Primary health care patients who completed a multifactorial falls prevention programme in Lahti, Finland, demonstrated substantially higher rates of injury-related specialized health care utilization and were markedly more likely to incur medical costs than matched controls from the general population, according to findings from a retrospective register-based controlled cohort investigation. Researchers observed that individuals enrolled in the specialized prevention initiative experienced higher incidence rates of specialized outpatient consultations as well as hospital admissions over extended follow-up compared with peers selected from the broader community. However, among the specific subset of individuals who actually required specialized medical care for injuries, the average expenditures accumulated per person-year did not significantly exceed the costs generated by service users in the control cohort. Because the cohort was assembled through targeted clinical referrals of individuals already experiencing pronounced frailty, balance impairments, and multiple chronic conditions, investigators underscored that the findings serve as a descriptive evaluation of long-term healthcare utilization within a clinically vulnerable population rather than an assessment of the intervention’s therapeutic efficacy.
The societal and clinical repercussions of physical trauma represent a persistent challenge for modern healthcare infrastructures worldwide, where an estimated seven hundred to nine hundred million injuries occur annually from unintentional mishaps, domestic accidents, and occupational hazards. Within this global trauma burden, falls constitute the primary cause of injury-related hospital admissions among aging populations, exerting acute operational strain on hospital emergency departments, diagnostic wards, and inpatient care units. Demographic analyses indicate that between twenty-eight and thirty-five percent of individuals aged sixty-five and older experience at least one fall each year, with the frequency and clinical severity of resultant injuries escalating sharply alongside chronological aging. In Finland, fall incidents generate approximately sixty percent of all acute injury-related hospital admissions nationwide, translating into sixty-two thousand six hundred and forty-eight hospitalizations during 2018 alone. Furthermore, public health registries tracking Finnish citizens aged sixty-five and older between 2021 and 2023 documented an annual average of twenty-four thousand one hundred and eighty-nine fall-related admissions, while nationwide outpatient injury encounters in 2017 reached four hundred and seventy thousand visits totaling an estimated expenditure of one hundred and sixty million euros.
To mitigate these extensive physical and financial burdens, health authorities have widely explored multifactorial falls prevention programmes that deliver tailored physical exercise regimens alongside comprehensive medication reviews to reduce fall incidence. Earlier clinical trials conducted in the Finnish municipalities of Lappeenranta and Tampere demonstrated that guided, progressive multifactorial models could successfully curb falls and fall-related injuries, while previous evaluations of the Lahti program indicated an association with reduced all-cause mortality compared with matched controls. Despite widespread adoption, broader international evidence regarding the financial sustainability and cost-effectiveness of multifactorial models has remained notably inconsistent across different clinical settings. Health economists and geriatricians have noted that while relatively healthy older adults with preserved physical reserves derive clear preventive advantages from multifactorial protocols, severely frail cohorts with extensive multimorbidity often fail to translate reductions in fall occurrences into lower hospital utilization or diminished healthcare spending. Consequently, the research team designed this retrospective registry investigation to evaluate long-term specialized care consumption and associated expenditures specifically among primary care patients referred to routine falls prevention services.
The investigation was designed as a single-center, observational retrospective register-based controlled cohort study conducted in Lahti, an urban municipality in Southern Finland encompassing approximately one hundred and twenty-one thousand residents. The clinical cohort comprised all five hundred and twenty-seven primary health care patients who successfully completed the municipal multifactorial falls prevention programme between January 2010 and December 2016, specifically excluding participants who discontinued the protocol prior to completion. For every enrolled patient, the research team selected three population-based control individuals matched strictly on age, sex, and municipal residence through official records maintained by the Digital and Population Data Services Agency, yielding an unexposed comparison group of one thousand five hundred and eighty-one citizens. Longitudinal tracking for both cohorts commenced on the exact index date corresponding to each patient’s initial clinical consultation within the prevention program and extended continuously until patient death or December 31, 2019. Both patient groups received medical treatment under the same unified regional healthcare system and accessed services through identical specialized facilities.
Clinical pathways governing entry into the Lahti multifactorial program relied entirely on individualized clinical judgment exercised by primary care and specialized healthcare physicians and nurses rather than automated population screening mechanisms. Healthcare professionals referred community-dwelling older individuals who exhibited complex multimorbidity and demonstrable physical impairments that threatened their capacity for independent daily living. Documented baseline conditions among participants included Alzheimer’s disease, Parkinson’s disease, unspecified cognitive impairment, diabetes mellitus, and cerebrovascular disorders, coupled with noticeable functional liabilities such as history of prior falls, kyphosis, height loss, poor physical conditioning, balance disorders, and frailty. Detailed medical chart abstractions revealed that the mean age of participants was seventy-seven years with an eight-year standard deviation and a broad age span ranging from forty-five to ninety-six years. Within the enrolled patient cohort, only ten percent were men, eight percent reported active cigarette smoking, and forty-two percent consumed alcohol. Furthermore, seventy-six percent possessed documented histories of previous falls, seventy-one percent had suffered fractures, seventy-three percent experienced balance difficulties, and forty-four percent had severe walking limitations.
