 months. All out-of-pocket costs incurred and income lost by injured persons and their caregivers associated with care and treatment of their injuries were reported. To examine associated factors, we used generalised estimating equation models for costs and modified Poisson regression for the risk of impoverishment. RESULTS The mean total costs by 12 months postdischarge were US$804, nearly 1.2 times the annual average income. Injuries that incurred highest costs were falls (US$950) and road traffic injuries (RTIs) (US$794). At 12-month follow-up, 181 persons (26.9%) became impoverished, with those injured in RTIs and falls at highest risk (26.1% and 35.4%, respectively). Factors associated with higher costs were also those associated with higher risk of impoverishment. These include those injured in RTIs or falls; having higher severity level; principal injured region as upper extremities, lower extremities or head; physical nature of injuries as fracture or concussion injuries; and longer hospitalisation. CONCLUSIONS Injuries impose significant economic burden on injured persons and their families during and beyond hospitalisation. In addition to prevention, there is a need to reform health financing system to protect injured persons from significant out-of-pocket expense for healthcare services.
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Affiliation(s)
- Ha Nguyen
- School of Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Rebecca Ivers
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Alexandra Martiniuk
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia
| | - Leonie Segal
- School of Population Health, University of South Australia, Adelaide, South Australia, Australia
| | - Cuong Pham
- The Center for Injury Policy and Prevention Research, Hanoi School of Public Health, Hanoi, Vietnam
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Porell FW, Carter MW. Risk of mortality and nursing home institutionalization after injury. J Am Geriatr Soc 2012; 60:1498-503. [PMID: 22862782 DOI: 10.1111/j.1532-5415.2012.04053.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To evaluate the effects of unintentional injuries on the risks of nursing home institutionalization and mortality in older adults. DESIGN A retrospective analysis of data from the Medicare Current Beneficiary Survey, a nationally representative survey of Medicare beneficiaries. SETTING Noninstitutionalized community residents. PARTICIPANTS Older adult panel members (N = 12,031) with continuous Medicare eligibility not enrolled in managed care in a cohort starting between 1998 and 2001. MEASUREMENTS Cox regression and competing risk survival models were estimated using time-varying injury-status dummy variables and control variables for outcomes measured as time until death and institutionalization, respectively. RESULTS Almost 4% of persons were institutionalized, 15% died, 14% had a sentinel injury, and 3% had two or more minor nonsentinel injuries within 1-year period. Persons hospitalized for sentinel injury had elevated institutionalization and mortality risks during an injury episode and after the episode ended. Persons receiving outpatient treatment for sentinel injuries had elevated institutionalization risk during injury episodes (subhazard ratio [SHR] = 6.78, 95% confidence interval [CI] = 3.72-12.37) and elevated mortality risk after episodes (hazard ratio [HR] = 1.60, 95% CI = 1.28-2.00). Persons with multiple minor nonsentinel injuries within a year also had elevated mortality (HR = 1.56, 95% CI = 1.15-2.11) and institutionalization (SHR = 3.55, 95% CI = 2.25-5.67) risks. CONCLUSION Mortality and institutionalization risks extend well beyond the acute episode of treatment for sentinel and repeated minor injuries. More research is needed on longer-term health outcomes of injury survivors to inform development of evidence-based quality-of-care indicators.
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Affiliation(s)
- Frank W Porell
- Gerontology Department and Institute, John W. McCormack Graduate School of Policy and Global Studies, University of Massachusetts, Boston, Massachusetts 02125, USA.
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Platts-Mills TF, Hunold KM, Esserman DA, Sloane PD, McLean SA. Motor vehicle collision-related emergency department visits by older adults in the United States. Acad Emerg Med 2012; 19:821-7. [PMID: 22724382 DOI: 10.1111/j.1553-2712.2012.01383.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Motor vehicle collisions (MVCs) are the second most common cause of nonfatal injury among U.S. adults age 65 years and older. However, the frequency of emergency department (ED) visits, disposition, pain locations, and pain severity for older adults experiencing MVCs have not previously been described. The authors sought to determine these characteristics using information from two nationally representative data sets. METHODS Data from the 2008 Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (NEDS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) were used to estimate MVC-related ED visits and ED disposition for patients 65 years and older. NHAMCS data from 2004 through 2008 were used to further characterize MVC-related ED visits. RESULTS In 2008, the NEDS contained 28,445,564 patient visits, of which 760,356 (2.7%) were due to MVCs. The NHAMCS contained 34,134 patient visits, of which 1,038 (3.0%) were due to MVCs. National estimates of MVC-related ED visits by patients 65 years and older in 2008 are 226,000 (95% confidence interval [CI]=210,000 to 240,000) for NEDS and 270,000 (95% CI=185,000 to 355,000) for NHAMCS. Most older adults with MVC-related ED visits were sent home from the ED (proportion discharged NEDS 78%, 95% CI=78% to 79%; NHAMCS 77%, 95% CI=66% to 86%). During the years 2004 through 2008, of MVC-related ED visits by older adults not resulting in hospital admission, moderate or severe pain was reported in 61% (95% CI=52% to 70%) of those with recorded pain scores. Older patients sent home after MVC-related ED visits were less likely than younger patients to receive analgesics (35%, 95% CI=26% to 43% vs. 47%, 95% CI=44% to 50%) during their ED evaluations or as discharge prescriptions (52%, 95% CI=41% to 62% vs. 65%, 95% CI=61% to 68%). CONCLUSIONS In 2008, adults age 65 years or older made more than 200,000 MVC-related ED visits. Approximately 80% of these visits were discharged home from the ED, but the majority of discharged patients reported moderate or severe pain. Further studies of pain and functional outcomes in this population are needed.
