Effect of Number of Household Members on Falls among Disabled Older People

The Impact of Living Arrangements on the Prevalence of Falls after Total Joint Arthroplasty: A Comparison between Institutionalized and General Geriatric Population

Due to population aging, there is an increasing need for orthopedic surgery, especially total knee arthroplasty (TKA) and total hip arthroplasty (THA). In geriatric patients, postoperative falls are common events which can compromise the success of these expensive procedures. The aim of our study was to assess the influence of living arrangements on the prevalence of postoperative falls following joint replacement. We included 441 patients after TKA or THA, living in nursing homes, alone or with family. The prevalence of falls in the first 2 years (15.2%) was significantly influenced by living arrangements: patients with TKA or THA living alone had three times higher odds of falling compared to those living with family, and institutionalized patients with THA had four times higher odds of falling compared to those living with family. Of 67 patients who fell, 6 (8.9%) needed reintervention. For TKA patients, the fall rates were not significantly different between institutions and family, indicating the interest of nursing homes in offering proper care. However, for the THA group, the results were poorer, emphasizing the need for improvement in postoperative rehabilitation. Further multi-centric studies are required for generalizing the impact of living arrangements on fall prevalence after joint replacement.

Health Need Factors Are the Key Drivers of Hospitalization among the Elderly Living Alone: An Analysis of Longitudinal Data

Elderly people living alone are a large and growing proportion of the population of many developed economies. The elderly, particularly those living alone, are more likely to be hospitalized overnight, with consequent substantial health and financial costs. A widely used model of health service utilization is augmented with social issues that may specifically delineate some of the issues associated with living alone. A longitudinal survey of elderly (aged 65 and over) living alone in Australia with three time points over four years was analyzed using logistic regressions for overnight hospitalization. The main set of data (n = 672) had an average age of 75.91 years and was 70.2% female. The health need factors of self-rated general health and illness severity, along with comorbidity, were the key drivers of hospitalization. There were some individuals with prioritized access to hospitalization due to forms of health funding. The social issues did not independently stand out as drivers of overnight hospitalization, but the complexity of the inter-relationships between issues when studying the health of the elderly began to arise. The results enhance our understanding of health services utilization, within the context of a relatively universal health care system.

Cumulative Health Drivers of Overnight Hospitalization for Australian Working-Age Adults Living Alone: The Early Warning Potential of Functionality

There is a need to better understand the drivers of hospital utilization for the large and growing number of adults living alone. The cumulative effect of health drivers can be assessed by initially considering clinically advised information, then considering issues that a general practitioner or the person themselves may know. Logistic regression analyses were conducted on longitudinal data from the Household, Income, and Labor Dynamics in Australia (HILDA) survey with three time points over four years (n = 1019). The significant predictors of overnight hospitalization were the presence of a long-term health condition (Time 1), hospitalization severity and comorbidity (Time 1), work ability (Time 2), physical functioning (Time 2), being separated/divorced and having one or more health care cards. Health issues were predictive up to four years before the hospitalization window. That baseline risk of hospitalization was modified as symptoms and relatively salient changes in functionality accumulated. Specific sub-groups of hospital users had access due to insurance or special coverage. The impact of living alone on hospitalization may be able to be partly addressed through interventions such as improving access to primary care and using early warning triggers such as decreasing functionality to seek primary care before seeking hospitalization.