Future hospital service utilisation in older adults living in long-term residential aged care or the community hospitalised with a fall-related injury

R Mitchell; B Draper; J Close; L Harvey; H Brodaty; V Do; T R Driscoll; J Braithwaite

doi:10.1007/s00198-019-05096-2

Future hospital service utilisation in older adults living in long-term residential aged care or the community hospitalised with a fall-related injury

Osteoporos Int. 2019 Oct;30(10):1995-2008. doi: 10.1007/s00198-019-05096-2. Epub 2019 Jul 24.

Authors

R Mitchell¹, B Draper^{2

3}, J Close^{4

5}, L Harvey⁴, H Brodaty^{2

3}, V Do⁶, T R Driscoll⁷, J Braithwaite⁶

Affiliations

¹ Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia. r.mitchell@mq.edu.au.
² Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia.
³ Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia.
⁴ Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia.
⁵ Prince of Wales Clinical School, University of New South Wales, Sydney, Australia.
⁶ Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia.
⁷ School of Public Health, University of Sydney, Camperdown, Australia.

PMID: 31342137
DOI: 10.1007/s00198-019-05096-2

Abstract

This study identified group-based trajectories of hospitalisation for older adults who were living in residential aged care facilities (RACF) or the community for up to 4 years after an index fall injury hospitalisation. Greater than 3 subsequent fall injury hospitalisations and time until move to a RACF were key predictors of RACF and community-living trajectory group memberships, respectively.

Introduction: To examine hospital service use trajectories of people aged ≥ 65 years who had a fall injury hospitalisation and were either living in a residential aged care facility (RACF) or the community at the time of the index fall and to identify factors predictive of their trajectory group membership.

Method: A group-based trajectory analysis of hospitalisations of people aged ≥ 65 years who had a fall injury hospitalisation during 2008-2009 in New South Wales, Australia, was conducted. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived based on number of subsequent hospital admissions following the index fall injury hospitalisation. Multinominal logistic regression examined predictors of trajectory group membership.

Results: There were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in a RACF. Five distinct trajectory groups were identified for community-living and four trajectory groups for RACF residents. Key predictors of trajectory group membership for both community-living and RACF residents were age group, number of comorbidities and dementia status. For RACF residents, depression, assistance with activities of daily living and number of subsequent fall injury admissions were also predictors of group membership, with time to move to a RACF a predictor of group membership for community living.

Conclusions: Identifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.

Keywords: Community; Fall; Hospitalisation; Injury; Residential aged care.

MeSH terms

Accidental Falls / statistics & numerical data*
Activities of Daily Living
Aged
Aged, 80 and over
Comorbidity
Female
Homes for the Aged
Hospitalization / statistics & numerical data*
Humans
Long-Term Care
Male
New South Wales / epidemiology
Wounds and Injuries / epidemiology
Wounds and Injuries / etiology*