Falls and subsequent health service utilization in community-dwelling Chinese older adults

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Abstract

There was no data on the impact of falls on health service utilizations in Chinese older adults. The present study investigated the impact of falls on health service utilizations in community-dwelling Chinese older adults in Hong Kong. A population-based sample of 1517 older adults aged 65 years or over was recruited. Baseline assessment at home and then the occurrence of falls as well as health services utilizations were monitored for 1 year. The prevalence of falls, single fallers and recurrent fallers were 26.4%, 19.4% and 4.75%, respectively. 95.6% (n = 1450) of the subjects completed the 1-year follow-up. Fallers had significantly greater numbers of hospitalizations, visits at specialist doctor clinics and emergency department than non-fallers (0.46 ± 0.09 versus 0.23 ± 0.03, 1.98 ± 0.25 versus 1.37 ± 0.11 and 0.40 ± 0.04 versus 0.21 ± 0.002, respectively; p < 0.05). Based on current Hong Kong public health care cost and population data, we calculated that fallers would consume approximately US$ 71 millions (HK$ 552 millions) public health care dollars more than non-fallers did annually in Hong Kong. A population-based falls prevention program is recommended to reduce falls, fall-related health care service utilizations and health care expenditure.

Introduction

Falls are common in the elderly population. According to previous studies, one-third of community-dwelling older adults will fall each year. Falls in older adults can lead to serious physical and psychological consequences. Common physical injuries include soft tissue injuries, subdural hematoma, and fractures. Ten to 18% of falls result in serious injuries. Approximately 5% of falls result in fractures, which include fracture of the neck of femur, humeral neck, distal radius, vertebrae, ribs and skull bone (Gryfe et al., 1977, Perry, 1982, Blake et al., 1988, Tinetti et al., 1988, Campbell et al., 1989, Nevitt et al., 1989, Robbins et al., 1989, Cummings and Nevitt, 1994, Ho et al., 1996, Tideiksaar, 1997, Lord et al., 2001, Chu et al., 2005, McClure et al., 2005).

Though only 1% of falls in women would result in hip fractures, such fractures account for a large share of the disability, death, and medical costs associated with falls (Cummings and Nevitt, 1994). Severe disability due to hip fracture will lead to an increased demand for long-stay hospital care (infirmary hospital bed) in Hong Kong and 7.4% of persons who are waiting for infirmary hospital beds in Hong Kong have severe disability due to previous hip fractures (Chu and Pei, 1997). Fallers, particularly recurrent fallers, are associated with an increased likelihood of hospitalizations with reported hospitalization rates of 35.3% and 21.5% for recurrent fallers and non-fallers, respectively (Kiel et al., 1991, Wolinsky et al., 1992, Stel et al., 2004). Rizzo et al. (1998) have reported that health care costs are higher in fallers than non-fallers. Furthermore, the cost increases with the frequency of falls as well as the severity of injuries after falls. However, there is no data regarding the impact of falls on health services utilizations among Chinese older adults. The objective of the present study was to investigate the impact of falls on health services utilizations among community home-dwelling Chinese older adults in Hong Kong.

Section snippets

Definition of falls

For the purpose of this study, a fall was defined as an event, which resulted in a person coming to rest unintentionally on the ground or other lower level, not due to any intentional movement, a major intrinsic event or extrinsic force (Tinetti et al., 1988, Chu et al., 1999, Chu et al., 2005).

Subjects

This was a 1-year prospective population-based cohort study performed in the community of Hong Kong. The research protocol was approved by the Ethics Committee of the University of Hong Kong. A random

Baseline characteristics of subjects

The final baseline sample consisted of 1517 older adults. 49.2% were women. The mean age was 73.2 ± 6.3 years. Co-morbid diseases were common, with 9.3% of them having five or more chronic diseases and 10.6% receiving five or more oral medications (Table 1). The 10 most commonly reported medical diagnoses were arthritis (61.4%), hypertension (33%), cataract (26.2), peptic ulcers (15.4%), diabetes mellitus (12.4%), coronary heart disease (8.6%), hyperlipidemia (7.4%), chronic obstructive airway

Discussion

This was the first prospective population-based Hong Kong study, which investigated the impact of falls on health services utilizations in Chinese older adults. This prospective study design would overcome the problem of recall bias in retrospective studies. Forgetting falls and recall bias was a common pitfall in previous retrospective studies (Cummings et al., 1988, Ho et al., 1996). Overall, we found fallers used health services more than non-fallers did. Compared to both non-fallers and

Acknowledgments

This project was sponsored by “The Health Services Research Committee of Hong Kong” (HSRC #631004). The authors would also like to thank Professor A.J. Hedley, committee members and reviewers of the Health Services Research Committee for their comments.

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