@article {8686, title = {The Costs of Fall-Related Injuries among Older Adults: Annual Per-Faller, Service Component, and Patient Out-of-Pocket Costs.}, journal = {Health Serv Res}, volume = {52}, year = {2017}, month = {2017 10}, pages = {1794-1816}, 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.

}, keywords = {Accidental Falls, Age Factors, Aged, Aged, 80 and over, Female, Financing, Personal, Health Expenditures, Health Services, Humans, Male, Medicare, Models, Econometric, Sex Factors, Socioeconomic factors, United States, Wounds and Injuries}, issn = {1475-6773}, doi = {10.1111/1475-6773.12554}, author = {Geoffrey J Hoffman and Hays, Ron D and Martin F Shapiro and Steven P Wallace and Susan L Ettner} } @article {8963, title = {Depressive symptomatology and fall risk among community-dwelling older adults.}, journal = {Social Science \& Medicine}, volume = {178}, year = {2017}, month = {04/2017}, pages = {206-213}, abstract = {

RATIONALE: Falls are common among older adults and may be related to depressive symptoms (DS). With advancing age, there is an onset of chronic conditions, sensory impairments, and activity limitations that are associated with falls and with depressive disorders. Prior cross-sectional studies have observed significant associations between DS and subsequent falls as well as between fractures and subsequent clinical depression and DS.

OBJECTIVE: The directionality of these observed relationship between falls and DS is in need of elaboration given that cross-sectional study designs can yield biased estimates of the DS-falls relationship.

METHODS: Using 2006-2010 Health and Retirement Study data, cross-lagged panel structural equation models were used to evaluate associations between falls and DS among 7233 community-dwelling adults ages >=65. Structural coefficients between falls and DS (in 2006{\textrightarrow}2008, 2008{\textrightarrow}2010) were estimated.

RESULTS: A good-fitting model was found: Controlling for baseline (2006) physical functioning, vision, chronic conditions, and social support and neighborhood social cohesion, falls were not associated with subsequent DS, but a 0.5 standard deviation increase in 2006 DS was associated with a 30\% increase in fall risk two years later. This DS-falls relationship was no longer significant when use of psychiatric medications, which was positively associated with falls, was included in the model.

CONCLUSION: Using sophisticated methods and a large U.S. sample, we found larger magnitudes of effect in the DS-falls relationship than in prior studies-highlighting the risk of falls for older adults with DS. Medical providers might assess older individuals for DS as well as use of psychotropic medications as part of a broadened falls prevention approach. National guidelines for fall risk assessments as well as quality indicators for fall prevention should include assessment for clinical depression.

}, keywords = {Community-dwelling, Depressive symptoms, Falls, Health Shocks, Older Adults, Restricted data}, issn = {1873-5347}, doi = {10.1016/j.socscimed.2017.02.020}, author = {Geoffrey J Hoffman and Hays, Ron D and Steven P Wallace and Martin F Shapiro and Susan L Ettner} } @article {8816, title = {Receipt of Caregiving and Fall Risk in US Community-dwelling Older Adults.}, journal = {Med Care}, volume = {55}, year = {2017}, month = {2017 04}, pages = {371-378}, abstract = {

BACKGROUND: Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk.

DESIGN: Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (>=14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (>=3 activities of daily living) or cognitive limitations moderated this relationship.

RESULTS: Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with >=3 activities of daily living, fall risks were reduced by 21\% for those receiving high levels of informal care; additionally, FRIs were reduced by 42\% and 58\% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54\% FRI risk reduction among the cognitively impaired.

CONCLUSIONS: Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.

}, keywords = {Accidental Falls, Activities of Daily Living, Aged, Aged, 80 and over, Caregivers, Female, Geriatric Assessment, Humans, Independent Living, Longitudinal Studies, Male, Middle Aged, Risk Assessment, Risk Factors, United States}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000677}, url = {http://content.wkhealth.com/linkback/openurl?sid=WKPTLP:landingpage\&an=00005650-900000000-98801}, author = {Geoffrey J Hoffman and Hays, Ron D and Steven P Wallace and Martin F Shapiro and Yakusheva, Olga and Susan L Ettner} } @article {8485, title = {Claims-based Identification Methods and the Cost of Fall-related Injuries Among US Older Adults.}, journal = {Med Care}, volume = {54}, year = {2016}, month = {2016 07}, pages = {664-71}, abstract = {

OBJECTIVES: Compare expenditures of fall-related injuries (FRIs) using several methods to identify FRIs in administrative claims data.

RESEARCH DESIGN: Using 2007-2009 Medicare claims and 2008 Health and Retirement Survey data, FRIs were identified using external-cause-of-injury (e-codes 880/881/882/884/885/888) only, e-codes plus a broad set of primary diagnosis codes, and a newer approach using e-codes and diagnostic and procedural codes. Linear regression models adjusted for sociodemographic, health, and geographic characteristics were used to estimate per-FRI, service component, patient cost share, expenditures by type of initial FRI treatment (inpatient, emergency department only, outpatient), and total annual FRI-related Medicare expenditures.

SUBJECTS: The analysis included 5497 community-dwelling adults >=65 (228 FRI, 5269 non-FRI individuals) with continuous Medicare coverage and alive during the 24-month study.

RESULTS: The 3 FRI identification methods produced differing distributions of index FRI type and varying estimated expenditures: $12,171 [95\% confidence interval (CI), $4662-$19,680], $5648 (95\% CI, $3819-$7476), and $9388 (95\% CI, $5969-$12,808). In all models, most spending occurred in hospital, outpatient, and skilled nursing facility (SNF) settings, but greater proportions of SNF and outpatient spending were observed with commonly used FRI identification methods. Patient cost-sharing was estimated at $691-$1900 across the 3 methods. Inpatient-treated index FRIs were more expensive than emergency department and outpatient-treated FRIs across all methods, but were substantially higher when identifying FRI using only e-codes. Estimated total FRI-related Medicare expenditures were highly variable across methods.

CONCLUSIONS: FRIs are costly, with implications for Medicare and its beneficiaries. However, expenditure estimates vary considerably based on the method used to identify FRIs.

}, keywords = {Accidental Falls, Aged, Aged, 80 and over, Cross-Over Studies, Female, Humans, Insurance Claim Review, Male, Medicare, United States, Wounds and Injuries}, issn = {1537-1948}, doi = {10.1097/MLR.0000000000000531}, url = {http://www.ncbi.nlm.nih.gov/pubmed/27057747}, author = {Geoffrey J Hoffman and Hays, Ron D and Martin F Shapiro and Steven P Wallace and Susan L Ettner} }