In the present study we found that the indoor activities distribution leading to TBIs and hip fractures differed. Notably, about half of the traumatic brain injuries and hip fractures in men and women aged 65-79 years occurred outdoors. This study provides new insights into patterns leading to injurious falls by age, gender and injury type, and may guide the targeting of falls prevention at specific activities and risk groups, including highly functional older men and women.
BackgroundThe use of Fall-Risk-Increasing-Drugs (FRIDs) has been associated with increased risk of falls and associated injuries. This study investigates the effect of withdrawal of FRIDs versus ‘care as usual’ on health-related quality of life (HRQoL), costs, and cost-utility in community-dwelling older fallers.MethodsIn a prospective multicenter randomized controlled trial FRIDs assessment combined with FRIDs-withdrawal or modification was compared with ‘care as usual’ in older persons, who visited the emergency department after experiencing a fall. For the calculation of costs the direct medical costs (intramural and extramural) and indirect costs (travel costs) were collected for a 12 month period. HRQoL was measured at baseline and at 12 months follow-up using the EuroQol-5D and Short Form-12 version 2. The change in EuroQol-5D and Short Form-12 scores over 12 months follow-up within the control and intervention groups was compared using the Wilcoxon Signed Rank test for continuous variables and the McNemar test for dichotomous variables. The change in scores between the control and intervention groups were compared using a two-way analysis of variance.ResultsWe included 612 older persons who visited an emergency department because of a fall. The mean cost of the FRIDs intervention was €120 per patient. The total fall-related healthcare costs (without the intervention costs) did not differ significantly between the intervention group and the control group (€2204 versus €2285). However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant. Furthermore, the control group had a greater decline in EuroQol-5D utility score during the 12-months follow-up than the intervention group (p = 0.02). The change in the Short Form-12 Physical Component Summary and Mental Component Summary scores did not differ significantly between the two groups.ConclusionsWithdrawal of FRID’s in older persons who visited an emergency department due to a fall, did not lead to reduction of total health-care costs. However, the withdrawal of FRIDs reduced medication costs with a mean of €38 per participant in combination with less decline in HRQoL is an important result.Trial registrationThe trial is registered in the Netherlands Trial Register (NTR1593 – October 1st 2008).Electronic supplementary materialThe online version of this article (doi:10.1186/s12877-016-0354-7) contains supplementary material, which is available to authorized users.
The number of falls in the elderly is becoming a major public health problem in our society. In the past decade life expectancy increased from 75 years in 1990 to 79 years in 2009 in the United States (US). It has been estimated that the number of persons aged 65 years and older in the US will double by 2050.In 2000 falls accounted for 45% of all injury-related inpatient stays, with almost 750,000 hospitalizations. Fractures were the most common primary injury diagnosis, including 314,006 hip fractures. Injury following a fall is associated with a decreased quality of life and poor functional outcome, in severe injuries these effects continue for a prolonged period of time.In 2006 fall-related medical costs in the population aged ≥65 in the US amounted to US$19 billion for non-fatal and US$0.2 billion for fatal injuries.In this paper we provide a literature overview on the impact of falls in the elderly, the demands on healthcare and the costs for our society.
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