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J Am Geriatr Soc. 2018 Jul;66(6):1195-1200. doi: 10.1111/jgs.15360. Epub 2018 Apr 17.

Underreporting of Fall Injuries of Older Adults: Implications for Wellness Visit Fall Risk Screening.

Hoffman GJ1, Ha J2, Alexander NB2,3, Langa KM4,5,6,7, Tinetti M8,9, Min LC2,3,4,5.

Author information

1
Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, Michigan and Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
2
Division of Geriatric and Palliative Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
3
Geriatric Research Education and Clinical Care Center, Veterans Affairs Medical Center, Ann Arbor, Michigan.
4
Center for Clinical Management and Research, Veterans Affairs Medical Center, Ann Arbor, Michigan.
5
Institute for Social Research, University of Michigan, Ann Arbor, Michigan.
6
Division of General Internal Medicine, Department of Medicine, University of Michigan, Ann Arbor, Michigan.
7
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI.
8
Division of Geriatrics, Department of Medicine, Yale University, New Haven, Connecticut.
9
School of Public Health, Yale University, New Haven, CT.

Abstract

OBJECTIVES:

To compare the accuracy of and factors affecting the accuracy of self-reported fall-related injuries (SFRIs) with those of administratively obtained FRIs (AFRIs).

DESIGN:

Retrospective observational study SETTING: United States PARTICIPANTS: Fee-for-service Medicare beneficiaries aged 65 and older (N=47,215).

MEASUREMENTS:

We used 24-month self-report recall data from 2000-2012 Health and Retirement Study data to identify SFRIs and linked inpatient, outpatient, and ambulatory Medicare data to identify AFRIs. Sensitivity and specificity were assessed, with AFRIs defined using the University of California at Los Angeles/RAND algorithm as the criterion standard. Logistic regression models were used to identify sociodemographic and health predictors of sensitivity.

RESULTS:

Overall sensitivity and specificity were 28% and 92%. Sensitivity was greater for the oldest adults (38%), women (34%), those with more functional limitations (47%), and those with a prior fall (38%). In adjusted results, several participant factors (being female, being white, poor functional status, depression, prior falls) were modestly associated with better sensitivity and specificity. Injury severity (requiring hospital care) most substantively improved SFRI sensitivity (73%).

CONCLUSION:

An overwhelming 72% of individuals who received Medicare-reimbursed health care for FRIs failed to report a fall injury when asked. Future efforts to address underreporting in primary care of nonwhite and healthier older adults are critical to improve preventive efforts. Redesigned questions-for example, that address stigma of attributing injury to falling-may improve sensitivity.

KEYWORDS:

Medicare; fall injuries; screening; self report; survey

PMID:
29665016
PMCID:
PMC6105546
[Available on 2019-07-01]
DOI:
10.1111/jgs.15360

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