Healthcare Utilization of Elderly Persons Hospitalized After a Noninjurious Fall in a Swiss Academic Medical Center

Authors

  • Laurence Seematter-Bagnoud MD,

    1. From the *Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, and Emergency Department, Centre Hospitalier Universitaire Vaudois, Lausanne, SwitzerlandInstitute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland. §Deceased.
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  • Vincent Wietlisbach BA,

    1. From the *Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, and Emergency Department, Centre Hospitalier Universitaire Vaudois, Lausanne, SwitzerlandInstitute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland. §Deceased.
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  • Bertrand Yersin MD,

    1. From the *Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, and Emergency Department, Centre Hospitalier Universitaire Vaudois, Lausanne, SwitzerlandInstitute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland. §Deceased.
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  • Christophe J. Büla MD

    1. From the *Service of Geriatric Medicine and Geriatric Rehabilitation, Department of Medicine, and Emergency Department, Centre Hospitalier Universitaire Vaudois, Lausanne, SwitzerlandInstitute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland. §Deceased.
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Address correspondence to Laurence Seematter-Bagnoud, MD, Service of Geriatric Medicine and Geriatric, CHUV, CUTR Sylvana, Ch de Sylvana 10, CH-1066 Epalinges, Switzerland. E-mail: Laurence.Seematter-Bagnoud@chuv.ch

Abstract

OBJECTIVES: To determine the risk of hospital readmission, nursing home admission, and death, as well as health services utilization over a 6-month follow-up, in community-dwelling elderly persons hospitalized after a noninjurious fall.

DESIGN: Prospective cohort study with 6-month follow-up.

SETTING: Swiss academic medical center.

PARTICIPANTS: Six hundred ninety persons aged 75 and older hospitalized through the emergency department.

MEASUREMENTS: Data on demographics and medical, physical, social, and mental status were collected upon admission. Follow-up data were collected from the state centralized billing system (hospital and nursing home admission) and proxies (death).

RESULTS: Seventy patients (10%) were hospitalized after a noninjurious fall. Fallers had shorter hospital stays (median 4 vs 8 days, P<.001) and were more frequently discharged to rehabilitation or respite care than nonfallers. During follow-up, fallers were more likely to be institutionalized (adjusted hazard ratio=1.82, 95% confidence interval=1.03–3.19, P=.04) independent of comorbidity and functional and mental status. Overall institutional costs (averaged per day of follow-up) were similar for both groups ($138.5 vs $148.7, P=.66), but fallers had lower hospital costs and significantly higher rehabilitation and long-term care costs ($55.5 vs $24.1, P<.001), even after adjustment for comorbidity, living situation, and functional and cognitive status.

CONCLUSION: Elderly patients hospitalized after a noninjurious fall were twice as likely to be institutionalized as those admitted for other medical conditions and had higher intermediate and long-term care services utilization during follow-up, independent of functional and health status. These results provide direction for interventions needed to delay or prevent institutionalization and reduce subsequent costs.

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