The Cost of a Fall Among Older Adults Requiring Emergency Services

J Am Geriatr Soc. 2021 Feb;69(2):389-398. doi: 10.1111/jgs.16863. Epub 2020 Oct 12.


Background/objective: The cost of a fall among older adults requiring emergency services is unclear, especially beyond the acute care period. We evaluated medical expenditures (costs) to 1 year among community-dwelling older adults who fell and required ambulance transport, including acute versus post-acute periods, the primary drivers of cost, and comparison to baseline expenditures.

Design: Retrospective cohort analysis.

Setting: Forty-four emergency medical services agencies transporting to 51 emergency department in seven northwest counties from January 1, 2011, to December 31, 2011, with follow-up through December 31, 2012.

Participants: We included 2,494 community-dwelling adults, 65 years and older, transported by ambulance after a fall with continuous fee-for-service Medicare coverage.

Measurements: The primary outcome was total Medicare expenditures to 1 year (2019 U.S. dollars), with separation by acute versus post-acute periods and by cost category. We included 48 variables in a standardized risk-adjustment model to generate adjusted cost estimates.

Results: The median age was 83 years, with 74% female, and 41.9% requiring admission during the index visit. The median total cost of a fall to 1 year was $26,143 (interquartile range (IQR) = $9,634-$68,086), including acute care median $1,957 (IQR = $1,298-$12,924) and post-acute median $20,560 (IQR = $5,673-$58,074). Baseline costs for the previous year were median $8,642 (IQR = $479-$10,948). Costs increased across all categories except outpatient, with the largest increase for inpatient costs (baseline median $0 vs postfall median $9,477). In multivariable analysis, the following were associated with higher costs: high baseline costs, older age, comorbidities, extremity fractures (lower extremity, pelvis, and humerus), noninjury diagnoses, and surgical interventions. Compared with baseline, costs increased for 74.6% of patients, with a median increase of $12,682 (IQR = -$185 to $51,189).

Conclusion: Older adults who fall and require emergency services have increased healthcare expenditures compared with baseline, particularly during the post-acute period. Comorbidities, noninjury medical conditions, fracture type, and surgical interventions were independently associated with increased costs.

Keywords: cost; emergency medical services; fall; older adults.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Accidental Falls* / economics
  • Accidental Falls* / statistics & numerical data
  • Aftercare / economics
  • Aftercare / methods
  • Aged, 80 and over
  • Chronic Disease / epidemiology
  • Comorbidity
  • Costs and Cost Analysis
  • Emergency Medical Services* / economics
  • Emergency Medical Services* / methods
  • Emergency Medical Services* / statistics & numerical data
  • Female
  • Fractures, Bone* / economics
  • Fractures, Bone* / etiology
  • Health Care Costs / statistics & numerical data
  • Hospitalization* / economics
  • Hospitalization* / statistics & numerical data
  • Humans
  • Independent Living / statistics & numerical data
  • Male
  • Medicare / statistics & numerical data
  • Transportation of Patients / statistics & numerical data
  • United States / epidemiology