Evaluating the Cost-Effectiveness of Fall Prevention Programs that Reduce Fall-Related Hip Fractures in Older Adults
ABSTRACT To model the incremental cost-utility of seven interventions reported as effective for preventing falls in older adults.
Mathematical epidemiological model populated by data based on direct clinical experience and a critical review of the literature.
Model represents population level interventions.
No human subjects were involved in the study. MEASUREMENS: The last Cochrane database review and meta-analyses of randomized controlled trials categorized effective fall-prevention interventions into seven groups: medical management (withdrawal) of psychotropics, group tai chi, vitamin D supplementation, muscle and balance exercises, home modifications, multifactorial individualized programs for all elderly people, and multifactorial individualized treatments for high-risk frail elderly people. Fall-related hip fracture incidence was obtained from the literature. Salary figures for health professionals were based on Bureau of Labor Statistics data. Using an integrated healthcare system perspective, healthcare costs were estimated based on practice and studies on falls in older adults. Base case incremental cost utility ratios were calculated, and probabilistic sensitivity analyses were conducted.
Medical management of psychotropics and group tai chi were the least-costly, most-effective options, but they were also the least studied. Excluding these interventions, the least-expensive, most-effective options are vitamin D supplementation and home modifications. Vitamin D supplementation costs less than home modifications, but home modifications cost only $14,794/quality-adjusted life year (QALY) gained more than vitamin D. In probabilistic sensitivity analyses excluding management of psychotropics and tai chi, home modification is most likely to have the highest economic benefit when QALYs are valued at $50,000 or $100,000.
Of single interventions studied, management of psychotropics and tai chi reduces costs the most. Of more-studied interventions, home modifications provide the best value. These results must be interpreted in the context of the multifactorial nature of falls.
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ABSTRACT: Objetivos Estudiar la percepción de la calidad de vida relacionada con la salud (CVRS) entre las personas mayores que viven en la comunidad, con antecedente de caída accidental. Material y métodos Estudio descriptivo basado en una muestra de 198 personas de entre 65-75 años residentes en la comunidad (edad media 69,5 años, 48,5% mujeres). Se les administró una encuesta en la que se solicitó información sobre edad, sexo, enfermedades, caídas accidentales y CVRS utilizando la encuesta EuroQol-5D (EQ-5D). Los resultados cualitativos fueron presentados como porcentajes, con un intervalo de confianza del 95%. Los datos continuos fueron comparados usando el estadístico U de Mann-Whitne. Resultados Existe un mayor porcentaje de sujetos con enfermedades en el grupo con antecedente de caída (AC) en comparación con el grupo sin antecedente de caída (NC). Existe un mayor porcentaje de sujetos con problemas en las 5 dimensiones del EQ-5D en el grupo AC (movilidad 59,4%, cuidado personal 29,0%, actividades cotidianas 60,6%, dolor/malestar 87,5% y ansiedad/depresión 62,5%), que en el grupo NC (movilidad 28,8%, cuidado personal 11,3%, actividades cotidianas 22,9%, dolor/malestar 65,4%, ansiedad/depresión 28,9%). Se encontró una diferencia estadísticamente significativa de 20 puntos a favor del grupo NC en la escala visual analógica del EQ-5D (p < 0,000) (AC 51,36 ± 22,79, NC 71,65 ± 18,93). Conclusiones Las personas mayores con AC durante los últimos 12 meses tienen peor percepción de su CVRS. Son necesarias más investigaciones para aclarar si se debe a la caída y/o a otras variables, como presentar enfermedades crónicas.Fisioterapia 10/2014; DOI:10.1016/j.ft.2014.03.001
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ABSTRACT: Principals. Throughout the world, falls are a major public health problem and a socioeconomic burden. Nevertheless there is little knowledge about how the injury types may be related to the aetiology and setting of the fall, especially in the elderly. We have therefore analysed all patients presenting with a fall to our Emergency Department (ED) over the past five years. Methods. Our retrospective data analysis comprised adult patients admitted to our Emergency Department between January 1, 2006, and December 31, 2010, in relation to a fall. Results. Of a total of 6357 patients 78% (n = 4957) patients were younger than 75 years. The main setting for falls was patients home (n = 2239, 35.3%). In contrast to the younger patients, the older population was predominantly female (56.3% versus 38.6%; P < 0.0001). Older patients were more likely to fall at home and suffer from medical conditions (all P < 0.0001). Injuries to the head (P < 0.0001) and to the lower extremity (P < 0.019) occurred predominantly in the older population. Age was the sole predictor for recurrent falls (OR 1.2, P < 0.0001). Conclusion. Falls at home are the main class of falls for all age groups, particularly in the elderly. Fall prevention strategies must therefore target activities of daily living. Even though falls related to sports mostly take place in the younger cohort, a significant percentage of elderly patients present with falls related to sporting activity. Falls due to medical conditions were most likely to result in mild traumatic brain injury.The Scientific World Journal 03/2014; 2014:256519. DOI:10.1155/2014/256519 · 1.73 Impact Factor
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ABSTRACT: Objective. Promoting participation in sport organizations may be a population strategy for preventing falls in older people. In this study, we examined whether participation in sport organizations is associated with fewer falls in older people even after adjusting for multiple individual and environmental factors. Methods. We used the Japan Gerontological Evaluation Study data of 90,610 people (31 municipalities) who were not eligible for public long-term care. Logistic regression analysis was performed, with multiple falls over the past year as the dependent variable and participation in a sport organization as the independent variable, controlling for 13 factors. These included individual factors related to falls, such as age and sex, and environmental factors such as population density of the habitable area. Results. A total of 6,391 subjects (7.1%) had a history of multiple falls. Despite controlling for 13 variables, those who participated in a sport organization at least once a week were approximately ≥20% less likely to fall than those who did not participate at all (once a week; odds ratio = 0.82 and 95% confidence interval = 0.72-0.95). Conclusion. Participation in a sport organization at least once per week might help prevent falls in the community-dwelling older people.BioMed Research International 05/2014; 2014:537614. DOI:10.1155/2014/537614 · 2.71 Impact Factor