One in five Medicare beneficiaries experience adverse events

The risk of an injury was greater among older adults in poorer health

Adverse medical events affect nearly one in five older adults in receipt of Medicare, according to research published online in Injury Prevention.

Nearly one in five 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 (ie, not in the hospital), according to Mary W. Carter, PhD, Gerontology Program Director, Towson University, Towson, Md.

Carter and colleagues used five years (1998 to 2005) of Medicare administrative claims data for more than 12,500 Medicare recipients linked with nationally representative survey data (Medicare Current Beneficiary Survey) to examine risk factors of and long-term consequences following adverse medical events among older adults. Their average age was 76.

Findings suggest that more than 60% of all medically serious adverse medical events among older adults occur outside of in-patient hospital settings. The events are associated with considerable mortality, morbidity and excess expenditures. Efforts to reduce adverse medical events 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, according to the study authors.

At least one medical injury occurred in the care of almost one in five (19%) of the sample during the study period.

The risk of an injury was greater among older adults in poorer health, the findings indicated, perhaps reflecting the difficulties of managing complex healthcare needs in different services, suggest the authors.

“Older adults that were in poorer health and who had greater levels of disability had the greatest risk,” she says. “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 extend periods of time, reflecting increased medical use and costs associated with medical injury.

“Adverse medical events are injuries that occur as the result of medical care and/or management of medical conditions,” Carter adds. “Although not all adverse medical events are preventable, many are. To date, few studies have considered both acute care and ambulatory care settings, and few studies have considered the long-term consequences of medical injury.

Funding for the study was provided by the National Institutes of Health.