Sex differences in falls and healthcare utilization among users of a Geriatrician-led Falls Prevention Clinic in Canada

Introduction: Females experience greater rates of fall-related hospitalizations, while males delay accessing fall-related medical care which can exacerbate complications. There is limited sex disaggregated falls and healthcare cost data for older Canadian adults. Our objective was to examine sex differences in the frequency of falls and healthcare costs among older adults with a history of falls receiving care from a Geriatrician-Led Falls Prevention Clinic in Vancouver, Canada.

Methods: We performed a secondary analysis of a 12-month randomized controlled trial of 344 participants (229 females; 115 males) recruited from the Falls Prevention Clinic. Monthly calendars tracked the number of falls over 12 months. Two-sample proportions tests established sex differences in the frequency of non-fallers, participants with one fall, and recurrent fallers. Self-reported healthcare utilization was collected for: 1) health/allied healthcare professional visits; 2) hospital admissions/procedures; and 3) laboratory tests/investigations. ANCOVAs controlling for experimental group (i.e., Otago Exercise Program with geriatrician care vs. geriatrician care only) established sex differences in costs for each domain, and total costs. We reported adjusted means and standard error.

Results: We observed a greater proportion of non-fallers among females (females: 104 (45.4%); males: 31 (27.0%), p<0.01)), no sex differences in individuals with one fall (females: 54 (23.6%); males: 28 (24.4%), p=0.87)), and more recurrent falls among males (females: 71 (31.0%); males: 56 (48.7%), p<0.01)). There were no differences in costs for health professional visits (females: 2,135 (152.6); males 2,626 (215.4), p=0.06)) nor laboratory investigations (females: 250 (14.9); males: 237 (21.0), p=0.27)), but males had greater hospital admissions and/or procedures (females: 1,662 (477.8); males: 3,711 (674.6), p=0.01)) and total costs (females: 3,292 (430.8); males: 5,820 (606.9), p<0.01)).

Conclusion: A greater proportion of males were recurrent fallers, and they accrued greater costs in hospital admissions/procedures and total healthcare costs. Sex-specific approaches for fall prevention in males warrant further investigation.