Prehospital and Posthospital Fall Injuries in Older US Adults

Key Points Question What are older adults’ risks of fall injuries in the periods surrounding hospitalization? Findings This retrospective cohort study using national survey and linked Medicare data observed spikes in older adult fall injury risk in the periods just before and after hospitalization. Risk increases were particularly pronounced for those who experienced an inpatient fall injury. Meaning These findings suggest that efforts to improve coordination of fall injury risk during care transitions into and out of the hospital are needed.
This cohort study estimates the risk of older adult fall injury within and across discrete periods during a 12-month care episode anchored by an acute hospitalization.
Importance To date, measurement and treatment of older adult fall injury has been siloed within specific care settings, such as a hospital or within a nursing home or community. Little is known about changes in fall risk across care settings. Understanding the occurrence of falls across settings has implications for measuring and incentivizing high-value care across care settings. Objective To estimate the risk of older adult fall injury within and across discrete periods during a 12-month care episode anchored by an acute hospitalization. Design, Setting, and Participants This cohort study is a longitudinal analysis of 12-month periods that include an anchor hospital stay using national data from 2006 to 2014. Participants included older (aged ≥65 years) Medicare fee-for-service beneficiaries from the Health and Retirement Study. Weekly fall injury rates were computed for 4 periods compared with the anchor hospitalization: at baseline (1-6 months before hospitalization), just before (