Falling Again? Falls in Geriatric Adults-Risk Factors and Outcomes Associated With Recidivism

Authors

Kartik Prabhakaran, New York Medical CollegeFollow
Shekhar Gogna
Seungwhan Pee
David J. Samson, New York Medical CollegeFollow
Jorge Con, New York Medical CollegeFollow
Rifat Latifi, New York Medical CollegeFollow

Author Type(s)

Faculty

DOI

10.1016/j.jss.2019.10.041

Journal Title

The Journal of Surgical Research

First Page

66

Last Page

76

Document Type

Article

Publication Date

3-2020

Department

Surgery

Keywords

Accidental Falls, Age Factors, Aged, Aged, 80 and over, Cost of Illness, Databases, Factual, Female, Humans, Male, Patient Readmission, Risk Factors, Sex Factors, United States, Wounds and Injuries

Disciplines

Medicine and Health Sciences

Abstract

BACKGROUND: The elderly population is at increased risk of fall-related readmissions (FRRs). This study is aimed to identify the factors predictive of repeat falls and to analyze the associated outcomes.

METHODS: We studied the Nationwide Readmission Database for the year 2010 and identified the patients (≥65 years) who were admitted after falls, and from that subset, further analyzed patients with ≥1 FRRs. Descriptive statistics were used to analyze continuous and categorical variables. Multivariable logistic regression was used to identify predictors of readmission in geriatric patients after controlling for covariates.

RESULTS: A total of 358,581 initial fall-related admissions in geriatric adults were identified, and of these, 21,713 experienced ≥1 FRRs (6.06% risk of repeat fall-related admission). Females outnumbered males, and female gender was identified as an independent predictor of FRR (OR 1.10 95% CI 1.07-1.14 P = 0.000). The other independent predictors significantly associated with FRR were age (OR 1.007, 95% CI 1.005-1.009), depression (OR 1.25, 95% CI 1.21-1.30), drug abuse (OR 1.37, 95% CI 1.15-1.63), liver disease (OR 1.25, 95% CI 1.15-1.43, P < 0.001), psychosis (OR 1.16, 95% CI 1.09-1.23), valvular heart disease (OR 1.07, 95% CI 1.02-1.12), chronic pulmonary disease (OR 1.10, 95% CI 1.06-1.13), and number of chronic conditions (OR 1.022, 95% CI 1.016-1.29). Patients admitted emergently or urgently had higher odds of FRR (OR 1.44, 95% CI 1.36-1.52). Hospital demographic was a significant predictor of FRR, as hospitals with bed number >500 was associated with lower odds (OR 0.95, 95% CI 0.92-0.98, P < 0.001). Geriatric patients admitted at nonteaching hospitals and hospitals in large metro areas (population > 1 million) had higher odds of FRR (OR 1.10, 95% CI 1.03 - 1.16) and (OR 1.10, 95% C1 1.07-1.14), respectively. With respect to discharge disposition, patients in the FRR group were less likely to go home (5.9% versus 21.0%) or with home health care (12.6% versus 18.5%), but more likely to be discharged to skilled nursing or intermediate-care facilities (64.1% versus 54.9%) and short-term hospitals (2.8% versus 1.4%). The mortality rate was higher in the FRR group but was not statistically significant (OR 1.06, 95% CI 0.99-1.14).

CONCLUSIONS: Given the high burden of fall-related injuries and FRRs to patients and the health care system, it is essential to identify those who are at risk. This study provides a comprehensive list of high-risk predictors as well as the impact on patient outcomes, and hence a chance to intervene for patients with FRRs.

Recommended Citation

Prabhakaran, K., Gogna, S., Pee, S., Samson, D. J., Con, J., & Latifi, R. (2020). Falling Again? Falls in Geriatric Adults-Risk Factors and Outcomes Associated With Recidivism. The Journal of Surgical Research, 247, 66-76. https://doi.org/10.1016/j.jss.2019.10.041