Fall Injuries Top Cause of Hospital Readmission in Elderly

Veronica Hackethal, MD

May 24, 2019

Fall-related injuries are a leading cause of 30-day readmission in older individuals who have recently been hospitalized, according to results from a study of more than 8.3 million Medicare beneficiaries.

Fall-related readmissions were particularly high among individuals initially hospitalized for a fall, those who had cognitive impairment, or those who were discharged home or to home healthcare rather than to a skilled nursing facility.

Results were published online May 24 in JAMA Network Open.

The findings highlight the need for a greater focus on fall prevention strategies before hospital discharge and for targeting those at increased risk for falls.

"Falls are a trifecta in terms of reasons why they need an increased focus. They are highly prevalent, cause a lot of damage, including death, and they are preventable. However, fall prevention is being left out of the discharge planning conversation, and that needs to change," author Geoffrey Hoffman, PhD, MPH, University of Michigan School of Nursing, Ann Arbor, said in a University of Michigan news release.

Falls represent the leading cause of injury-related hospitalizations among older individuals. Those with a history of falls or cognitive impairment are at increased risk.

"After discharge, the goal is to provide patient-centered fall prevention and to safely encourage patients to get up and move. Previous research suggests that in the long term, limited mobility can harm patients and increase fall risks, something many caregivers and patients may not realize, because sedentary behavior appears to reduce fall risks and falls in the shorter term," Hoffman said.

Medicare currently penalizes hospitals for inpatient fall injuries. Incentives from Medicare's Hospital Readmissions Reduction Program include a focus on fall prevention and managing patient discharge to prevent readmissions. Despite these initiatives, little is known about the impact of falls with respect to readmission.

The researchers analyzed hospital discharge data from 2013 and 2014 in the Nationwide Readmissions Database of the Agency for Healthcare Research and Quality's Hospital Cost and Utilization Project. That database includes nationally representative data on hospital discharges among Medicare beneficiaries aged 65 years or older. The analysis focused on 30-day hospital readmissions for the entire cohort, as well as for two groups at high risk for falls: those initially hospitalized for falls, and those with cognitive impairment.

The analysis included 8,382,074 patients. Of these, 4,736,281 (56.5%) were women (mean age, 77.7 years). Overall, 746,397 of these patients (8.9%) had a fall-related injury, and 1,367,759 (16.3%) had cognitive impairment upon their first admission.

More than 1 million (1,205,962; 14.4%) of these patients were readmitted within 30 days of their first admission.

Overall, fall-related injuries ranked as the third-leading cause of readmissions (5.1%; n = 60,954), after septicemia (9.5%; n = 115,026) and heart failure (8.8%; n = 105,771).

Fall-related injuries ranked as the second-leading reason for readmission among patients initially admitted for a fall-related injury (10.3%; n = 9915/96,301) and those initially admitted with cognitive impairment (7.0%; n = 15,262/218,351).

Among patients initially hospitalized with a fall-related injury who were discharged home or to home healthcare, a repeat fall-related injury ranked as the leading cause of readmission (12.3%; n = 2103/17,098; and 11.8%; n = 2091/17,772, respectively).

This last finding is new and highlights the need to target patients discharged home for fall prevention strategies, the authors state. Such individuals may not receive adequate care and assistance with daily tasks and rehabilitation, which may put them at risk for future falls.

Post-hospitalization fall-prevention interventions do exist and have been found to be effective in preventing falls, the researchers explain.

These include community-based interventions, home modifications, and education.

Proper education is key, senior author Lillian Min, MD, MSHS, University of Michigan, Ann Arbor, said in the press release.

"Discharge planners, doctors, patients, and families should develop a personalized plan to balance increased mobility and fall prevention," she said.

Because claims data may not capture all fall-related admissions and the study did not include same-injury readmissions, results may underestimate the number of fall-related readmissions during the study period.

The study was supported by grants from the University of Michigan Older Americans Independence Center and the University of Michigan Pepper Center. One or more authors report havng received grants and salary support from the National Institute on Aging Older Americans Independence Center (University of Michigan), the National Institute on Aging Pepper Center, OncoImmune, the National Institutes of Health, and/or the Veterans Affairs Healthcare System.

JAMA Netw Open. Published online May 24, 2019. Full text

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