Falls are the leading cause of injury in older adults [1]. Each year, approximately 3 million older adults are treated for injurious falls in U.S. emergency departments and more than 800,000 are hospitalized [2]. Fall injuries not only lead to substantial morbidity and mortality, but have significant financial implications comprising an estimated $50 billion dollars annually in health care spending for adults 65 years and older [3,4]. While numerous studies have estimated the economic burden of falls, [4], [5], [6], [7], [8], [9], [10], [11], [12] little is known about how the costs of acute medical care for falls differ by injury type and medical care setting. Given that fall injury and fall related healthcare utilization are projected to rise[13], understanding factors affecting cost of treating fall injury among older adults by setting (inpatient hospital vs. emergency department) will be important for guiding fall prevention and monitoring efforts as well as planning for future care needs in the context of population aging.

Among older adults who fall, over half receive medical care in the hospital; 34% are treated and released from the emergency department and 19% are admitted for their injuries [14]. Those who are admitted tend to be older and have more severe injury, often involving fracture [14]. The cost and outcomes of fall-related hip fractures has been a longstanding topic of study [15], [16], [17], [18], [19], however little is known about the treatment cost of other fall related fracture types (e.g., humerus, ankle) which are becoming more prevalent among older adults [20,21]. Fall mechanism is another under-studied aspect that may have important implications for cost as well as clinical care management. While most older adults’ fall injuries are from low level falls, falls from height are increasing in older men and women potentially leading to more severe injury[20] though the cost of emergency department and inpatient care by fall mechanism has not been studied. Acute care cost by injury type and care setting are relevant to payment initiatives which incentivize clinicians to coordinate care across care settings and could motivate hospitals to align resources and partner with clinicians and community-based organization on improving care pathways and implementing fall prevention interventions. This is especially important because fall injuries are the leading hospital readmission diagnosis among older adults initially hospitalized for a fall. [22]

Given the importance of acute care cost for the design and implementation of fall injury prevention and treatment initiatives, we describe the frequency and costs of inpatient and emergency department visits for fall injuries among older adults in the United States using 2016–2018 data from the National Inpatient Sample and National Emergency Department Sample. We specifically focus on cost differences by injury type, fall mechanism, and treatment setting, with attention to variation in cost by demographic and health characteristics.