Fall-related healthcare use and mortality among older adults in the Netherlands, 1997-2016

Objectives: Fall-related injuries are a leading cause of morbidity among older adults, leading to a high healthcare consumption and mortality. We aim to describe and quantify time trends of fall-related healthcare use and mortality among adults aged ≥65 years in the Netherlands, 1997–2016. Design: Data were extracted from the Dutch Injury Surveillance System, Dutch Hospital Discharge Registry, and Cause-of-Death Statistics Netherlands, by age, sex, diagnosis, injury location, and year. Measurements: Absolute numbers and age-standardized rates of fall-related Emergency Department (ED) visits, hospital admissions, and fatalities, as well as average length of hospital stay (LOS) were calculated. Results: Between 1997 and 2016, absolute numbers of fall-related ED visits increased by 48%, hospital admissions increased by 59%, and mortality showed an almost threefold increase. These absolute numbers doubled among adults aged ≥85 years. A shift in fall-related injury diagnosis was observed over the years with a growing share of skull/brain injuries. In contrast to the increase in absolute numbers, standardized incidence rates of ED visits decreased by 30% (p = 0.00), whereas incidence rates of hospital admissions and mortality did not significantly change over time. Furthermore, the absolute number of hospital admission days almost halved, due to a reduced average LOS from 18.5 (95% confidence interval (CI): 18.2–18.8) days (1997) to 6.1 (95% CI, 6.1–6.2) days (2016). Conclusion: Even though the standardized incidence rates of ED visits decreased in the past twenty years, the absolute number of fall-related ED visits increased. The number of hospital admissions has also increased, but the total number of admission days has almost halved during the same period. If the observed trends would continue, this may have implications for healthcare resource allocation, as the burden of care in EDs increases, and the admission duration reduces