Madison Blake

Aim: We aimed to compare Quan and colleagues (2011) established weights for the Charlson Comorbidity Index (CCI) conditions to autism-specific weights for predicting mortality risk in autistic older adults. Materials & methods: We used inpatient healthcare claims from autistic older adults (aged 65+; n = 2829) using the Medicare Standard Analytic Files from 2021 to 2023. We used a machine learning technique called stochastic hill climbing to assign weights to the 12 CCI conditions to maximize predictive ability for 30-day and 1-year mortality. We then compared the resulting area under the curve (AUC) against the established weights. Results: The established weights had poor predictive ability for 30-day (AUC: 0.68; 95% CI: 0.62–0.74) and 1-year mortality (AUC: 0.67; 95% CI: 0.63–0.72). The autism-specific weights also had poor predictive ability for 30-day (AUC: 0.67; 95% CI: 0.61–0.73) and 1-year mortality (AUC: 0.67; 95% CI: 0.62–0.71). Conclusion: The established and autism-specific CCI weights performed similarly in predicting mortality among autistic older adults. Findings may suggest adjusting CCI weights alone is insufficient to accurately predict mortality risk in autistic older adults, and additional health conditions not currently captured by the CCI may need to be added to better predict mortality in this population. Future studies on developing an autism-specific mortality risk index are warranted.

Fall-related injuries are a major public health issue for older adults, contributing to mortality, morbidity, decreased functional ability, loss of independence, and increased healthcare costs. Autistic older adults may be at greater risk for falls due to motor coordination difficulties and antipsychotic medication use. This cohort study used multivariable logistic regression to compare the odds of falling and negative binomial regression to compare the rate of fall-related injuries. Data from Medicare Standard Analytical Files (2013–2021) for autistic and non-autistic older adults aged 65+ were analyzed. The sample included 13,732 autistic and 25,497 matched non-autistic older adults. Our dependent variables were (1) falls, (2) unique fall-related injuries, and (3) fall-related hospitalizations. Overall, 47.4% of autistic older adults had a fall compared to 31.5% of non-autistic older adults. Autistic older adults also had more fall-related injuries and hospitalizations. Accounting for duration of observation, autistic older adults had significantly higher odds of any fall (odds ratio = 1.99; 95% confidence interval = 1.89–2.08), rate of fall-related injuries (incidence rate ratio = 1.93; 95% confidence interval = 1.86–2.01), and rate of fall-related hospitalizations (incidence rate ratio = 1.43; 95% confidence interval = 1.35–1.51) than non-autistic older adults. These findings highlight the need for targeted fall prevention strategies for autistic older adults to reduce morbidity and mortality. Lay Falls are a big problem for older adults, often causing injuries and making it hard for them to live independently. Autistic older adults might be at higher risk of falling because of movement difficulties. However, no one has studied how often autistic older adults fall. Our study looked at the difference in fall rates, injuries, and hospitalizations between autistic and non-autistic older adults. We used Medicare data from 2013 to 2021 and included people aged 65 and older. We had 13,732 autistic older adults and 25,497 non-autistic older adults in our study. We matched them based on factors like sex, race, and health status to make sure the comparison was fair. We found that almost half (47.4%) of autistic older adults had a fall, compared to only 31.5% of non-autistic older adults. Autistic older adults also had more injuries and hospitalizations from falls. They had about double the likelihood of falling than non-autistic older adults. The rates of injuries and hospitalizations from falls were more about double for autistic older adults compared to non-autistic older adults. These results suggest that we need special programs to help prevent falls and support the health of autistic older adults.