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Affiliation(s)
- Timothy F Platts-Mills
- Department of Emergency Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC, USA.
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Thompson HJ, Weir S, Rivara FP, Wang J, Sullivan SD, Salkever D, MacKenzie EJ. Utilization and costs of health care after geriatric traumatic brain injury. J Neurotrauma 2012; 29:1864-71. [PMID: 22435729 DOI: 10.1089/neu.2011.2284] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite the growing number of older adults experiencing traumatic brain injury (TBI), little information exists regarding their utilization and cost of health care services. Identifying patterns in the type of care received and determining their costs is an important first step toward understanding the return on investment and potential areas for improvement. We performed a health care utilization and cost analysis using the National Study on the Costs and Outcomes of Trauma (NSCOT) dataset. Subjects were persons 55-84 years of age with TBI treated in 69 U.S. hospitals located in 14 states (n=414, weighted n=1038). Health outcomes, health care utilization, and 1-year costs of care following TBI in 2005 U.S. dollars were estimated from hospital bills, patient surveys, medical records, and Medicare claims data. The subjects were further analyzed in three subgroups (55-64, 65-74, and 75-84 years of age). Unadjusted cost models were built, followed by a second set of models adjusting for demographic and pre-injury health status. Those in the oldest category (75-84 years) had significantly higher numbers of re-hospitalizations, home health care visits, and hours per week of unpaid care, and significantly lower numbers of physician and mental health professional visits than younger age groups (age 55-64 and 65-74 years). Significant age-related differences were seen in all health outcomes tested at 12 months post-injury except for incidence of depressive symptoms. One-year total treatment costs did not differ significantly across age categories for brain-injured older adults in either the unadjusted or adjusted models. The unadjusted total mean 1-year cost of care was $77,872 in persons aged 55-64 years, $76,903 in persons aged 65-74 years, and $72,733 in persons aged 75-84 years. There were significant differences in cost drivers among the age groups. In the unadjusted model index hospitalization costs and inpatient rehabilitation costs were significantly lower in the oldest age category, while outpatient care costs and nursing home stays were lower in the younger age categories. In the adjusted model, in addition to these cost drivers, re-hospitalization costs were significantly higher among those 75-84 years of age, and receipt of informal care from friends and family was significantly different, being lowest among those aged 65-74 years, and highest among those aged 75-84 years. Identifying variations in care that these patients are receiving and determining the costs versus benefits is an important next step in understanding potential areas for improvement.
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Affiliation(s)
- Hilaire J Thompson
- Biobehavioral Nursing and Health Systems, University of Washington, Seattle, WA 98195-7266, USA.
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Bohl AA, Phelan EA, Fishman PA, Harris JR. How are the costs of care for medical falls distributed? The costs of medical falls by component of cost, timing, and injury severity. THE GERONTOLOGIST 2012; 52:664-75. [PMID: 22403161 DOI: 10.1093/geront/gnr151] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE STUDY To examine the components of cost that drive increased total costs after a medical fall over time, stratified by injury severity. DESIGN AND METHODS We used 2004-2007 cost and utilization data for persons enrolled in an integrated care delivery system. We used a longitudinal cohort study design, where each individual provides 2-3 years of administrative data grouped into 3-month intervals relative to an index date. We identified 8,969 medical fallers through International Classification of Diseases, 9th Revision, codes and E-Codes and used 8,956 nonfaller controls, identified through age and gender frequency matching. Total costs were partitioned into 7 components: inpatient, outpatient, emergency, radiology, pharmacy, postacute care, and "other." RESULTS The large increase in costs after a hospitalized fall is mainly associated with inpatient and postacute care components. The spike in costs after a nonhospitalized fall is attributable to outpatient and "other" (e.g., ambulatory surgery or community health services) components. Hospitalized fallers' inpatient, emergency, postacute care, outpatient, and radiology costs are not always greater than those for nonhospitalized fallers. IMPLICATIONS Components associated with increased costs after a medical fall vary over time and by injury severity. Future studies should compare if delivering certain acute and postacute health services improve health and reduce cost trajectories after a medical fall more than others. Additionally, since the older adult population and the problem of falls are growing, health care delivery systems should develop standardized methodology to monitor medical fall rates.
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Affiliation(s)
- Alex A Bohl
- Mathematica Policy Research, Inc., 955 Massachusetts Avenue, Suite 801, Cambridge, MA 02139, USA.
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