Underreporting of Fall Injuries of Older Adults: Implications for Wellness Visit Fall Risk Screening.

TitleUnderreporting of Fall Injuries of Older Adults: Implications for Wellness Visit Fall Risk Screening.
Publication TypeJournal Article
Year of Publication2018
AuthorsHoffman, GJ, Ha, J, Alexander, NB, Langa, KM, Tinetti, M, Min, LC
JournalJ Am Geriatr Soc
Date Published2018 07
ISSN Number1532-5415
KeywordsAccidental Falls, Activities of Daily Living, Aged, Female, Hospitalization, Humans, Insurance Claim Reporting, Male, Mass Screening, Medicare, Primary Health Care, Retrospective Studies, Risk Assessment, Risk Factors, Self Report, Sensitivity and Specificity, United States

OBJECTIVES: To compare the accuracy of and factors affecting the accuracy of self-reported fall-related injuries (SFRIs) with those of administratively obtained FRIs (AFRIs).

DESIGN: Retrospective observational study SETTING: United States PARTICIPANTS: Fee-for-service Medicare beneficiaries aged 65 and older (N=47,215).

MEASUREMENTS: We used 24-month self-report recall data from 2000-2012 Health and Retirement Study data to identify SFRIs and linked inpatient, outpatient, and ambulatory Medicare data to identify AFRIs. Sensitivity and specificity were assessed, with AFRIs defined using the University of California at Los Angeles/RAND algorithm as the criterion standard. Logistic regression models were used to identify sociodemographic and health predictors of sensitivity.

RESULTS: Overall sensitivity and specificity were 28% and 92%. Sensitivity was greater for the oldest adults (38%), women (34%), those with more functional limitations (47%), and those with a prior fall (38%). In adjusted results, several participant factors (being female, being white, poor functional status, depression, prior falls) were modestly associated with better sensitivity and specificity. Injury severity (requiring hospital care) most substantively improved SFRI sensitivity (73%).

CONCLUSION: An overwhelming 72% of individuals who received Medicare-reimbursed health care for FRIs failed to report a fall injury when asked. Future efforts to address underreporting in primary care of nonwhite and healthier older adults are critical to improve preventive efforts. Redesigned questions-for example, that address stigma of attributing injury to falling-may improve sensitivity.

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Alternate JournalJ Am Geriatr Soc
Citation Key9790
PubMed ID29665016
PubMed Central IDPMC6105546
Grant ListUL1 TR000433 / TR / NCATS NIH HHS / United States
P30 AG053760 / AG / NIA NIH HHS / United States
KL2 TR002241 / TR / NCATS NIH HHS / United States
U01 AG009740 / AG / NIA NIH HHS / United States
P30 AG024824 / AG / NIA NIH HHS / United States
KL2 TR000434 / TR / NCATS NIH HHS / United States
R01 AG047178 / AG / NIA NIH HHS / United States
UL1 TR002240 / TR / NCATS NIH HHS / United States