TY - JOUR

T1 - Predicting mortality risk after a fall in older adults using health care spending patterns: a population-based cohort study

AU - Katsiferis, Alexandros

AU - Mortensen, Laust Hvas

AU - Khurana, Mark Poulsen

AU - Mishra, Swapnil

AU - Jensen, Majken Karoline

AU - Bhatt, Samir

PY - 2023

Y1 - 2023

N2 - ObjectiveTo develop a prognostic model of 1-year mortality for individuals aged 65+ presenting at the emergency department (ED) with a fall based on health care spending patterns to guide clinical decision-making.DesignPopulation-based cohort study (n = 35,997) included with a fall in 2013 and followed 1 year.MethodsHealth care spending indicators (dynamical indicators of resilience, DIORs) 2 years before admission were evaluated as potential predictors, along with age, sex and other clinical and sociodemographic covariates. Multivariable logistic regression models were developed and internally validated (10-fold cross-validation). Performance was assessed via discrimination (area under the receiver operating characteristic curve, AUC), Brier scores, calibration and decision curve analysis.ResultsThe AUC of age and sex for mortality was 72.5% [95% confidence interval 71.8 to 73.2]. The best model included age, sex, number of medications and health care spending DIORs. It exhibited high discrimination (AUC: 81.1 [80.5 to 81.6]), good calibration and potential clinical benefit for various threshold probabilities. Overall, health care spending patterns improved predictive accuracy the most while also exhibiting superior performance and clinical benefit.ConclusionsPatterns of health care spending have the potential to significantly improve assessments on who is at high risk of dying following admission to the ED with a fall. The proposed methodology can assist in predicting the prognosis of fallers, emphasising the added predictive value of longitudinal health-related information next to clinical and sociodemographic predictors.

AB - ObjectiveTo develop a prognostic model of 1-year mortality for individuals aged 65+ presenting at the emergency department (ED) with a fall based on health care spending patterns to guide clinical decision-making.DesignPopulation-based cohort study (n = 35,997) included with a fall in 2013 and followed 1 year.MethodsHealth care spending indicators (dynamical indicators of resilience, DIORs) 2 years before admission were evaluated as potential predictors, along with age, sex and other clinical and sociodemographic covariates. Multivariable logistic regression models were developed and internally validated (10-fold cross-validation). Performance was assessed via discrimination (area under the receiver operating characteristic curve, AUC), Brier scores, calibration and decision curve analysis.ResultsThe AUC of age and sex for mortality was 72.5% [95% confidence interval 71.8 to 73.2]. The best model included age, sex, number of medications and health care spending DIORs. It exhibited high discrimination (AUC: 81.1 [80.5 to 81.6]), good calibration and potential clinical benefit for various threshold probabilities. Overall, health care spending patterns improved predictive accuracy the most while also exhibiting superior performance and clinical benefit.ConclusionsPatterns of health care spending have the potential to significantly improve assessments on who is at high risk of dying following admission to the ED with a fall. The proposed methodology can assist in predicting the prognosis of fallers, emphasising the added predictive value of longitudinal health-related information next to clinical and sociodemographic predictors.

U2 - 10.1093/ageing/afad159

DO - 10.1093/ageing/afad159

M3 - Journal article

C2 - 37651750

VL - 52

JO - Age and Ageing

JF - Age and Ageing

SN - 0002-0729

IS - 8

ER -