The health-related quality of life and cost implications of falls in elderly women
Fractures and falls are serious cause of morbidity and cost to society. Our results suggest that the main burden to morbidity, measured as impact on health-related quality of life, is due to fear of falling rather than falls or their sequelae, such as fractures.
Fractures and falls are serious cause of morbidity and cost to society. We investigated the impact on health-related quality of life (HRQoL) associated with falls, fractures and fear of falling and falls and fractures cost.
Three datasets providing longitudinal data on fear of falling, HRQoL and a common set of baseline risk factors for fracture (smoking status, weight and age) were analysed. Multilevel random effects models were used to estimate the long-term impact on HRQoL associated with falls, fractures and fear of falling. Healthcare resource use primary data were collected to estimate falls and fractures cost.
Older, low weight and smoking women reported lower HRQoL. The impact on HRQoL of a fracture was at least twice as large as that associated with falls. The largest negative effect on HRQoL was associated with self-reported fear of falling. The cost of falls was £1088. Similarly, the cost of falls leading to a fracture was £15,133, £2,753, £1,863, £1,331 and £3,498 for hip, wrist, arm, vertebral and other fractures, respectively.
The main burden to morbidity is due to fear of falling. Interventions aimed at reducing fear of falling may produce larger gains in HRQoL.
KeywordsEQ-5D Falls Fear of falling Multilevel modelling Quality of life
- 2.UK Department of Health (2001) National service framework for older people. Department of Health, LondonGoogle Scholar
- 3.Torgerson DJ Iglesias CP Reid DM (2001) The economics of fracture prevention. In Barlow DH, Francis RM, Miles A (eds) The effective management of osteoporosis. Aesculapius Medical, London, pp 111–121Google Scholar
- 4.OECD—Organisation for Economic Co-operation and Development (2007) Purchasing power parities (PPP). http://www.oecd.org/std/ppp
- 8.Lawrence TM, White CT, Wenn R, Moran CG (2005) The current hospital costs of treating hip fractures. J Care Injured 36:88–91Google Scholar
- 15.Fleurence R, Iglesias CP, Torgerson DJ (2008) Economic aspects of osteoporosis treatments. In Treatment and prevention of osteoporosis. Arnold (in press)Google Scholar
- 16.Kind P (1996) The EuroQoL instrument: an index of health-related quality of life. In: Spilker B (ed) Quality of life and pharmacoeconomics in clinical trials. Lippincott-Raven, Philadelphia, pp 191–201Google Scholar
- 17.Drummond MF, Sculpher MJ, Torrance G, O’Brien BJ, Stoddart G (2005) Methods for the economic evaluation of health care programmes. Oxford University Press, OxfordGoogle Scholar
- 19.Likert R (1932) A technique for the measurement of attitudes. Arch Psychol 140:1–55Google Scholar
- 20.Porthouse J, Birks YF, Torgerson DJ, Cockayne S, Puffer S, Watt I (2004) Risk factors for fracture in a UK population: a prospective cohort study. Q J Med 97:569–574Google Scholar
- 21.Department UK of Health (2004) Reference cost 2002/2003. Department of Health, LondonGoogle Scholar
- 22.The Chartered Institute of Public Finance and Accountancy (CIPFA) (2004) The Health Service Database. http://www.cipfa.org.uk
- 23.Netten A, Dennett J, Knight J (2004) Unit costs of health and social care. PSSRU, University of Kent, CanterburyGoogle Scholar
- 26.Rasbash J, Browne W, Goldstein H et al (2000) A user’s guide to MLwiN Version 2.1. Institute of Education, University of London, LondonGoogle Scholar
- 28.Kanis JA, Brazier JE, Stevenson M, Calvert NW, Lloyd Jones M (2002) Treatment of established osteoporosis: a systematic review and cost-utility analysis. Health Technol Assess (Winchester, England) 6:1–146Google Scholar
- 34.Cumming RG, Salkeld G, Thomas M, Szonyi G (2000) Prospective study of the impact of fear of falling on activities of daily living, SF-36 scores, and nursing home admission. J Gerontol 55A:M299–M305Google Scholar
- 36.Nevitt M, Cummings S, Browner W, Seeley D, Canley J, Vogt T (1992) The accuracy of self-report of fractures in elderly women: evidence from a prospective study. A J Epidemiol 135:490–499Google Scholar
- 37.McColl E, JAcoby A, Thomas L, Soutter J, Thomas R, Harvey E, Garrat A, Bond J (2003) Design and use of questionnaires: a review of best practice applicable to surveys of health service staff and patients. Health Technol Assess 5:1–272Google Scholar