Falls are a leading cause of hospitalizations and emergency room visits among older adults, but until now, little was known about the relationship between falls and hospital readmissions.
A new University of Michigan study found that in people 65 or older, fall-related injuries within a month of hospital discharge ranked as high as the third-leading diagnosis for readmission.
The risk was greater for patients already deemed fall risks, or who were discharged to their homes or home health care.
The findings suggest that by emphasizing personalized fall prevention before discharge, especially for at-risk patients, hospitals could improve patients’ recovery and mobility, and minimize costly fall-related penalties, said principal investigator Geoffrey Hoffman, an assistant professor at the U-M School of Nursing.
Falls Are Serious and Costly
- One out of five falls causes a serious injury such as broken bones or a head injury,4,5
- Each year, 3 million older people are treated in emergency departments for fall injuries.6
- Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.6
- Each year at least 300,000 older people are hospitalized for hip fractures.7
- More than 95% of hip fractures are caused by falling,8 usually by falling sideways.9
- Falls are the most common cause of traumatic brain injuries (TBI).10
- In 2015, the total medical costs for falls totaled more than $50 billion.11 Medicare and Medicaid shouldered 75% of these costs.
What Can Happen After a Fall?
Many falls do not cause injuries. But one out of five falls does cause a serious injury such as a broken bone or a head injury.4,5 These injuries can make it hard for a person to get around, do everyday activities, or live on their own.
- Falls can cause broken bones, like wrist, arm, ankle, and hip fractures.
- Falls can cause head injuries. These can be very serious, especially if the person is taking certain medicines (like blood thinners). An older person who falls and hits their head should see their doctor right away to make sure they don’t have a brain injury.
- Many people who fall, even if they’re not injured, become afraid of falling. This fear may cause a person to cut down on their everyday activities. When a person is less active, they become weaker and this increases their chances of falling.12
What Conditions Make You More Likely to Fall?
Research has identified many conditions that contribute to falling. These are called risk factors. Many risk factors can be changed or modified to help prevent falls. They include:
- Lower body weakness
- Vitamin D deficiency (that is, not enough vitamin D in your system)
- Difficulties with walking and balance
- Use of medicines, such as tranquilizers, sedatives, or antidepressants. Even some over-the-counter medicines can affect balance and how steady you are on your feet.
- Vision problems
- Foot pain or poor footwear
- Home hazards or dangers such as
- broken or uneven steps, and
- throw rugs or clutter that can be tripped over.
Most falls are caused by a combination of risk factors. The more risk factors a person has, the greater their chances of falling.
Healthcare providers can help cut down a person’s risk by reducing the fall risk factors listed above.
What You Can Do to Prevent Falls
Falls can be prevented. These are some simple things you can do to keep yourself from falling.
Talk to Your Doctor
- Ask your doctor or healthcare provider to evaluate your risk for falling and talk with them about specific things you can do.
- Ask your doctor or pharmacist to review your medicines to see if any might make you dizzy or sleepy. This should include prescription medicines and over-the counter medicines.
- Ask your doctor or healthcare provider about taking vitamin D supplements.
Do Strength and Balance Exercises
Do exercises that make your legs stronger and improve your balance. Tai Chi is a good example of this kind of exercise.
Have Your Eyes Checked
Have your eyes checked by an eye doctor at least once a year, and be sure to update your eyeglasses if needed.
If you have bifocal or progressive lenses, you may want to get a pair of glasses with only your distance prescription for outdoor activities, such as walking. Sometimes these types of lenses can make things seem closer or farther away than they really are.
Make Your Home Safer
- Get rid of things you could trip over.
- Add grab bars inside and outside your tub or shower and next to the toilet.
- Put railings on both sides of stairs.
- Make sure your home has lots of light by adding more or brighter light bulbs.
The study came about after he and colleagues in a previous study interviewed patients and caregivers about fall prevention, hospital-to-home transition and fall risk awareness.
They found that most respondents recalled receiving little fall prevention information at the hospital discharge, though all were considered fall risks.
“Falls are a trifecta in terms of reasons why they need an increased focus,” said Hoffman, who also is a member of the U-M Institute for Healthcare Policy and Innovation.
“They are highly prevalent, cause a lot of damage, including death, and they are preventable.
However, fall prevention is being left out of the discharge planning conversation and that needs to change.”
Researchers examined 8.3 million patient readmissions using two years of Hospital Cost and Utilization Project Nationwide Readmissions data.
They identified the frequency of fall-related readmissions overall and for two high-risk subgroups: those with cognitive impairment and those whose initial hospitalization was fall-related.
The overall readmission rate was 14 percent.
It was a bit higher for those with cognitive impairment (16 percent), but a bit lower for those with a previous fall injury (13 percent).
Falls were the second-leading diagnosis at readmission for patients with cognitive impairment and whose initial hospitalization was fall-related.
Falls were the leading reason for readmission among patients whose initial hospital was fall-related and who were discharged to home, even with home health care.
From their earlier interviews, researchers knew that many caregivers and patients perceived the discharged patients’ fall risk as low, even though all were deemed fall risks while hospitalized.
Some caregivers were overly cautious, and restricted the patient’s mobility following discharge, which could explain the lower perceived risk.
“After discharge, the goal is to provide patient-centered fall prevention and to safely encourage patients to get up and move,” Hoffman said.
“Previous research suggests that in the long-term, limited mobility can harm patients and increase fall risks, something many caregivers and patients may not realize, because sedentary behavior appears to reduce fall risks and falls in the shorter-term.”
Proper education is key, said senior author Lillian Min, U-M associate professor of geriatrics and palliative medicine.
“Discharge planners, doctors, patients and families should develop a personalized plan to balance increased mobility and fall prevention,” she said.
This can include community-based interventions, home modifications and education.
Hoffman said that while the prevalence of fall-related readmissions is high, hospitals can use existing tools to reduce their frequency.
Hospitals already know how to identify those with cognitive impairment and fall risk, and have improved their discharge procedures to avoid Medicare’s costly readmission penalty. Now, they just need to include fall prevention in that discharge discussion.
“If they’re in the hospital already, they can be reached with education and prevention before they get home,” Hoffman said.
The study, “Post-Hospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older,” will appear May 24 in JAMA Network Open.
More information: “Post-Hospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older,” JAMA Network Open (2019). DOI: 10.1001/jamanetworkopen.2019.4276
Journal information: JAMA Network Open
Provided by University of Michigan