MedicalResearch: What are the main findings of the study?
Dr. Carter: Nearly 1 in 5 older adults experienced at least one severe medical injury during the five-year study period, and more than half of these occurred in an ambulatory care setting (i.e., not in the hospital). Older adults that were in poorer health and who had greater levels of disability had the greatest risk. Mortality rates were nearly twice as high among older adults experiencing a medical injury in comparison with otherwise similar older adults not experiencing a medical injury. Among survivors, the impact of medical injury was observed for extended periods of time, reflecting increased medical use and costs associated with medical injury.
MedicalResearch: Were any of the findings unexpected?
Dr. Carter: Although we anticipated that medical injuries would be associated with increased mortality, morbidity, and costs, we did not anticipate how large the initial impact would be, nor how long the consequences of medical injury would last over the long run. We also did not expect to find that more than half of all medical injuries would be identified from outpatient records.
MedicalResearch: What should clinicians and patients take away from your report?
Dr. Carter: Findings suggest that more than 60% of all medically serious adverse medical events (medical injuries) among older adults occur outside of in-patient hospital settings. The events are associated with considerable mortality, morbidity, and excess expenditures. Efforts to reduce medical injuries among older adults must focus on both in-patient and out-patient settings. Moreover, following implementation of the Affordable Care Act, medical management across settings represents an important focus of care.
Medical injuries are a relatively common experiences among older adults, and are associated with excess mortality, morbidity, and costs. Because more than half of these events occur outside of the in-patient hospital setting, efforts to reduce medical injuries must focus on the management of medical care for frail older adults across providers and medical settings.
MedicalResearch: What recommendations do you have for future research as a result of this study?
Dr. Carter: Future studies should focus on care practices that improve the management of medically complex older adults across providers and care settings.