Non-Fracture Fall Injuries and Long-Term Geriatric Consequences in Older Women and Men from a Cross-Cohort Study

项目摘要/摘要 此R01应用程序的目标是检查Medicare中事故坠落伤害的时间趋势，包括非 骨折坠落伤(NFFI)和骨折，跨越20年的队列数据，如果危险因素的变化解释 趋势，然后评估NFFI事件后的主要老年结果。与骨质疏松症不同 骨折，NFFI--定义为无骨折的跌倒损伤--不被视为老年衰退的标志， 尤其是如果呈现的损伤不是严重的(例如软组织损伤)。我们的初步数据发现秋季 在过去的几十年里，老年人的死亡率大幅上升，其中老年人的增幅更大 年龄最大的一群。我们将评估这种跌倒死亡率的趋势是否延伸到非致命性的医疗跌伤。 在几个合并的老年人流行病学队列中超过20年，时间段重叠，从 1998-2019年。具体目标是：1)检查联邦医疗保险中坠落伤害事件的时间趋势，包括 NFFI和骨折，跨越20年的队列数据，如果风险因素在一段时间内的变化解释 趋势；以及2)确定事件NFFI是否预测未来住院患者，增加SNF的风险 女性和男性在NFFI后停留时间和死亡率长达5年。在4个合并的纵向队列中(61% 女性，33%的少数民族，36%的年龄在80岁以上，27%的人肥胖)，4,653名男性和7,338名男性参加了面对面考试 女性，事故坠落伤害将从5-10年的自我报告问题和医疗保险费中确定 服务(FFS)A和B部分索赔。我们假设坠落伤的发生率会随着时间的推移而增加。 总共有近12,000名女性和男性，年龄最大的人增长更快，总体上 跌伤发生率和NFFI发生率的增加将部分由代谢危险因素(例如， 肥胖、糖尿病、血压)和神经肌肉功能(力量、步态速度、椅子站立速度) 我们在过去的工作中已经确定了NFFI的新危险因素。我们假设估计有1867起事故 NFFI将预测未来的住院人数、SNF住院风险和死亡率的增加。我们经过验证的 来自过去项目的方法结合了20年来广泛的队列数据，并将医疗保险索赔与 检查跌倒伤害的增加趋势，包括临床上的NFFI，作为老年的一个重要的公共卫生问题。

Project Summary/Abstract The goal of this R01 application is to examine time trends for incident fall injuries in Medicare, including non- fracture fall injuries (NFFI) and fractures, across 20 years of cohort data and if changes in risk factors explains trends, and then to evaluate major geriatric outcomes subsequent to incident NFFI. Unlike osteoporotic fracture, NFFI - defined as fall injuries without fracture - are not treated as hallmarks of geriatric decline, particularly if the presenting injury is not severe (e.g., soft tissue injury). Our preliminary data found fall mortality in older adults increased substantially over the past several decades, with higher increases for the oldest cohorts. We will evaluate if this trend in fall mortality extends to non-fatal medically treated fall injuries over 20 years in several combined epidemiologic cohorts of older adults with overlapping time periods from 1998-2019. The Specific Aims are: 1) To examine time trends for incident fall injuries in Medicare, including NFFI and fractures, across 20 years of cohort data and if changes in risk factors over the time period explains trends; and 2) To determine if incident NFFI predict future inpatient hospitalizations, increased risk of SNF stays and mortality for up to 5 years after NFFI in women and men. In 4 pooled longitudinal cohorts (61% women, 33% minorities, 36% aged >80 years, 27% obese) with in-person exams of 4,653 men and 7,338 women, incident fall injuries will be identified from 5-10 years of self-reported questions and Medicare Fee for Service (FFS) Parts A and B claims. We hypothesize fall injury incidence will increase over time in the combined cohort of nearly 12,000 women and men, with increases higher at the oldest ages, and that overall fall injury incidence and NFFI incidence increases will be partially explained by risk factors of metabolic (e.g., obesity, diabetes, blood pressure) and neuromuscular function (strength, gait speed, chair stand speed) that we have identified in past work as novel risk factors for NFFI. We hypothesize that an estimated 1,867 incident NFFI will predict future inpatient hospitalizations, increased risk of SNF stays and mortality. Our validated approaches from past projects combine extensive cohort data across 20 years and linked Medicare claims to examine increasing trends in fall injuries, including clinical NFFI, as a significant public health issue in old age.