Volume 10, Issue 3 (July-Sep 2021)
JCHR 2021, 10(3): 251-263 |
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fallahi A, riahi L, nikravan A. Effect of Fall on Medical Costs among Elderly Inpatients; A Case-Study in Iran. JCHR 2021; 10 (3) :251-263
URL: http://jhr.ssu.ac.ir/article-1-688-en.html
URL: http://jhr.ssu.ac.ir/article-1-688-en.html
1- Department of Health Services Administration, Science and Research Branch, Islamic Azad University, Tehran, Iran
2- Department of Health Services Administration, Science and Research Branch, Islamic Azad University, Tehran, Iran , l.riahi@srbiau.ac.ir
2- Department of Health Services Administration, Science and Research Branch, Islamic Azad University, Tehran, Iran , l.riahi@srbiau.ac.ir
Abstract: (1846 Views)
Objective: Falls are the main cause of injuries and death among the elderly and lead to using medical services. This study aimed to assess the effect of falls on medical costs among elderly inpatients.
Methods: This retrospective cross-sectional study was done in a public hospital (heart center) in Qazvin, Iran. In this study, 79 medical records of the elderly who had experienced in-hospital falls and 79 medical records in control group with similar characteristics who had not experienced in- hospital falls during 2016-2019. The data, including the elderly age, sex, fall characteristics, and all hospital costs related to falls were gathered from hospital accident forms, medical records, nursing reports, and official data banks. The overall costs of services provided for fallen elderly were compared with the control group. The data were analyzed by SPSS software, version 22, using Chi-square and paired sample t-test. P<0.05 was considered statistically significant.
Results: Total cost of all services provided for the elderly during their hospitalization was 106.596$ (base year: 2019, $1=42500 IRR), of this amount 8.600$ (8.06%) was related to the services due to in-hospital falls. The highest costs were related to treatment services (40%), diagnostic services (33%), visits (21%) and consultation (6%). The difference between the case and control groups was 7.310$. The elderly falls significantly increased medical costs by 8.06% (P≤0.01).
Conclusions: Even falls that do not lead to serious injuries waste medical services and increase hospital costs by making changes in treatment methods and increasing the length of hospital stay.
Methods: This retrospective cross-sectional study was done in a public hospital (heart center) in Qazvin, Iran. In this study, 79 medical records of the elderly who had experienced in-hospital falls and 79 medical records in control group with similar characteristics who had not experienced in- hospital falls during 2016-2019. The data, including the elderly age, sex, fall characteristics, and all hospital costs related to falls were gathered from hospital accident forms, medical records, nursing reports, and official data banks. The overall costs of services provided for fallen elderly were compared with the control group. The data were analyzed by SPSS software, version 22, using Chi-square and paired sample t-test. P<0.05 was considered statistically significant.
Results: Total cost of all services provided for the elderly during their hospitalization was 106.596$ (base year: 2019, $1=42500 IRR), of this amount 8.600$ (8.06%) was related to the services due to in-hospital falls. The highest costs were related to treatment services (40%), diagnostic services (33%), visits (21%) and consultation (6%). The difference between the case and control groups was 7.310$. The elderly falls significantly increased medical costs by 8.06% (P≤0.01).
Conclusions: Even falls that do not lead to serious injuries waste medical services and increase hospital costs by making changes in treatment methods and increasing the length of hospital stay.
Review: Research |
Subject:
Public Health
Received: 2020/10/7 | Accepted: 2021/07/19 | Published: 2021/09/29
Received: 2020/10/7 | Accepted: 2021/07/19 | Published: 2021/09/29
References
1. 1. Salminen MJ, Vahlberg TJ, Salonoja MT, Aarnio PT, Kivelä SL. Effect of a risk‐based multifactorial fall prevention program on the incidence of falls. Journal of the American Geriatrics Society. 2009 Apr;57(4):612-9.. [DOI:10.1111/j.1532-5415.2009.02176.x]
2. Tromp AM, Pluijm SM, Smit JH, Deeg DJ, Bouter LM, Lips PT. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. Journal of clinical epidemiology. 2001 Aug 1;54(8):837-44. [DOI:10.1016/S0895-4356(01)00349-3]
3. Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged Medicare population. American journal of preventive medicine. 2012 Jul 1;43(1):59-62. [DOI:10.1016/j.amepre.2012.03.008]
4. Azadi A, Bastami M, Mmalek M. Effect of Fall-Preventive Program on Fear of Falling, Falling Frequency, and Quality of Life in the Elderly Living in Nursing Homes. Iranian Journal of Nursing Research. 2017 Oct 10;12(4):68-75. [DOI:10.21859/ijnr-12049]
5. NHS Improvement. The incidence and costs of inpatient falls in hospitals. London: NHS Improvement; 2017. Available from: https://improvement.nhs.uk/documents/1471/Falls_report_July2017.v2.pdf.
