HLTH 4200 Week 11 Applied Epidemiology Paper Example

Falls Bringing Harmon County Residents Aged 65 and Older to the Emergency Department, 2019 and 2024: An Applied Epidemiology Paper in Which Every Number Carries Its Numerator, Denominator and Year

Student Name

Walden University

HLTH 4200: Principles of Epidemiology

Instructor Name

Month Day, Year

Falls Bringing Harmon County Residents Aged 65 and Older to the Emergency Department, 2019 and 2024: An Applied Epidemiology Paper in Which Every Number Carries Its Numerator, Denominator and Year

Background

Falls cause more injuries to older Americans than any other mechanism. In 2014, 28.7% of adults aged 65 and older said they had fallen during the previous 12 months, an estimated 29.0 million falls, and about 2.8 million older adults were treated in emergency departments for fall injuries (Bergen et al., 2016). A later national analysis followed self-reported falls and fall injuries among older adults from 2012 to 2018 (Moreland et al., 2020). This paper applies the methods of the course to one composite county, Harmon County, describing emergency visits for falls by its older residents in 2019 and 2024, and to ask whether the rate changed.

Case Definition

Each case is one emergency department visit made by a Harmon County resident aged 65 or older at the time of the visit, in calendar year 2019 or 2024, with an injury diagnosis and an external cause code indicating a fall (ICD-10-CM codes W00 to W19). Visits are counted, not people; a person who fell twice and visited twice counts twice. Visits resulting in hospital admission are included. Visits by nonresidents are excluded, even if they occurred in the county, so that the numerator matches a resident population denominator.

Data Sources

The numerator comes from the state's emergency department discharge database, which records every visit to licensed hospitals in the state, with age, county of residence, diagnosis and external cause codes. The denominator comes from the Census Bureau's county population estimates for July 1 of each year. Rates are given per 1,000 older residents per year. Defining the population, numerator and denominator in this way follows standard epidemiologic practice (Centers for Disease Control and Prevention, 2012).

Rates in 2024

In 2024, Harmon County residents aged 65 and older made 2,310 fall-related emergency department visits, a rate of 55.0 per 1,000. The rate doubled from ages 65-74 to 75-84 and rose again among those 85 and older, at 112.0 per 1,000, or more than one visit for every nine residents in that age group. Women had a higher rate than men.

Table 1

Fall-Related ED Visits Among Residents 65 and Older, Harmon County, 2024

Counts and populations are composite values for the exercise. Each rate equals visits divided by residents, multiplied by 1,000, for calendar year 2024.

Has the Rate Changed? Crude and Age-Specific Comparisons

In 2019, Harmon County residents aged 65 and older made 2,050 fall-related visits among 38,000 residents, a crude rate of 53.9 per 1,000. The crude rate in 2024, 55.0, is slightly higher. But the older population also changed: between 2019 and 2024, the county's residents aged 85 and older grew faster than younger groups, as baby boomers aged. Because fall rates rise steeply with age, an older age structure can raise the crude rate even if the rate within each age group stays the same. Age is a potential confounder of the comparison between years.

Within every age group, the 2024 rate was slightly lower than in 2019. The crude rate rose only because the population shifted toward older ages, the same pattern of confounding by a third variable seen earlier in the course. Applying 2024's age-specific rates to the 2019 population, a direct standardization, gives an expected rate of about 53.0 per 1,000, below 2019's 53.9. On a common age structure, the fall-related visit rate changed little and, if anything, fell slightly.

Table 2

Age-Specific Rates, 2019 and 2024

Within each age group, the 2024 rate is slightly lower than the 2019 rate; the crude rate rose because a larger share of residents were in the oldest groups.

Interpreting the Change

The age-specific declines are small, and with numerators of several hundred visits per group, differences of one or two visits per 1,000 could reflect chance. The paper therefore does not claim that falls declined. It does claim that the rise in the crude rate is explained by aging, not by a higher risk of falling at any given age.

Three surveillance cautions apply. First, emergency department data count only falls that led to a visit; most falls do not, and about half of older adults who fall do not tell their health care provider (Bergen et al., 2016). Second, coding practices for external causes can change between years; an increase in the share of injury visits with a recorded external cause would raise the fall count without any change in falls. Third, the county's population estimates are revised each year, and rates for 2019 calculated with older estimates may differ from those calculated with newer ones.

Implications

The number of fall-related visits rose by 260 from 2019 to 2024, from 2,050 to 2,310, even though age-specific rates did not. For health services, that count matters: emergency departments, ambulance services and rehabilitation programs must handle more visits as the population ages. For prevention, the age-specific rates matter: they show where risk is concentrated. Residents 85 and older made up 12% of the older population in 2024 (5,000 of 42,000) but accounted for 24% of fall-related visits (560 of 2,310). Prevention programs that screen for fall risk and address medications, strength and balance would reach the most visits per person screened in that group.

Conclusion

In 2024, Harmon County residents aged 65 and older made 2,310 fall-related emergency department visits, 55.0 per 1,000 residents, with rates rising steeply with age. The crude rate was higher than in 2019, but within each age group it was slightly lower; the crude increase reflected an older population, not a higher risk at any age. Every figure in this paper can be rebuilt from its stated numerator, denominator and year.

References

Bergen, G., Stevens, M. R., & Burns, E. R. (2016). Falls and fall injuries among adults aged ≥65 years: United States, 2014. Morbidity and Mortality Weekly Report, 65(37), 993-998. https://doi.org/10.15585/mmwr.mm6537a2

Centers for Disease Control and Prevention. (2012). Principles of epidemiology in public health practice: An introduction to applied epidemiology and biostatistics (3rd ed.). U.S. Department of Health and Human Services. https://archive.cdc.gov/www_cdc_gov/csels/dsepd/ss1978/index.html

Moreland, B., Kakara, R., & Henry, A. (2020). Trends in nonfatal falls and fall-related injuries among adults aged ≥65 years: United States, 2012-2018. Morbidity and Mortality Weekly Report, 69(27), 875-881. https://doi.org/10.15585/mmwr.mm6927a5