During their enrollment in the multifactorial falls prevention programme, all five hundred and twenty-seven patients received individualized physical exercise prescriptions along with professional pharmaceutical medication reviews coordinated by specialized nurses operating within primary care centers. To track subsequent medical utilization, investigators performed comprehensive bulk data extractions from regional electronic medical records covering all specialized outpatient attendances and inpatient hospitalizations across the Päijät-Häme healthcare district. All emergency department visits and outpatient consultations were integrated under a single outpatient category and mapped to diagnostic classifications from the International Classification of Diseases and Related Health Problems, Tenth Revision, encompassing traumatic diagnoses from codes S00 through S99 and T00 through T14. The authors noted that external cause codes describing fall mechanisms from W00 to W19 were documented in only eight percent of patient visits and nine percent of control visits, necessitating an analytical focus on overall injury-related codes. Individual patient expenditures were calculated using regional provider administrative accounting records reflecting actual diagnosis-specific unit costs adjusted to 2023 price levels.
To rigorously evaluate skewed utilization and economic parameters, the biostatistical team applied Poisson regression models and logistic frameworks to calculate incidence rate ratios and utilization odds ratios, confirming good statistical fit through deviance and Pearson chi-squared testing. Because health economics data frequently exhibit pronounced positive right-skewness characterized by a large proportion of non-users generating zero expenditures, the researchers implemented a two-part hurdle count methodology. In this analytical framework, a logistic regression component evaluated the probability of generating non-zero specialized care costs, while a generalized linear gamma regression model utilizing a logarithmic link function evaluated conditional expenditure levels among actual healthcare consumers. The gamma distribution and logarithmic link formulation were independently validated through modified Park’s tests. In addition, the analysts constructed three-knot restricted cubic spline Poisson regression models positioned at Harrell’s recommended percentiles to explore potential non-linear relationships across chronological age regarding specialized outpatient attendances and hospital admissions. All statistical analyses were conducted utilizing the Stata statistical package version seventeen point zero.
Longitudinal analysis demonstrated substantial differences in specialized healthcare usage between programme participants and the matched community cohort. Programme patients experienced a seventy-six percent higher rate of specialized outpatient injury visits, yielding an incidence rate ratio of one point seven six with a ninety-five percent confidence interval of one point six three to one point nine one. Hospitalizations were similarly elevated, showing an incidence rate ratio of one point eight eight with a ninety-five percent confidence interval of one point seven six to two point zero one. Hurdle logistic models confirmed elevated odds among participants for outpatient visits at two point four one, hospitalizations at two point one zero, and overall care utilization at two point four six. In total, fifty-two percent of programme participants attended specialized outpatient injury consultations and twenty-five percent experienced injury hospitalizations, compared to thirty-one percent and fourteen percent of controls.
Economic evaluations revealed that unadjusted medical expenditures across the entire cohort averaged two thousand one hundred and eighty-nine euros per person-year for programme patients versus one thousand one hundred and seventy-five euros for controls, producing a mean cost ratio of one point eight six with a ninety-five percent confidence interval from zero point nine two to two point six five. Fifty-three percent of programme participants generated injury-related specialized costs compared with thirty-two percent of controls. However, among individuals who actively utilized specialized services, expenditures per person-year were not significantly higher for programme patients, exhibiting mean ratios of one point zero six for outpatient visits, one point zero three for hospital admissions, and one point one one for total costs.
Restricted cubic splines revealed higher outpatient visits at younger ages and age-dependent hospitalization rates among participants, while expenditures concentrated heavily beyond the eightieth percentile in both cohorts. Furthermore, outpatient visit rates for hip, foot, and multiple injuries did not differ significantly. The authors emphasized that because participants were clinically selected with severe baseline frailty while control health data were absent, these observational findings describe healthcare burdens rather than intervention effectiveness.
Subject of Research: Injury-related specialized health care utilization and costs in a falls prevention program
Article Title: Injury-related health care utilization and costs among participants in a multifactorial falls prevention programme
Article References: Korpi, N. J. E., Laine, M. K., Korpi, T. P. T., Kautiainen, H., & Mikkelsson, M. K. (2026). Injury-related health care utilization and costs among participants in a multifactorial falls prevention programme. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01638-0
Image Credits: AI Generated
DOI: 10.1007/s41999-026-01638-0
Keywords: falls prevention, health economics, specialized health care, older adults, geriatric medicine, hospitalization, injury prevention, cohort study, Injury-related, health, care, utilization
News Source: Ophelia Keating. (November 6, 2026). Finnish Registry Study Evaluates Healthcare Costs in Multifactorial Falls Prevention Program. Scienmag.