6. Worapanwisit T, Prabpai S, Rosenberg E. Correlates of falls among community-dwelling elderly in Thailand. Journal of aging research. 2018 May 24;2018. [DOI:10.1155/2018/8546085]
7. Statistical Center of Iran. Population and Housing Censuses. Tehran: Statistical Center of Iran. Available from: https://www.amar.org.ir/english/Population-and-Housing-Censuses
8. World Health Organization. WHO global report on falls prevention in older age. Geneva: World Health Organization; 2008. Available from: https://apps.who.int/iris/handle/10665/43811
9. Najafi Ghezlcheh T, Ariapour S, Jafari Oori M. Epidemiology and relationship of fall and fear of falling in the elderly residing at Kamrani nursing home, Tehran, Iran. Iranian Journal of Ageing. 2016 Jan 10;10(4):152-61.
10. King T. Helping baccalaureate nursing students care for the wellbeing of older adults. International journal of nursing education scholarship. 2005 Jun 29;2(1). [DOI:10.2202/1548-923X.1131]
11. Fields J, Alturkistani T, Kumar N, Kanuri A, Salem DN, Munn S, Blazey-Martin D. Prevalence and cost of imaging in inpatient falls: the rising cost of falling. ClinicoEconomics and outcomes research: CEOR. 2015;7:281. [DOI:10.2147/CEOR.S80104]
12. Currie L. Fall and injury prevention. 2008. In: Patient Safety and Quality: An Evidence-Based Handbook for Nurses (Internet). Rockville, Maryland: Agency for Healthcare Research and Quality (US). Available from: https://www.ncbi.nlm.nih.gov/books/NBK2653/.
13. Hitcho EB, Krauss MJ, Birge S, Claiborne Dunagan W, Fischer I, Johnson S, Nast PA, Costantinou E, Fraser VJ. Characteristics and circumstances of falls in a hospital setting: a prospective analysis. Journal of general internal medicine. 2004 Jul;19(7):732-9. [DOI:10.1111/j.1525-1497.2004.30387.x]
14. Tian Y, Thompson J, Buck D, et al. Exploring the System-Wide Costs of Falls in Older People in Torbay. London: The King's Fund; 2013.
15. Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. Journal of the American Geriatrics Society. 2018 Apr;66(4):693-8. [DOI:10.1111/jgs.15304]
16. Homann B, Plaschg A, Grundner M, Haubenhofer A, Griedl T, Ivanic G, Hofer E, Fazekas F, Homann CN. The impact of neurological disorders on the risk for falls in the community dwelling elderly: a case-controlled study. BMJ open. 2013 Nov 1;3(11). [DOI:10.1136/bmjopen-2013-003367]
17. Carroll NV, Slattum PW, Cox FM. The cost of falls among the community-dwelling elderly. Journal of Managed Care Pharmacy. 2005 May;11(4):307-16. [DOI:10.18553/jmcp.2005.11.4.307]
18. Wu S, Keeler EB, Rubenstein LZ, Maglione MA, Shekelle PG. A cost-effectiveness analysis of a proposed national falls prevention program. Clinics in geriatric medicine. 2010 Nov 1;26(4):751-66. [DOI:10.1016/j.cger.2010.07.005]
19. Stolze H, Klebe S, Zechlin C, Baecker C, Friege L, Deuschl G. Falls in frequent neurological diseases. Journal of neurology. 2004 Jan 1;251(1):79-84. [DOI:10.1007/s00415-004-0276-8]
20. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Injury prevention. 2006 Oct 1;12(5):290-5. [DOI:10.1136/ip.2005.011015]
21. Alekna V, Stukas R, Tamulaitytė-Morozovienė I, Šurkienė G, Tamulaitienė M. Self-reported consequences and healthcare costs of falls among elderly women. Medicina. 2015 Feb;51(1):57-62. [DOI:10.1016/j.medici.2015.01.008]
22. Hartholt KA, Polinder S, Van der Cammen TJ, Panneman MJ, Van der Velde N, Van Lieshout EM, Patka P, Van Beeck EF. Costs of falls in an ageing population: a nationwide study from the Netherlands (2007-2009). Injury. 2012 Jul 1;43(7):1199-203. [DOI:10.1016/j.injury.2012.03.033]
23. Morello RT, Barker AL, Watts JJ, Haines T, Zavarsek SS, Hill KD, Brand C, Sherrington C, Wolfe R, Bohensky MA, Stoelwinder JU. The extra resource burden of in‐hospital falls: a cost of falls study. Medical journal of Australia. 2015 Nov;203(9):367. [DOI:10.5694/mja15.00296]
24. Fu D. Health service impacts and costs of falls in older age. Geneva: World Health Organization. Available from: http://www.who.int/entity/ageing/projects/4%20Health%20service%20impacts%20and%20costs%20of%20falls2.pdf.
