To assess the annual costs 2 years before and 2 years after a hospitalized fall-related injury (HFRI) and the 2-year survival among the population 75+ years old.
We performed a population-based, retrospective cohort study using the French national health insurance claims database.
Setting and Participants
Patients 75+ years old who had experienced a fall followed by hospitalization, identified using an algorithm based on International Classification of Diseases codes. Data related to a non-HFRI population matched on the basis of age, sex, and geographical area were also extracted.
Cost analyses were performed from a health insurance perspective and included direct costs. Survival analyses were conducted using Kaplan-Meier curves and Cox regression. Descriptive analyses of costs and regression modeling were carried out. Both regression models for costs and on survival were adjusted for age, sex, and comorbidities.
A total of 1495 patients with HFRI and 4484 non-HFRI patients were identified. Patients with HFRI were more comorbid than the non-HFRI patients over the entire periods, particularly in the year before and the year after the HFRI. Patients with HFRI have significantly worse survival probabilities, with an adjusted 2.14-times greater risk of death over 2-year follow-up and heterogeneous effects determined by sex. The annual incremental costs between patients with HFRI and non-HFRI individuals were €1294 and €2378, respectively, 2 and 1 year before the HFRI, and €11,796 and €1659, respectively, 1 and 2 years after the HFRI. The main cost components differ according to the periods and are mainly accounted for by paramedical acts, hospitalizations, and drug costs. When fully adjusted, the year before the HFRI and the year after the HFRI are associated with increase in costs.
Conclusions and Implications
We have provided real-world estimates of the cost and the survival associated with patients with HFRI. Our results highlight the urgent need to manage patients with HFRI at an early stage to reduce the significant mortality as well as substantial additional cost management. Special attention must be paid to the fall-related increasing drugs and to optimizing management of comorbidities.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- WHO Global Report on Falls Prevention in Older Age.World Health Organization, 2008
- Falls in older aged adults in 22 European countries: Incidence, mortality and burden of disease from 1990 to 2017.Inj Prev. 2020; 26: i67-i74
- Injuries in the European Union, Summary on injury statistics 2012e2014.European Association for Injury Prevention and Safety Promotion (EuroSafe), 2016
- Falls: Epidemiology, pathophysiology, and relationship to fracture.Curr Osteoporos Rep. 2008; 6: 149-154
- Differences in fall injury hospitalization and related survival rates among older adults across age, sex, and areas of residence in Canada.Inj Epidemiol. 2015; 2: 24
- One-year mortality among elderly people after hospitalization due to fall-related fractures: comparison with a control group of matched elderly.Cad Saúde Pública. 2012; 28: 801-805
- Mortality from falls among US adults aged 75 years or older, 2000-2016.JAMA. 2019; 321: 2131-2133
- Falls in older adults requiring emergency services: Mortality, use of healthcare resources, and prognostication to one year.West J Emerg Med. 2022; 23: 375-385
- The impact of osteoporosis, falls, fear of falling, and efficacy expectations on exercise among community-dwelling older adults.Orthop Nurs. 2014; 33: 277-288https://doi.org/10.1097/NOR.0000000000000084
- EUGMS task and finish group on fall-risk-increasing drugs. Fall-risk-increasing d: A systematic review and meta-analysis: I. cardiovascular drugs.J Am Med Dir Assoc. 2018; 19: 371.e1-371.e9
- EUGMS task and finish group on fall-risk-increasing drugs. Fall-risk-increasing drugs: A systematic review and meta-analysis: II. Psychotropics.J Am Med Dir Assoc. 2018; 19: 371.e11-371.e17
- EUGMS task and finish group on fall-risk-increasing drugs. Fall-risk-increasing drugs: A systematic review and meta-analysis: III. others.J Am Med Dir Assoc. 2018; 19: 372.e1-372.e8
- Patterns of comorbidity in community-dwelling older people hospitalised for fall-related injury: A cluster analysis.BMC Geriatr. 2011; 11: 45
- Falls and comorbidity: The pathway to fractures.Scand J Public Health. 2014; 42: 287-294
- Frailty as a risk factor for falls among community dwelling people: Evidence from a meta-analysis.J Nurs Scholarsh. 2017; 49: 529-536
- International comparison of cost of falls in older adults living in the community: A systematic review.Osteoporos Int. 2010 Aug; 21: 1295-1306
- The costs of fall-related injuries among older adults: Annual per-faller, service component, and patient out-of-pocket costs.Health Serv Res. 2017; 52: 1794-1816
- The cost of a fall among older adults requiring emergency services.J Am Geriatr Soc. 2021; 69: 389-398
- Évaluation économique des lésions associées aux chutes des personnes âgées vivant à domicile [cost evaluation of hospital inpatient stays induced by injuries due to falls for elderly people].Geriatr Psychol Neuropsychiatr Vieil. 2015; 13: 36-44
- The national healthcare system claims databases in France, SNIIRAM and EGB: Powerful tools for pharmacoepidemiology.Pharmacoepidemiol Drug Saf. 2017; 26: 954-962
- Value of a national administrative database to guide public decisions: From the système national d'information interrégimes de l'Assurance Maladie (SNIIRAM) to the système national des données de santé (SNDS) in France.Rev Epidemiol Sante Publique. 2017; 65: S149-S167
- French health insurance databases: What interest for medical research?.Rev Med Interne. 2015; 36: 411-417
- Inflation (CPI) (indicator).2022https://doi.org/10.1787/eee82e6e-en (Accessed on 09 May 2022)
- The best use of the Charlson Comorbidity Index with electronic health care database to predict mortality.Med Care. 2016; 54: 188-194
- Risk factors for poor functional recovery, mortality, recurrent fractures, and falls among patients participating in a Fracture Liaison Service Program.J Am Med Dir Assoc. 2019; 20: 1129-1136.e1
- New horizons in frailty: Ageing and the deficit-scaling problem.Age Ageing. 2013; 42: 416-423
- Frailty in older adults evidence for a phenotype.J Gerontol A: Bio Sci Med Sci. 2001; 56: M146-M157
- The cost of frailty in France.Eur J Health Econ. 2017; 18: 243-253
- The impact of frailty on healthcare resource use: A longitudinal analysis using the clinical practice research Datalink in England.Age Ageing. 2019; 48: 665-671
- Effect of frailty on resource use and cost for Medicare patients.J Comp Eff Res. 2018; 7: 817-825
- The impact of frailty on the economic evaluation of geriatric surgery: Hospital costs and opportunity costs based on meta-analysis.J Med Econ. 2020; 23: 819-830
- Pre-frailty, frailty, and multimorbidity: Prevalences and associated characteristics from two french national surveys.J Nutr Health Aging. 2016; 20: 860-869
- Causal inference in public health.Annu Rev Public Health. 2013; 34: 61-75
- Societal costs of informal care of community-dwelling frail elderly people.Scand J Public Health. 2021; 49: 433-440
Published online: March 16, 2023
Publication stageIn Press Uncorrected Proof
This work was supported by the Court of Auditors, a French public organization.
The authors declare no conflicts of interest.
© 2023 Published by Elsevier Inc. on behalf of AMDA - The Society for Post-Acute and Long-Term Care Medicine.