A. Shashua1, I. Levran1
1Clalit Health Services, Physical Therapy, Tel Aviv, Israel
Background: Preventing falls among the elderly is a worldwide challenge. Pleural studies indicate that exercises are effective in reducing the number of falls and the risk of falls among healthy elderly people. However, there is limited data regarding serious injuries resulting from falls.
Purpose: To evaluate the rate of hospitalizations due to fractures among elderly aged 65 or older, who participated a physical therapy (PT) group setting intervention, and compare it to matched individuals who did not participate in PT intervention.
Methods: A retrospective cohort study among patients aged 65 years or older who participated in a PT group setting treatment, containing education and balance and strength exercises, during 2015-2019. Patients were excluded if they had less that two group sessions. Matched socio-demographic individuals who did not participate in PT intervention were identified for comparison.
Patient-level data were extracted from Clalit Health Services electronic medical records.
The primary outcome measure was the hospitalization rate due to fractures during one-year post-intervention. We recognized fractures according to the International Classification of Diseases diagnostic code descriptions (ICD-9) documented at hospitalization.
Other factors included socio-demographic characteristics, comorbidities, and use of various drugs associated with an increased risk of falling. Additionally, we measured the hospitalization rate due fractures during the year pre-intervention.
For comparison between rates of hospitalization pre- and post-intervention, we used paired t-test, and for comparison between the PT group and the matched group, we used the chi-square Fisher's test. Univariate and multivariable logistic regression models were analyzed for the association of the independent variables with hospitalizations due to fractures pre- and post-intervention.
Patient-level data were extracted from Clalit Health Services electronic medical records.
The primary outcome measure was the hospitalization rate due to fractures during one-year post-intervention. We recognized fractures according to the International Classification of Diseases diagnostic code descriptions (ICD-9) documented at hospitalization.
Other factors included socio-demographic characteristics, comorbidities, and use of various drugs associated with an increased risk of falling. Additionally, we measured the hospitalization rate due fractures during the year pre-intervention.
For comparison between rates of hospitalization pre- and post-intervention, we used paired t-test, and for comparison between the PT group and the matched group, we used the chi-square Fisher's test. Univariate and multivariable logistic regression models were analyzed for the association of the independent variables with hospitalizations due to fractures pre- and post-intervention.
Results: The PT intervention group comprises 45,120 participants. Their mean age was 74±6.526, most of them in an average socio-economic status (mean=5.79±2.170 in a scale of 10), and sixty-eight percent of them are female.
The rate of hospitalizations due to fractures pre- and post-intervention decreased from 1.84% (N=829) to 0.78% (N=350), with mean difference of 0.011 (95% CI=0.009-0.012, P<0.001). No association was found between hospitalization pre- and post-intervention. In the matched group (N= 39,366) no differences were observed in hospitalization rates between pre- and post-intervention periods (0.52%, 0.54%, respectively).
In a multivariable logistic regression model, older age and female were consistently associated with increased odds of hospitalization either post- or pre-intervention in both groups.
The rate of hospitalizations due to fractures pre- and post-intervention decreased from 1.84% (N=829) to 0.78% (N=350), with mean difference of 0.011 (95% CI=0.009-0.012, P<0.001). No association was found between hospitalization pre- and post-intervention. In the matched group (N= 39,366) no differences were observed in hospitalization rates between pre- and post-intervention periods (0.52%, 0.54%, respectively).
In a multivariable logistic regression model, older age and female were consistently associated with increased odds of hospitalization either post- or pre-intervention in both groups.
Conclusions: PT group setting treatments lead to decreased hospitalizations rates due to fractures among elderly at risk of falling during a year after the intervention. Older age and female are risk factors for hospitalizations due to fractures, reflecting major fall injuries.
Implications: The study results reflect the real world of clinical practice, with high generalizability among elderly aged 65 or older. Along with fall prevention, it is of great importance to reduce hospitalizations due to falls. This study results place PT intervention in the front line of prevention programs for the elderly at risk of falling. Stakeholders and policymakers should consider involving PT intervention in fall prevention programs.
Funding acknowledgements: The work was unfunded
Keywords:
Hospitalization due to fractures
Elderly
Physical therapy intervention
Hospitalization due to fractures
Elderly
Physical therapy intervention
Topics:
Community based rehabilitation
Health promotion & wellbeing/healthy ageing/physical activity
Innovative technology: information management, big data and artificial intelligence
Community based rehabilitation
Health promotion & wellbeing/healthy ageing/physical activity
Innovative technology: information management, big data and artificial intelligence
Did this work require ethics approval? Yes
Institution: Clalit Health Services
Committee: Community Helsinki Committee
Ethics number: 0081-20-COM1
All authors, affiliations and abstracts have been published as submitted.
