Understanding hospitalization discharge location for better fall-prevention intervention

Falls are a significant risk for older adults, who are more likely to experience falls and be injured by them than younger people are. In addition to the affect they have on older adults’ health and well-being, injuries related to falls further add to the strain on the U.S. health care system. Older adults with a history of previous falls are also more likely to end up in institutional settings (such as nursing homes) after another fall, further adding to the financial load. As more Americans enter the 65 and older age bracket, there will be a greater need for better interventions and discharge planning for people who have experienced a fall.

The first step in that process is to better understand where older adults with a fall-related hospitalization are discharged to following the receipt of care in an acute care setting, such as a hospital. To that end, Samuel D. Towne Jr., PhD, assistant professor at the Texas A&M School of Public Health and former student Kayla Fair, DrPH, who is now at the University of Texas Southwestern Medical Center, along with other researchers, conducted a multilevel study of fall-related hospital discharges in Texas. The study published in the journal Health Services Research used a dataset of adults age 65 and older who had a fall-related hospitalization, examining the discharge destinations of more than 40,000 patients per year in 2011, 2012 and 2013.

Towne, Fair and colleagues were interested in where patients went after being discharged from the hospital. Discharge locations included home without additional care (self-care), home with additional care (home health care) and other care facilities such as nursing homes. The research team looked at several individual factors such as age, sex, race and ethnicity as well as payment or insurance type. They also looked at community-level factors such as whether the patient was in an urban or rural area and if the hospital was a teaching facility.

Their analysis found that roughly one-third of patients were discharged home each year, meaning that approximately two-thirds went to an institutionalized setting.

“Factors associated with increased odds of being sent to a institutional setting after a fall-related hospitalization were being older than 74 (versus 65–74 years of age), being female, having a higher risk of mortality, being treated in a non-teaching hospital, and having Medicare as the primary payment source,” Towne said. “People who were more likely to be discharged home included Asian or Pacific Islander, black or Hispanic patients versus those who were white and those whose primary payment source was private insurance rather than Medicare.”

The population of older adults in Texas grew approximately 10 percent between 2011 and 2013, and falls among older adults increased at a slightly higher rate. The increasing size of the older adult population and the rise in fall-related hospitalizations highlights the need to create better interventions at multiple levels. Further research will be needed to consider the severity of fall injuries and to follow patients beyond their immediate discharge from the hospital.

This study identifies a few ways to improve interventions and help form policies that control what gets included in standard discharge planning. Such plans will need to be based on evidence and clearly show patients how to access care. The various providers and facilities in such plans rely on patients to share information, which is something people who have been recently hospitalized for a fall may not be able to do. Thus, discharge plans will need to include better communication.

“Importantly, suffering a fall is a major risk factor for future falls,” Towne said. “Identifying factors associated with fall-related hospitalizations and knowing where individuals are more likely to be discharged to can help tailor discharge planning to fit the unique needs of older adults. Doing so may help prevent future falls, potentially reducing health care costs and improving older adults’ health and well-being.”