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Future hospital service utilisation in older adults living in long-term residential aged care or the community hospitalised with a fall-related injury

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Abstract

Summary

This study identified group-based trajectories of hospitalisation for older adults who were living in residential aged care facilities (RACF) or the community for up to 4 years after an index fall injury hospitalisation. Greater than 3 subsequent fall injury hospitalisations and time until move to a RACF were key predictors of RACF and community-living trajectory group memberships, respectively.

Introduction

To examine hospital service use trajectories of people aged ≥ 65 years who had a fall injury hospitalisation and were either living in a residential aged care facility (RACF) or the community at the time of the index fall and to identify factors predictive of their trajectory group membership.

Method

A group-based trajectory analysis of hospitalisations of people aged ≥ 65 years who had a fall injury hospitalisation during 2008–2009 in New South Wales, Australia, was conducted. Linked hospitalisation and RACF data were examined for a 5-year period. Group-based trajectory models were derived based on number of subsequent hospital admissions following the index fall injury hospitalisation. Multinominal logistic regression examined predictors of trajectory group membership.

Results

There were 24,729 fall injury hospitalisations; 78.8% of fallers were living in the community and 21.2% in a RACF. Five distinct trajectory groups were identified for community-living and four trajectory groups for RACF residents. Key predictors of trajectory group membership for both community-living and RACF residents were age group, number of comorbidities and dementia status. For RACF residents, depression, assistance with activities of daily living and number of subsequent fall injury admissions were also predictors of group membership, with time to move to a RACF a predictor of group membership for community living.

Conclusions

Identifying trajectories of ongoing hospital use informs targeting of strategies to reduce hospital admissions and design of services to allow community-living individuals to remain as long as possible within their own residence.

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Acknowledgements

The authors wish to thank the NSW Ministry of Health for providing access to the NSW hospitalisation data, the National Aged Care Data Clearinghouse for providing access to the Residential Aged Care data and the CHeReL for hospitalisation data extraction and the AIHW Data Linkage Unit for conducting the record linkage. The data were analysed within the Secure Unified Research Environment.

Funding

This research was part-funded by the Dementia Centre for Research Collaboration. R. Mitchell was supported by a career fellowship from the NSW Ministry of Health under the NSW Health Early-Mid Career Fellowships Scheme.

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Authors and Affiliations

  1. Australian Institute of Health Innovation, Macquarie University, Macquarie Park, NSW, 2109, Australia

    R. Mitchell, V. Do & J. Braithwaite

  2. Dementia Collaborative Research Centre - Assessment and Better Care, University of New South Wales, Sydney, Australia

    B. Draper & H. Brodaty

  3. Centre for Healthy Brain Ageing, School of Psychiatry, University of New South Wales, Sydney, Australia

    B. Draper & H. Brodaty

  4. Falls, Balance and Injury Research Centre, Neuroscience Research Australia, University of New South Wales, Sydney, Australia

    J. Close & L. Harvey

  5. Prince of Wales Clinical School, University of New South Wales, Sydney, Australia

    J. Close

  6. School of Public Health, University of Sydney, Camperdown, Australia

    T. R. Driscoll

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  1. R. Mitchell
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Correspondence to R. Mitchell.

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Ethical approval was obtained from the NSW Population and Health Services Research Ethics Committee (2008/10/108) and the Australian Institute of Health and Welfare (AIHW) Human Research Ethics Committee (2015/1/159).

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Mitchell, R., Draper, B., Close, J. et al. Future hospital service utilisation in older adults living in long-term residential aged care or the community hospitalised with a fall-related injury. Osteoporos Int 30, 1995–2008 (2019). https://doi.org/10.1007/s00198-019-05096-2

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