Older adults are at high risk for fall-related hospitalizations, yet little is known about care processes and outcomes for autistic older adults. This study compared fall-related hospitalization outcomes between autistic and non-autistic older adults. Using 2013–2021 Medicare inpatient claims, we conducted a retrospective cohort study of beneficiaries aged ≥ 65 hospitalized for a fall. Autistic older adults were identified using ICD codes and matched 1:1 to non-autistic peers on demographic, clinical, and geographic factors. Outcomes included length of stay (LOS), receipt of inpatient occupational therapy (OT) or physical therapy (PT), discharge destination, and all-cause 30-day readmission. Multivariable models, stratified by age, adjusted for sociodemographic, clinical, and contextual covariates. Sensitivity analyses controlled for dual Medicaid eligibility. Autistic older adults had longer LOS and were less likely to receive OT during hospitalization than matched non-autistic peers. They were less often discharged home or to inpatient rehabilitation and were more likely to be discharged to a skilled nursing facility. Autistic older adults also had an 18% higher risk of 30-day readmission. Age-stratified and sensitivity analyses yielded similar patterns. Autistic older adults hospitalized for falls experience longer stays, lower access to rehabilitative services, less favorable discharge destinations, and higher readmission risk compared to non-autistic peers. These disparities highlight the need to improve access to OT, PT, and post-acute supports for autistic older adults and to better understand barriers to equitable fall-related care.

Dataset DOI: 10.5061/dryad.vq83bk47t

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PROJECT OVERVIEW

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This project uses Medicare claims data (Parts A & B) to compare autistic and non-autistic older adults' fall-related hospitalization care and outcomes.

Key components:

- Data Cleaning: Prepares raw Medicare claims data for analysis.

- SAS Macros: Creates table 1 and calculates effect size.

- Table Generation: Produces descriptive and outcome table for cohort.

- Matched Cohort Analysis: Uses propensity-score matching (1 autistic : ~2 non-autistic ratio).

NOTE: This project uses restricted Medicare data that requires CMS Data Use Agreement (DUA) approval. The datasets cannot be shared publicly.

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TOOLS AND DEPENDENCIES

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- Language: SAS v9.4

- Required Access: Secure server with Medicare Parts A & B claims files

- Matching Method: Variable-ratio propensity score matching

- Required SAS Macros: Ensure "4. Table 1 Macro - Two Dec.sas" and "5. Effect Size Macro.sas" is saved in the working directory before running table generation and multivariable analyses scripts.

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FILE DESCRIPTIONS

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1._Find_Severe_Fall_Dates_and_Disposition.sas Locates first severe fall date and disposition

2._Data_Cleaning_Part_1.sas: Cleans and prepares raw Medicare data (step 1)

3._Data_Cleaning_Part_2.sas: Finalizes analytic datasets (step 2)

4._Table_1_Macro_-_Two_Dec.sas: Macro to produce descriptive statistics

5._Effect_Size_Macro.sas Macro to produce effect sizes

6._Multivariable_Analyses.sas Runs models for cohort

7._Table_1_Creation.sas: Generates descriptive statistics for cohort

Differences_in_Hospital_Outcomes_for_Severe_Falls_Data_Dictionary.docx: Variable names and definitions

READme.txt: Project overview and instructions

Differences_in_Hospital_Outcomes_for_Severe_Falls_Data_Dictionary.pdf: PDF version of the prior file with same filename

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HOW TO RUN

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/* Step 1: Data Cleaning */

Run the file "1. Find Severe Fall Dates and Disposition.sas"

Run the file "2. Data Cleaning Part 1.sas"

Run the file "3. Data Cleaning Part 2.sas"

/* Step 2: Save Macros */

Run the file "4. Table 1 Macro - Two Dec.sas"

Rn the file "5. Effect Size Macro.sas"

/* Step 3: Multivariable Models and Tables*/

Run the file "6. Multivariable Analysis Matched.sas"

Run the file "7. Table 1 Creation.sas"

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OUTPUTS

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Table 1 MB 28Jan2025.rtf: Descriptive statistics for matched cohort

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DATA USE DISCLAIMER

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Medicare data are protected under CMS Data Use Agreements. This repository does NOT include raw data. Users must obtain appropriate DUA approval to access Medicare claims.

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CITATION

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If you use this project or scripts, we kindly request that you consider citing:

Blake, M., Nikahd, M., Hyer, J. M., Patterson, B. W., Wolf, B. J., Bishop, L., & Hand, B. N. (2025). Comparing Autistic and Non-Autistic Older Adults' Fall-Related Hospitalization Care and Outcomes. Journal of general internal medicine, 10.1007/s11606-025-09933-5. Advance online publication. https://doi.org/10.1007/s11606-025-09933-5

Data from: Comparing autistic and non-autistic older adults' fall-related hospitalization care and outcomes

Data files

Abstract

Data from: Comparing autistic and non-autistic older adults' fall-related hospitalization care and outcomes

Data files

Abstract

README: Data from: Comparing autistic and non-autistic older adults' fall-related hospitalization care and outcomes