Surveillance for Falls Among Older Adults: Should We be Including Some Observation Stays Along with Hospitalizations?

BACKGROUND:  Increasingly hospitals are placing patients on observation status instead of admitting them to the hospital, a trend being driven by reimbursement issues. This can have financial implications for the older adult patient if they need nursing home care. In Washington State from 2010 to 2012, there was a 25% increase in the age-adjusted rate of observation stays among older adults with a primary diagnosis of an unintentional fall. The purpose of this analysis was to compare characteristics of older adults with a primary diagnosis for an unintentional fall between those hospitalized and those held in observation status to determine if there are similarities in the clinical picture.

METHODS:  Washington State Department of Health started collecting data on observation stays in 2007 in a database similar to hospital discharges. This analysis compares data among older adults with a primary diagnosis of an unintentional fall between those hospitalized and those held in observation status from 2010–2012 on mean age and length of stay, percentage with a diagnosis of traumatic brain injury or hip fracture, and discharge status.

RESULTS:  From 2010-2012 among older adults, there were 29,806 hospitalizations and 4,223 observation stays with an unintentional fall as the primary diagnosis. Although the mean age of the patients and the percentage with a traumatic brain injury diagnosis were not different between those hospitalized and those held in observation status, those hospitalized were more likely to have a hip fracture diagnosis, had a significantly longer length of stay and were more likely to be discharged to a skilled nursing facility compared to than those held in observation status. Among those with a diagnosis of a hip fracture, those hospitalized had a significantly longer length of stay and were more likely to be discharged to a skilled nursing facility than those held in observation status.

CONCLUSIONS: Despite the concerning trend of increasing observation stays for falls among older adults, it appears that clinically those who were hospitalized were significantly worse off compared to those held in observation status. It does not appear that older adults with a primary diagnosis of an unintentional fall held in observation status should be included with fall hospitalizations during routine surveillance.