Associations between home injury falls and prior hospitalizations in community dwelling older adults: A population case-crossover study

Christy M. Adams, Daniel J. Tancredi, Janice F. Bell, Sheryl L. Catz, Patrick S. Romano

Research output: Contribution to journalArticle

Abstract

Objective: The purpose of this study was to examine risk factor and temporal associations between acute care hospitalization and post-discharge home injury falls in a population-based analysis sample of community dwelling older adults. Methods: We applied a unidirectional case-crossover design to a retrospective analysis sample derived from healthcare administrative data from all non-federal licensed hospitals in the State of California. The analysis sample was comprised of California residents age 65 years or older with a record of treatment for injury fall occurring at home from January 1, 2014 to December 31, 2014. A conditional Poisson regression with fixed person effects and a robust estimator of variance was used to calculate the incidence rate ratio of acute care admissions during the 90 day period immediately preceding an injury fall, with the period of 360–271 days prior to index fall as reference. Results: The rate of acute care admissions was 121% greater (IRR: 2.21; 95% CI 2.15–2.27) during the 90 days immediately preceding the index injury fall than 181–360 days prior. Period effects on rates of admissions were significantly higher in the acute care treatment subsample (IRR 2.63; 95% CI 2.51–2.76) than the emergency department treatment subsample (IRR 2.00; 95% CI 1.94–2.07). Discharge to post-acute care facilities; discharge to home health and Elixhauser comorbidity index all significantly modified period effects on acute care admissions. Conclusions: Older adults have an increased risk of falling at home after being discharged from an acute care hospitalization, with highest risk occurring during the 90-day post-discharge period. Special consideration should be given to assessing hospital-associated changes in fall risk among geriatric patients prior to discharge directly home. Discharge planning should include efforts to reduce home fall risk during the period of transition from hospital care.

Original languageEnglish (US)
JournalInjury
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Independent Living
Cross-Over Studies
Subacute Care
Hospitalization
Wounds and Injuries
Population
Accidental Falls
State Hospitals
Emergency Treatment
Patient Discharge
Geriatrics
Hospital Emergency Service
Comorbidity
Delivery of Health Care
Incidence
Health
Therapeutics
insulin receptor-related receptor

Keywords

  • Community dwelling
  • Injury falls
  • Injury prevention
  • Older adult falls
  • Post-hospital home falls

ASJC Scopus subject areas

  • Emergency Medicine
  • Orthopedics and Sports Medicine

Cite this

@article{ca476b5a66b847f0bf0966615f9513e7,
title = "Associations between home injury falls and prior hospitalizations in community dwelling older adults: A population case-crossover study",
abstract = "Objective: The purpose of this study was to examine risk factor and temporal associations between acute care hospitalization and post-discharge home injury falls in a population-based analysis sample of community dwelling older adults. Methods: We applied a unidirectional case-crossover design to a retrospective analysis sample derived from healthcare administrative data from all non-federal licensed hospitals in the State of California. The analysis sample was comprised of California residents age 65 years or older with a record of treatment for injury fall occurring at home from January 1, 2014 to December 31, 2014. A conditional Poisson regression with fixed person effects and a robust estimator of variance was used to calculate the incidence rate ratio of acute care admissions during the 90 day period immediately preceding an injury fall, with the period of 360–271 days prior to index fall as reference. Results: The rate of acute care admissions was 121{\%} greater (IRR: 2.21; 95{\%} CI 2.15–2.27) during the 90 days immediately preceding the index injury fall than 181–360 days prior. Period effects on rates of admissions were significantly higher in the acute care treatment subsample (IRR 2.63; 95{\%} CI 2.51–2.76) than the emergency department treatment subsample (IRR 2.00; 95{\%} CI 1.94–2.07). Discharge to post-acute care facilities; discharge to home health and Elixhauser comorbidity index all significantly modified period effects on acute care admissions. Conclusions: Older adults have an increased risk of falling at home after being discharged from an acute care hospitalization, with highest risk occurring during the 90-day post-discharge period. Special consideration should be given to assessing hospital-associated changes in fall risk among geriatric patients prior to discharge directly home. Discharge planning should include efforts to reduce home fall risk during the period of transition from hospital care.",
keywords = "Community dwelling, Injury falls, Injury prevention, Older adult falls, Post-hospital home falls",
author = "Adams, {Christy M.} and Tancredi, {Daniel J.} and Bell, {Janice F.} and Catz, {Sheryl L.} and Romano, {Patrick S.}",
year = "2019",
month = "1",
day = "1",
doi = "10.1016/j.injury.2019.11.035",
language = "English (US)",
journal = "Injury",
issn = "0020-1383",
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T1 - Associations between home injury falls and prior hospitalizations in community dwelling older adults

