Determinants of prolonged hospital stay following a fall among older adults in Kuwait - A prospective cohort study.

Abstract

Falls among older adults constitute a critical public health concern, ranking as the leading cause of hospital admissions and contributing significantly to healthcare expenditures and socioeconomic burden. A shorter length of stay (LOS) after a fall typically indicates earlier mobilization, lower healthcare costs, and better outcomes, while a longer LOS often reflects higher resource use and poorer prognosis.. This prospective cohort study aimed to assess the average of fall-related hospitalizations among older adults (aged ≥55 years), identify key predictors of prolonged hospital stay, and examine subgroups with the highest utilization of inpatient services. Conducted at Al-Razi Orthopaedic Hospital in Kuwait, the study evaluated 393 older adults admitted for fall-related injuries and discharged alive over 12-months. Logistic regression, random forest, Cox proportional hazards modeling, and survival analysis were used to analyze factors influencing the duration of stay in fall-related hospitalizations. The median LOS was 14days, with wide variability. Prolonged LOS (exceeding the 75th percentile = 25 days) accounted for approximately 23.2%of the admitted patients. Across all analytical approaches, advanced age was the strongest predictor of LOS (OR = 3.66, 95% CI: 1.39-9.65, p = 0.008). older adults aged 75-84 years had a significantly increased hazard of prolonged hospitalization (HR = 1.41, 95% CI: 1.01-1.97, p = 0.04). Social support factors such as widowhood and single status showing additional influence to increase the length of hospital stay (HR = 1.45, 95% CI: 0.99-2.11, p = 0.05). Dependence level was significantly associated with increased hazard (HR = 1.22, 95% CI: 1.01-1.48, p = 0.03). Conversely, a history of previous falls was linked to a reduced risk of extended hospital stay (HR = 0.76, 95% CI: 0.64-0.89, p = 0.001). Length of hospital stay may serve as a broader indicator of healthcare system discharge planning complexity, age-related factors, and social care needs, rather than a direct proxy for injury severity. These findings underscore the importance of integrating clinical and social determinants into discharge planning for older adults hospitalized due to falls, and highlight the need for age-sensitive care pathways, strengthened fall-prevention strategies, and enhanced social support services to improve recovery outcomes and reduce hospital burden.