Osteoporosis International

, Volume 23, Issue 5, pp 1513–1519 | Cite as

The cost of fall related presentations to the ED: A prospective, in-person, patient-tracking analysis of health resource utilization

  • J. C. Woolcott
  • K. M. Khan
  • S. Mitrovic
  • A. H. Anis
  • C. A. MarraEmail author
Original Article



We prospectively collected data on elderly fallers to estimate the total cost of a fall requiring an Emergency Department presentation. Using data collected on 102 falls, we found the average cost per fall causing an Emergency Department presentation of $11,408. When hospitalization was required, the average cost per fall was $29,363.


For elderly persons, falls are a major source of mortality, morbidity, and disability. Previous Canadian cost estimates of seniors' falls were based upon administrative data that has been shown to underestimate the incidence of falls. Our objective was to use a labor-intensive, direct observation patient-tracking method to accurately estimate the total cost of falls among seniors who presented to a major urban Emergency Department (ED) in Canada.


We prospectively collected data from seniors (>70 years) presenting to the Vancouver General Hospital ED after a fall. We excluded individuals who where cognitively impaired or unable to read/write English. Data were collected on the care provided including physician assessments/consultations, radiology and laboratory tests, ED/hospital time, rehabilitation facility time, and in-hospital procedures. Unit costs of health resources were taken from a fully allocated hospital cost model.


Data were collected on 101 fall-related ED presentations. The most common diagnoses were fractures (n = 33) and lacerations (n = 11). The mean cost of a fall causing ED presentation was $11,408 (SD: $19,655). Thirty-eight fallers had injuries requiring hospital admission with an average total cost of $29,363 (SD: $22,661). Hip fractures cost $39,507 (SD: $17,932). Among the 62 individuals not admitted to the hospital, the average cost of their ED visit was $674 (SD: $429).


Among the growing population of Canadian seniors, falls have substantial costs. With the cost of a fall-related hospitalization approaching $30,000, there is an increased need for fall prevention programs.


Cost Economic analysis Fall Older adults 



This research was funded by the Michael Smith Foundation for Health Services Research (JCW, KK, CAM and Canadian Institutes for Health Research (JCW, KK, CAM). CAM is the holder of a Government of Canada Research Chair in Pharmaceutical Outcomes.