T2 - A population case-crossover study

AU - Adams, Christy M.

AU - Tancredi, Daniel J.

AU - Bell, Janice F.

AU - Catz, Sheryl L.

AU - Romano, Patrick S.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objective: The purpose of this study was to examine risk factor and temporal associations between acute care hospitalization and post-discharge home injury falls in a population-based analysis sample of community dwelling older adults. Methods: We applied a unidirectional case-crossover design to a retrospective analysis sample derived from healthcare administrative data from all non-federal licensed hospitals in the State of California. The analysis sample was comprised of California residents age 65 years or older with a record of treatment for injury fall occurring at home from January 1, 2014 to December 31, 2014. A conditional Poisson regression with fixed person effects and a robust estimator of variance was used to calculate the incidence rate ratio of acute care admissions during the 90 day period immediately preceding an injury fall, with the period of 360–271 days prior to index fall as reference. Results: The rate of acute care admissions was 121% greater (IRR: 2.21; 95% CI 2.15–2.27) during the 90 days immediately preceding the index injury fall than 181–360 days prior. Period effects on rates of admissions were significantly higher in the acute care treatment subsample (IRR 2.63; 95% CI 2.51–2.76) than the emergency department treatment subsample (IRR 2.00; 95% CI 1.94–2.07). Discharge to post-acute care facilities; discharge to home health and Elixhauser comorbidity index all significantly modified period effects on acute care admissions. Conclusions: Older adults have an increased risk of falling at home after being discharged from an acute care hospitalization, with highest risk occurring during the 90-day post-discharge period. Special consideration should be given to assessing hospital-associated changes in fall risk among geriatric patients prior to discharge directly home. Discharge planning should include efforts to reduce home fall risk during the period of transition from hospital care.

AB - Objective: The purpose of this study was to examine risk factor and temporal associations between acute care hospitalization and post-discharge home injury falls in a population-based analysis sample of community dwelling older adults. Methods: We applied a unidirectional case-crossover design to a retrospective analysis sample derived from healthcare administrative data from all non-federal licensed hospitals in the State of California. The analysis sample was comprised of California residents age 65 years or older with a record of treatment for injury fall occurring at home from January 1, 2014 to December 31, 2014. A conditional Poisson regression with fixed person effects and a robust estimator of variance was used to calculate the incidence rate ratio of acute care admissions during the 90 day period immediately preceding an injury fall, with the period of 360–271 days prior to index fall as reference. Results: The rate of acute care admissions was 121% greater (IRR: 2.21; 95% CI 2.15–2.27) during the 90 days immediately preceding the index injury fall than 181–360 days prior. Period effects on rates of admissions were significantly higher in the acute care treatment subsample (IRR 2.63; 95% CI 2.51–2.76) than the emergency department treatment subsample (IRR 2.00; 95% CI 1.94–2.07). Discharge to post-acute care facilities; discharge to home health and Elixhauser comorbidity index all significantly modified period effects on acute care admissions. Conclusions: Older adults have an increased risk of falling at home after being discharged from an acute care hospitalization, with highest risk occurring during the 90-day post-discharge period. Special consideration should be given to assessing hospital-associated changes in fall risk among geriatric patients prior to discharge directly home. Discharge planning should include efforts to reduce home fall risk during the period of transition from hospital care.

KW - Community dwelling

KW - Injury falls

KW - Injury prevention

KW - Older adult falls

KW - Post-hospital home falls

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U2 - 10.1016/j.injury.2019.11.035

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JF - Injury

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