Falls and Fall-Related Injuries and Hospitalizations in Autistic Older Adults: A Medicare Data Study.

Autism was identified from billing codes, so autistic people who have never been diagnosed are missing from the autistic group. The authors say that could mean the true difference in falls is larger than the one reported. Only falls that led to a billed healthcare encounter were counted. Falls that nobody reported and that did not lead to care do not appear, and the authors say a substantial number of falls happen without a medical encounter. The method used to detect fall-related injuries in claims has only moderate sensitivity compared with self-report, so some falls were missed even when care was sought. The data exclude Medicare Part C and Part D and care billed by individual clinicians such as doctors and nurse practitioners, so some falls and injuries were not captured. Living situation, such as a group home or assisted living, is not recorded in the data, and the authors note that these settings may change both how often people fall and whether a fall is written down. The sample was 89.3% white and 64.0% male, and mostly from metro areas, so these figures may not describe other groups. Everyone in the sample was born before autism was added to the diagnostic manual, so the findings may not carry over to future generations of autistic older adults. This is a study of insurance records, not a trial. It can show that falls are more common in this group, but not what causes the difference. There is no information on which fall prevention approaches any of these people received, so nothing here tests whether treatment works.

The work was funded by the National Institute on Aging at the National Institutes of Health (award R01AG082873), with the Eunice Kennedy Shriver National Institute of Child Health and Human Development also named. The authors state that the content is their responsibility and does not necessarily represent the views of the NIH, and they declared no potential conflicts of interest.

Do not read this as proof that autism itself causes falls. People who see doctors more often are more likely to be diagnosed autistic and to have a fall recorded in their claims, and the authors say their matching cannot fully remove this bias. Nor is this a test of any falls programme.