Conflicts of interest



  1. 1.
    Tinetti ME, Kumar C (2010) The patient who falls: "it's always a trade-off". JAMA 303(3):258–266, 1538–3598 (Electronic); 0098–7484 (Linking)PubMedCrossRefGoogle Scholar
  2. 2.
    Tinetti ME, Williams CS (1997) Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 337(18):1279–1284, 0028–4793 (Print)PubMedCrossRefGoogle Scholar
  3. 3.
    Weir E, Culmer L (2004) Fall prevention in the elderly population. CMAJ 171(7):724PubMedCrossRefGoogle Scholar
  4. 4.
    Davis JC, Robertson MC, Ashe MC, Liu-Ambrose T, Khan KM, Marra CA (2010) International comparison of cost of falls in older adults living in the community: a systematic review. Osteoporos Int. (1433–2965 (Electronic); 0937-941X (Linking))Google Scholar
  5. 5.
    Heinrich S, Rapp K, Rissmann U, Becker C et al (2010) Cost of falls in old age: a systematic review. Osteoporos Int 21(6):891–902, Epub 2009 Nov 19.(1433–2965 (Electronic); 0937-941X (Linking))PubMedCrossRefGoogle Scholar
  6. 6.
    Belanger A, Martel L, Caron-Malenfant E. Catalogue no.91-52--XIE population projections for canada, provinces and territories. [Internet]. 2005 December 2005:July 9, 2010Google Scholar
  7. 7.
    Iezzoni LI (1997) Assessing quality using administrative data. Ann Intern Med 127(8 Pt 2):666–674, 0003–4819 (Print)PubMedGoogle Scholar
  8. 8.
    Preen DB, Holman CD, Lawrence DM, Baynham NJ et al (2004) Hospital chart review provided more accurate comorbidity information than data from a general practitioner survey or an administrative database. J Clin Epidemiol 57(12):1295–1304, 0895–4356 (Print)PubMedCrossRefGoogle Scholar
  9. 9.
    Finkler S (1982) The distinction between costs and charges. Ann Intern Med 96(1):102–109PubMedGoogle Scholar
  10. 10.
    Lamb SE, Jorstad-Stein EC, Hauer K, Becker C et al (2005) Development of a common outcome data set for fall injury prevention trials: The prevention of falls network europe consensus. J Am Geriatr Soc 53(9):1618–1622, 0002–8614 (Print)PubMedCrossRefGoogle Scholar
  11. 11.
    Salter AE, Khan KM, Donaldson MG, Davis JC et al (2006) Community-dwelling seniors who present to the emergency department with a fall do not receive guideline care and their fall risk profile worsens significantly: a 6-month prospective study. Osteoporos Int 17(5):672–683, Epub 2006 Feb 21.(0937-941X (Print); 0937-941X (Linking))PubMedCrossRefGoogle Scholar
  12. 12.
    Woolcott JC, Davis JC, Buchanan J, Abu-Laban RB, Khan KM, Marra CA. The direct costs of injurious falls in seniors. International Society for Pharmacoeconomics and Outcomes Research Thirteenth Annual International Meeting May 3–7, 2008Google Scholar
  13. 13.
    Baladi J. A guidance document for the costing process. version 1.0. 1996Google Scholar
  14. 14.
    Shalensky K, Hill S (ed) (2009) Formulary of Vancouver general hospital, UBC hospital, GF strongGoogle Scholar
  15. 15.
    MSP-MSC payment schedule [Internet]. Victoria, British Columbia: British Columbia Ministry of Health Services; 2009 [updated April 1, 2009. Available from:
  16. 16.
    Ambulance fee changes [Internet].; 2007 [updated September 12, 2007. Available from:
  17. 17.
    Najafzadeh M, Marra CA, Sadatsafavi M, Aaron SD et al (2008) Cost effectiveness of therapy with combinations of long acting bronchodilators and inhaled steroids for treatment of COPD. Thorax 63(11):962–967, Epub 2008 Jul 11.(1468–3296 (Electronic))PubMedCrossRefGoogle Scholar
  18. 18.
  19. 19.
    Consumer price index, health and personal care, by province. [Internet].: Statistics Canada; 2010 [updated March 29, 2010. Available from:
  20. 20.
  21. 21.
    Alberta case cost report [Internet].; 2008 [updated December 2008. Available from:
  22. 22.
    Alberta health care insurance plan procedure list [Internet].; 2010 [updated January 1, 2010. Available from:
  23. 23.
    Close J, Ellis M, Hooper R, Glucksman E et al (1999) Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet 353(9147):93–97, 0140–6736 (Print)PubMedCrossRefGoogle Scholar
  24. 24.
    Davis JC, Guy P, Ashe MC, Liu-Ambrose T et al (2007) HipWatch: Osteoporosis investigation and treatment after a hip fracture: A 6-month randomized controlled trial. J Gerontol A Biol Sci Med Sci 62(8):888–891. (1079–5006 (Print); 1079–5006 (Linking))Google Scholar
  25. 25.
    Tiedemann AC, Murray SM, Munro B, Lord SR et al (2008) Hospital and non-hospital costs for fall-related injury in community-dwelling older people. N S W Public Health Bull 19(9–10):161–165, 1034–7674 (Print); 1034–7674 (Linking)PubMedCrossRefGoogle Scholar
  26. 26.
    Wiktorowicz ME, Goeree R, Papaioannou A, Adachi JD et al (2001) Economic implications of hip fracture: health service use, institutional care and cost in canada. Osteoporos Int 12(4):271–278, 0937-941X (Print)PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2011

Authors and Affiliations

  • J. C. Woolcott
    • 1
    • 2
    • 3
  • K. M. Khan
    • 4
    • 5
  • S. Mitrovic
    • 6
  • A. H. Anis
    • 3
    • 7
  • C. A. Marra
    • 1
    • 2
    • 3
    • 8
    Email author
  1. 1.Faculty of Pharmaceutical SciencesUniversity of British ColumbiaVancouverCanada
  2. 2.Collaboration for Outcomes Research and EvaluationVancouverCanada
  3. 3.Centre for Health Evaluation and Outcome SciencesProvidence Health Research InstituteVancouverCanada
  4. 4.Centre for Hip Health and MobilityVancouver Coastal Research InstituteVancouverCanada
  5. 5.Department of Family PracticeUniversity of British ColumbiaVancouverCanada
  6. 6.Faculty of MedicineUniversity of British ColumbiaVancouverCanada
  7. 7.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  8. 8.Centre for Health Evaluation and Outcome SciencesVancouverCanada

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