A prospective study of the costs of falls in older adults living in the community

Objective: To establish the hospital cost and three-month, post-hospital community and personal costs associated with older adults discharged to the community after a fall. The timing, incidence and the determinants of these costs to the various sectors were also examined. Methods: Patients who attended the Emergency Department of a teaching hospital in Perth, Western Australia, were asked to complete a daily diary for three months of all community and informal care they received due to their fall and any associated expenses. Unit costs were collected from various sources and used to estimate the cost of community and informal care. Hospital inpatient costs were estimated using a patient-based costing system. Results: Seventy-nine patients participated with a total estimated falls-related cost for the three-month period of $316,155 to $333,648 (depending on assumptions used) and a mean cost per patient of between $4,291 and $4,642. The hospital cost accounted for 80%, community costs 16% and personal costs 4% of the total. Of community and personal costs, 60% was spent in the first month. Type of injury was the most significant determinant of hospital and community costs. Extrapolating these figures to the WA population provided an estimate of the total hospital and three-month, post-hospital cost of falls of $24.12 million per year, with $12.1 million funded by the Federal Government, $10.1 million by State/local government and $1.7 million in out-of pocket expenses by patients. Conclusion: In the acute and immediate post-discharge period, hospital costs accounted for most of the cost of care for older adults discharged to the community after a fall. Community and personal costs, however, were also incurred. The cost estimates provide useful information for planners of hospital and community care for older people who have sustained a fall.