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ICD-10 Coding Uncovers Higher Rate of Fatal Falls Among Seniors

 |  By cclark@healthleadersmedia.com  
   May 21, 2012

The risk of falls among seniors should become an even more important prevention focus for clinicians and discharge planners because of new research that ICD-10 coding shows a 42% increase in falls as a cause of death among those 65 and older between 1999 and 2007.

One subcategory, falls on the same level, which went up 698%, was largely responsible for the overall increase.

The report, from the Johns Hopkins Center for Injury Research and Policy, concludes that the increased death rate is not because more seniors are suffering more serious falls, but because coding for death classification was updated from International Classification of Diseases (ICD) ninth revision to ICD-10 in 1999, which encourages more detail about the underlying cause of death.

The paper is published this month in the journal Public Health Reports.

Since the transition to ICD-10 cause-of-death coding, "There has been increasing attention to educating doctors and medical examiners to let them know there's a correct way to code death, and (in these cases) that there was a fall that led to it," says Susan Baker, a professor with the Johns Hopkins Bloomberg School of Public Health, the author of the report.

"This calls attention to the fact that falls are an extremely important cause of morbidity and mortality in the elderly, and now we're starting to see what the real numbers are. They are far and away the leading cause of death in the elderly."

The greatest increase, her research discovered, was a 698% increase in mortality coding under the category "other falls on the same level," falls that aren't as likely to result in injury as a fall down a flight of stairs, for example. 

In 1999, the first year of ICD-10, only 1.6 people age 65 or older per 100,000 population were said to have died from a fall on the same level. But by 2007, that had jumped to 13 per 100,000.

These same-level falls, perhaps resulting after someone loses one's balance, occur more often in the elderly and don't result in injuries that are immediately life threatening.

Instead, they prompt a trip to the doctor or hospital, a diagnosis of a broken or fractured hip, and often complications from surgery or pneumonia weeks or months later.  Before the switch to ICD-10 in 1999, Baker says, physicians signing death certificates were more likely to code such deaths as simply resulting from pneumonia or other complications, and ignore the fall that precipitated it weeks before.

"If death follows a minor injury, such as a rib fracture, it is likely to occur weeks or months later as the result of pneumonia or other complications," the paper said.

The second highest jump in coding was those deaths classified as falls among seniors involving wheelchairs or furniture, which were listed at 2.1 per 100,000 in 1999 but rose to 3 in 2007.  Two other types of falls, such as those attributed to slipping or tripping or falls on or from stairs, fluctuated slightly but in essence, remained the same over 1999-2007.

The long transition to correctly report fall-related deaths is not surprising, Baker notes.  "These things don't happen overnight. When people started wearing seatbelts, a death involving a vehicle collision in which the passenger or driver failed to wear a seatbelt took 30 years to code correctly," after which failure to wear a seatbelt as a cause of death went from 12% to 90%.

Baker says the jump in falls among this population should not only emphasize the importance of accurate coding, but also prompt clinicians to be on a much more attentive lookout for this risk in their patients and take greater precautions. 

"We can try to improve bone health, either with proper diet and vitamins or other treatments. And we can teach people about hazards in the home, the importance of wearing footwear that's not likely to contribute to slips and falls, and improving wheelchairs so they won't move when a person stands up or sits down," she says.

 

The information should also send an important message to building planners and architects, especially as they plan housing for the nation's growing population of seniors. "Some years ago, architects thought it was cute to have one or two steps between the kitchen or living room," which hasn't turned out to be an excellent way to increase the risk of falls.

Baker's report is based on statistics from the Centers for Disease Control and Prevention's National Center for Health Statistics Compressed Mortality File.

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