A fall too far: Trauma outcomes in the uninsured fall patient

Falls are a leading cause of nonfatal injury among older adults. Although most older adults are covered by Medicare, a subset remains uninsured. This study evaluates the impact of insurance status on outcomes following fall-related injuries among older adults.

A retrospective analysis of the American College of Surgeons Trauma Quality Improvement Program from 2017 to 2021 was conducted. Patients aged ≥65 years who sustained a fall were identified and included. Patients were categorized based on their insurance status on admission to uninsured, Medicaid, Medicare, and other. The primary outcome was mortality, with secondary outcomes including discharge disposition and in-hospital complications.

Of 980,343 older adults, 1.1% were uninsured. Among uninsured patients, the majority were female (60.8%) and of White race (67.4%). Despite lower injury severity scores, uninsured patients had higher mortality (7.7%), increased failure to rescue (0.9%), and lower discharge rates to rehabilitation (9.4%) or skilled nursing facilities (19.1%) (P < .001 for all). Adjusted logistic regression revealed that uninsured patients had 23% higher odds of mortality (odds ratio 1.23, 95% confidence interval 1.18-1.28) and 34% higher odds of failure to rescue (odds ratio 1.34, 95% confidence interval 1.22-1.47) compared with Medicare patients.

Uninsured older adults with fall-related injuries face a significantly higher risk of mortality and failure to rescue compared with insured patients. Our findings emphasize the need for further investigation into the factors driving these disparities and for the development of targeted policies aimed at improving access to comprehensive care for underserved older adults.