Factors associated with older adult fracture visits to United States emergency departments, 2013-2022.

Abstract

Fractures in older adults are increasingly burdensome on U.S. emergency departments (EDs) and the greater healthcare system. As the older adult population continues to grow, the number, cost, and complexity of fall-related injuries, particularly fractures are rising. This study aimed to identify national trends and factors associated with fracture-related ED visits among older adults. We conducted a retrospective analysis using 2013-2022 National Hospital Ambulatory Medical Care Survey-Emergency Department (NHAMCS-ED) data. Adults aged ≥65 with a primary fracture diagnosis were included. Fractures were then categorized by location and mechanism. Demographic and clinical parameters were compared across age groups: 65-74, 75-84, and ≥85 years. Analyses used SPSS Complex Samples v30.0, accounting for survey design, with p < .05 considered significant. An estimated 5.5% or 12.5 million older adult ED visits were fracture-related from 2013 to 2022. Adults aged 65-74 accounted for 39.1% of visits, followed by 75-84 (33.2%) and ≥85 (27.7%). Falls were the most frequent cause of fracture (74.5%), (p = .002). The proportion of femur fractures rose steadily with age, accounting for 10.9% of fractures in adults 65-74, 21.2% in those 75-84%, and 30.1% in those ≥85 years (p < .001). History of osteoporosis was associated with increasing age along with ambulance transport (60.8%) and hospital admission (46.2%)(p < .05). Fracture-related ED visits among older adults vary by age in injury patterns, clinical characteristics, and healthcare utilization. These findings suggest a potential benefit of age-specific strategies, including fall prevention and earlier osteoporosis evaluation.