Abstract: FR-PO922
Serious Fall Injury History and Adverse Health Outcomes after Initiating Hemodialysis among Older US Adults
Session Information
- Geriatric Nephrology
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Geriatric Nephrology
- 901 Geriatric Nephrology
Authors
- Bowling, C. Barrett, Durham VA Medical Center, Decatur, Georgia, United States
- Hall, Rasheeda K., Duke University, Durham, North Carolina, United States
- Khakharia, Anjali, Emory University, Atlanta, Georgia, United States
- Franch, Harold A., Emory University, Atlanta, Georgia, United States
- Plantinga, Laura, Emory University, Atlanta, Georgia, United States
Background
Although older adults with pre-dialysis CKD are at increased risk for falls, the prognostic significance of a serious fall injury prior to dialysis initiation has not been well described in the end-stage renal disease population.
Methods
We examined the association between a serious fall injury in the year prior to starting hemodialysis and adverse health outcomes in the year following dialysis initiation using a retrospective cohort study of U.S. Medicare claims data from the 2 years spanning dialysis start, among patients initiating dialysis in 2010-2012. Participants included Medicare beneficiaries aged ≥67 years. Serious fall injuries were defined using diagnostic codes for falls in combination with an injury code for a fracture, joint dislocation, or head injury. Outcomes were defined as time-to-event variables within the first year of dialysis for four outcomes: subsequent serious fall injury, hospital admission, post-acute skilled nursing facility (SNF) utilization, and mortality.
Results
Among this cohort of 81,653 initiating hemodialysis, 2,958 (3.6%) patients had a serious fall injury in the year prior to hemodialysis initiation. Compared to those without serious fall injuries, those with a serious fall injury in the prior year were older (mean age 78.1 vs 76.7), more likely to be female (57.7% vs. 46.8%) and white (73.5% vs. 65.2%), and more likely to need assistance with daily activities (27.2% vs. 17.8%). In the first year of dialysis, 7.6%, 67.6%, 30.7%, and 26.1% had a serious injury fall, hospitalization, SNF claim, or died. Multivariable adjusted hazard ratios (95% confidence intervals) for a serious fall injury, hospitalization, SNF claim, or death for those with vs. without a history of serious fall injury in the year prior to hemodialysis initiation were 2.94 (2.71-3.20), 1.20 (1.15-1.26), 1.62 (1.52-1.73), and 1.28 (1.20-1.43), respectively.
Conclusion
A serious fall injury in the year prior to dialysis was associated with an increased risk for adverse health outcomes. For older adults initiating dialysis, a history of a serious fall injury may be novel marker for frailty and provide prognostic information to support decision-making and establish expectations for life after dialysis initiation.
Funding
- Veterans Affairs Support