25. Verma SK, Willetts JL, Corns HL, Marucci-Wellman HR, Lombardi DA, Courtney TK. Falls and fall-related injuries among community-dwelling adults in the United States. PLoS one. 2016 Mar 15;11(3):e0150939. [DOI:10.1371/journal.pone.0150939]
26. Watson WL, Clapperton AJ, Mitchell RJ. The cost of fall-related injuries among older people in NSW, 2006-07. New South Wales public health bulletin. 2011 Jun 23;22(4):55-9. [DOI:10.1071/NB10002]
27. Paliwal Y, Slattum PW, Ratliff SM. Chronic health conditions as a risk factor for falls among the community-dwelling US older adults: a zero-inflated regression modeling approach. BioMed research international. 2017 Mar 28;2017. [DOI:10.1155/2017/5146378]
28. Kelsey JL, Berry SD, Procter‐Gray E, Quach L, Nguyen US, Li W, Kiel DP, Lipsitz LA, Hannan MT. Indoor and outdoor falls in older adults are different: the maintenance of balance, independent living, intellect, and Zest in the Elderly of Boston Study. Journal of the American Geriatrics Society. 2010 Nov;58(11):2135-41. [DOI:10.1111/j.1532-5415.2010.03062.x]
29. Torkaman Gholami J, Mohamadi Shahbolaghi F, Norouzi K. The Relationship between Fear of falling and Activity Limitations among Seniors of Ghaem Shahr City in 2013. Iranian Journal of Rehabilitation Research. 2015 Oct 10;2(1):45-52.
30. Iran SCo. Population and Housing Census Results Year 2016: Institute for Scientific Research; 2016. Available from: http://www.sci.org
31. Chang NT, Chi LY, Yang NP, Chou P. The impact of falls and fear of falling on health-related quality of life in Taiwanese elderly. Journal of community health nursing. 2010 Apr 28;27(2):84-95. [DOI:10.1080/07370011003704958]
32. Scuffham P, Chaplin S, Legood R. Incidence and costs of unintentional falls in older people in the United Kingdom. Journal of Epidemiology & Community Health. 2003 Sep 1;57(9):740-4. [DOI:10.1136/jech.57.9.740]
33. Araújo E, Martins K, Lima R, et al. Concern with falls in elderly people attended in an Integral Attention Center. Rev Eletr Enf. 2016;18:e1186. [DOI:10.5216/ree.v18.39899]
34. Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults-United States. Journal of safety research. 2016 Sep 1;58:99-103. [DOI:10.1016/j.jsr.2016.05.001]
35. Haddad YK, Bergen G, Florence C. Estimating the economic burden related to older adult falls by state. Journal of public health management and practice: JPHMP. 2019 Mar;25(2):E17. [DOI:10.1097/PHH.0000000000000816]
36. Carey BJ, Potter JF. Cardiovascular causes of falls. Age and ageing. 2001 Nov 1;30(suppl_4):19-24.. [DOI:10.1093/ageing/30.suppl_4.19]
37. Dykes PC, Adelman J, Adkison L, et al. Preventing falls in hospitalized patients Silver Spring, Maryland: American Nurse; 2018. Available from: https://www.myamericannurse.com/preventing-falls-hospitalized-patients/
38. Syrjälä P, Luukinen H, Pyhtinen J, Tolonen U. Neurological diseases and accidental falls of the aged. Journal of neurology. 2003 Sep 1;250(9):1063-9. [DOI:10.1007/s00415-003-0152-y]
39. Miertová M, Bóriková I, Tomagová M, Žiaková K. Risk factors of falling in patients with neurological diseases. Kontakt. 2018 Sep 1;20(3):e217-22. [DOI:10.1016/j.kontakt.2018.07.002]
40. Amirian Z, Jalali R. Assessment of hospitalized patients fall out of bed in hospitals of Kermanshah University of Medical Sciences. Journal of Clinical Research in Paramedical Sciences. 2014;(3):130-134.
41. Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA. International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporosis international. 2010 Aug 1;21(8):1295-306. [DOI:10.1007/s00198-009-1162-0]
42. Lane AJ. Evaluation of the fall prevention program in an acute care setting. Orthopaedic Nursing. 1999 Nov 1;18(6):37. [DOI:10.1097/00006416-199911000-00008]
43. Morse JM, Prowse MD, Morrow N, et al. A retrospective analysis of patient falls. Can J Public Health. 76 (1985): 116-118.
44. Lund C, Sheafor ML. Is your patient about to fall?. Journal of Gerontological Nursing. 1985 Apr 1;11(4):37-41. [DOI:10.3928/0098-9134-19850401-11]
45. Hendrich AL, Bender PS, Nyhuis A. Validation of the Hendrich II Fall Risk Model: a large concurrent case/control study of hospitalized patients. Applied Nursing Research. 2003 Feb 1;16(1):9-21. [DOI:10.1053/apnr.2003.016009]
46. Biderman A, Cwikel J, Fried AV, Galinsky D. Depression and falls among community dwelling elderly people: a search for common risk factors. Journal of epidemiology & community health. 2002 Aug 1;56(8):631-6. [DOI:10.1136/jech.56.8.631]
47. Steinberg M, Cartwright C, Peel N, Williams G. A sustainable programme to prevent falls and near falls in community dwelling older people: results of a randomised trial. Journal of Epidemiology & Community Health. 2000 Mar 1;54(3):227-32. [DOI:10.1136/jech.54.3.227]
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