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According to the results of a study involving more than 8.3 million Medicare beneficiaries, falls-related injuries are one of the leading causes of readmission within 30 days in newly hospitalized seniors.
Readmissions following a fall were particularly high for people who were initially hospitalized for a fall, those who had a cognitive impairment, or those who had been discharged at home or at a home care center rather than in the home. a qualified nursing facility.
The results were published online on May 24 JAMA Network open now.
The findings highlight the need to put more emphasis on fall prevention strategies prior to discharge from the hospital and to target individuals at increased risk of falls.
"Falls are a tripta as to why they need more attention – they are widespread, cause a lot of damage, including death, and can be avoided. Falls is excluded from the conversation about the planning of the release, and that must change, "said Ann Arbor, author, Geoffrey Hoffman, PhD, MPH, at the University of Michigan School of Nursing. , in a press release issued by the University of Michigan.
Falls are the leading cause of injury-related hospitalization in the elderly. People with a history of falls or cognitive impairment are at increased risk.
"After discharge, the goal is to provide patient-centered fall prevention and to safely encourage patients to get up and move." Previous research suggests that in the long run , limited mobility can harm patients and increase the risk of falling, which many caregivers fail to achieve because sedentary behavior appears to reduce the risk of falling and falls in the short term, "said Hoffman.
Medicare currently penalizes hospitals for fall-related injuries in hospitalized patients. The Medicare Hospital Readmission Reduction Program includes incentives for falls prevention and discharge management to prevent readmissions. Despite these initiatives, the impact of falls on readmission is poorly understood.
Researchers badyzed hospital discharge data from 2013 and 2014 in the National Readmission Database of the Agency's Costs and Utilization of Research Hospitals project. in health and quality. This database includes nationally representative data on hospital discharges among Medicare beneficiaries aged 65 and over. The badysis focused on readmissions to the hospital within 30 days for the entire cohort, as well as for two high-risk groups of falls: those initially hospitalized for one year. fall and those with cognitive impairment.
The badysis involved 8,382,074 patients. Of these, 4,736,281 (56.5%) were women (mean age 77.7 years). Overall, 746,397 (8.9%) of these patients experienced a fall – related injury and 1,367,759 (16.3%) had a cognitive impairment at first admission.
More than one million (1,205,962, 14.4%) of these patients were readmitted within 30 days of first admission.
Overall, falls-related injuries were the third leading cause of readmission (5.1%, n = 60 954), sepsis (9.5%, n = 115 026), and Heart failure (8.8%, n = 105,771).
Fall-related injuries ranked second among the primary reasons for readmission for patients initially admitted for fall-related injury (10.3%, n = 9915 / 96.301) and those initially admitted for cognitive impairment (7.0% n = 262/218 351). .
Among patients initially hospitalized as a result of a fall-related injury and returned home or receiving home care, a new fall injury was the leading cause of readmission (12.3%; = 2103/17098 and 11.8%, n = 2091 / 17,772, respectively).
This latest discovery is new and underscores the need to target homebound patients for fall prevention strategies, say the authors. These people may not receive the proper care and badistance for daily tasks and rehabilitation, which can put them at risk of falling.
The researchers explain that post-hospital discharge prevention interventions exist and have been shown to be effective in preventing falls.
These include community interventions, home modifications and education.
Adequate education is essential, said senior editor Lillian Min, MD, MSHS of the University of Michigan at Ann Arbor in a press release.
"Leave planners, doctors, patients and families should develop a personalized plan to balance increased mobility and fall prevention," she said.
Since claim data may not cover all fall-related admissions and the study does not include re-admissions for injuries resulting from the same injury, the results may – Estimate the number of readmissions related to a fall during the period of the study.
The study was funded by grants from the Older Americans Independence Center of the University of Michigan and the Pepper Center of the University of Michigan. One or more authors report receiving grants and salary badistance from the Aging Independence Center of the National Institute on Aging Americans (University of Michigan), the National Institute on Aging Pepper Center, OncoImmune, National Institutes of Health and / or Veterans Affairs Healthcare System.
JAMA Netw Open. Posted online 24th May 2019.
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