Sex differences in falls and healthcare utilization among users of a Geriatrician-led Falls Prevention Clinic in Canada
Abstract
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.
Comments
Congratulations
Dear authors,
Congratulations to this interesting work!
In my research, we also found differences between males and females at high risk of falls.
What is your opinion on the possible reasons for these differences?
Regards,
Juliana Ansai
Thank you for the comment
Thanks for the comment and sharing that you have identified similar findings.
We believe these differences may be attributed to the intersection of sex-and gender-based factors, whereby men exhibit behaviours where they are less likely to participate in physical activity programs for older adults, and thus putting them at a higher risk of falls and frailty. In contrast, women commonly seeking greater social connectedness and have greater health awareness, and thus have increased participation in physical activity programs designed for older adults. We also know that men are less likely to seek medical attention after a fall due to social stigmas of appearing to be less masculine, which perhaps helps explain in part why they were likely to be recurrent fallers. They may also have greater urgent/severe hospital admissions, as a result of delaying previous more minor events that ultimately snowball into a major event.