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UBC Theses and Dissertations

A health care operations research analysis of elderly fallers' emergency department services utilization and cost Woolcott, John Clifford


Introduction: Falls in the elderly are a significant cause of morbidity. Prescription medication use has been identified as an independent risk factor for falls. Among all Emergency Department (ED) presentations by elderly persons, 14-40% are due to falls, placing considerable strain on ED resources. Aims: In my thesis I aimed to 1) Provide updated estimates of the association between the use of specific medications and falling, 2) Determine whether the care provided to elderly fallers while patients in the ED follows published recommendations and was provided in a timely fashion, 3) Estimate the cost per fall resulting in an ED presentation, 4) Design a discrete event simulation (DES) model simulating care and then simulating other approaches to care including hypothetical changes. Methods: 1) A Bayesian meta-analysis of studies assessing the association between specific classes of medication use and risk of a fall. 2) A cohort study of elderly fallers presenting to the ED. 3) DES of the ED care received by elderly fallers. Results: Use of anti-hypertensives, diuretics, sedatives and hypnotics, neuroleptics and anti-psychotics, antidepressants, benzodiazepines, and non-steroidal antiinflammatory drugs are associated with an increased risk of falling. 1) In a sample of 101 ED fall presentations, 38% of elderly fallers leave the ED without a geriatric assessment and 14% are assessed by a physiotherapist. Less than 8% of fallers received care which met the wait time benchmarks. The estimated cost per fall causing an ED presentation is $11,408 with the cost per fall-related hospitalization estimated to be $29,363. 2) Providing care in a timely fashion could significantly reduce the time an elderly faller spends in the ED and the opportunity costs associated with waiting to be seen by physician or admission to hospital. Summary: Many commonly used medications are associated with falls. The care provided by the elderly faller in the ED does not currently meet the recommendations of published guidelines, nor is it provided in a timely fashion. The economic burden of falls is significant. By not providing ED care that meets recommended wait time benchmarks significant opportunity costs are incurred by the ED.

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