Fall-related hospitalization and facility costs among residents of institutions providing long-term care.

PURPOSE: The purpose of this study was to estimate hospital and long-term-care costs resulting from falls in long-term-care facilities (LTCFs). DESIGN AND METHODS: The study used a retrospective, pre/post with comparison group design. We used matching, based on propensity scores, to control for baseline differences between fallers and non-fallers. We estimated residents' propensity to fall from demographics, comorbidities, and reimbursement in the pre-period. The matched sample included 1,130 fallers and 1,130 non-fallers who were residents of a large, multifacility long-term-care chain. Cost estimates were based on information in the Minimum Data Set and were defined as hospital and LTCF reimbursements. We estimated fall-related costs as the difference between changes in costs for fallers and non-fallers from the pre- to post-period. RESULTS: Fallers were substantially more likely to suffer fractures and hospitalizations in the post-period than were non-fallers. Fall-related LTCF and hospital costs were $6,259 (95% confidence interval = $2,034-$10,484) per resident per year. About 60% of this amount was attributable to higher hospitalization costs. Fallers were more likely to be discharged to hospitals or to die. IMPLICATIONS: Falls in LTCFs are associated with costs of about $6,200 per resident per year. These results provide baseline estimates that one may use to estimate the cost-effectiveness of interventions to reduce fall rates.

The cost of falls among the community-dwelling elderly.

OBJECTIVE: To estimate the direct medical costs of falls in the population of community-dwelling elderly. METHODS: Data from a sample of 4,025 consumers from the 1997 Medical Expenditure Panel Survey were used to make estimates that were representative of the population of civilian, noninstitutionalized elderly in the United States. RESULTS: In 1997, 9% of the noninstitutionalized elderly population of the United States reported medical conditions related to falls. The estimated total direct medical cost of these conditions was dollar 6.2 billion in 1997 dollars and dollar 7.8 billion in 2002 dollars. The mean cost per person who had fallen was dollar 2,039 in 1997 dollars and dollar 2,591 in 2002 dollars. Inpatient hospitalizations accounted for 65% of total costs, followed by office-based medical visits and home health care, each accounting for about 10% of total direct medical costs, and hospital outpatient visits for 7.6%. About 78% of fall-related costs were reimbursed by Medicare. CONCLUSION: Fall-related medical conditions affect a substantial number of the community-dwelling elderly and result in direct medical costs of dollar 6 to dollar 8 billion per year in the United States. The total economic burden of falls is significantly higher because this estimate does not include direct nonmedical, intangible, and indirect costs. The results of this study highlight the importance of research aimed at decreasing the incidence and severity of falls in the elderly.