The Incidence, Risk and Outcomes of Hospitalized Fall Injuries
Among Older
Adults in Virginia
SAWIDA KAMARA
Advisor, Shelley Harris, Ph.D.
Preceptor, Erima Shields-Fobbs, M.P.H.
Purpose: The research on falls thoroughly illustrates the extensive impact of falls among older adults; However, most studies aggregate falls, and do not focus on the impact of the various fall types on older adults. Since there is no empirical or a priori reason to believe that various types of fall have similar demographic risk factors and consequences, the purpose of this study is to describe those various fall types that result in older adult hospitalizations. The primary objective of this study is to examine fall incidence, types of falls, and the outcomes of fall injuries and their relationship to an elder adult’s age, gender and race/ethnicity. This study also sets out to determine whether particular types of falls account for the large increase in fall injuries that come with age.
Methods: An analysis was conducted on injury-related hospital discharge data. The full data set consists of records of injury hospitalizations occurring in Virginia during 2000. This study includes 15,621 elder adults, aged 65 years and older, hospitalized with an injury in a licensed Virginia hospital. For analyses, the hospitalized adults were stratified into age groups. The pertinent outcome of interest in this study is a hospitalization with a fall injury as the principle external cause of injury. The following variables, recorded as patient information in the discharge data set, were analyzed by type of fall, demographic characteristics (age, gender, race/ethnicity), primary diagnosis, length of stay, disposition at discharge, and total charges.
Results: Of the 15,621 adults aged 65 years and older hospitalized, 11,014 (70.5%) had fall injuries. The total rate for fall injury hospitalizations, 1,390.1 per 100,000, is over four times that of the total rate of non-fall injury hospitalizations. Women have higher rates of fall injuries within each successive age group, however there is an increase in risk across age for both women and men. Among race/ethnic groups, whites are at most risk for both fall injuries and non-fall injuries. The three key fall types are slipping, tripping, or stumbling on the same level (rate=391.2), followed by falling from one level to another (rate=129.4), and falling on or from stairs or steps (rate=69.9). Rates increase with age for the three leading types of falls. Women have higher rates for the three leading types of falls. Men, on the other hand, have higher rates for fall injuries from falling on or from a ladder or scaffolding. Fractures of the femur neck are the most frequent primary diagnoses among fall injury-hospitalized patients. Of the 11,014 fall injury patients hospitalized, 4,305 (3 9%) were discharged to a nursing facility. Mean charges and length of stay do not greatly vary with age for fall injury hospitalizations, but do vary with fall type. The fall type with the largest means was falling from one level to another (charges=$ 15,663 and length of stay7 days). The results of the multivariate analysis of the risk for a fall injury hospitalization are consistent with the trends seen in the rate findings.
Conclusion: Given the extremely high rates of older-adult fall injuries, the aging of our population, both statewide and nationally, and the possibly increasing rates, the prevention of falls among older adults should be a priority among public health officials and prevention workers. Finding considerable variation in demographic risk factors, primary diagnoses, and mean hospital charges and length of stay for falling by type of fall suggests that more research and prevention programs should focus on individual types of falls rather than on falls as a collective.
