Falls Among Older Adults: An Overview

Each year, one in every three adults age 65 and older falls. Falls can cause moderate to severe injuries, such as hip fractures and head injuries, and can increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable.

How big is the problem?

• One out of three adults age 65 and older falls each year,1 but less than half talk to their healthcare providers about it.
• Among older adults (those 65 or older), falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.2
• In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized.2
• In 2010, the direct medical costs of falls, adjusted for inflation, was $30.0 billion.4

What outcomes are linked to falls?

• Twenty to thirty percent of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.5,6  
• Falls are the most common cause of traumatic brain injuries (TBI).7 In 2000, TBI accounted for 46% of fatal falls among older adults.3  
• Most fractures among older adults are caused by falls.8 The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.9
• Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn increases their actual risk of falling.10

Who is at risk?

Fall-related Deaths

• The death rates from falls among older men and women have risen sharply over the past decade.3
• In 2009, about 20,400 older adults died from unintentional fall injuries.2
• Men are more likely than women to die from a fall.  After taking age into account, the fall death rate in 2009 was 34% higher for men than for women.2
• Older whites are 2.4 times more likely to die from falls as their black counterparts.2
• Rates also differ by ethnicity. Older non-Hispanics have higher fatal fall rates than Hispanics.11

Fall Injuries

• People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.12
• Rates of fall-related fractures among older women are more than twice those for men.13
• Over 95% of hip fractures are caused by falls.14 In 2009, there were 271,000 hip fractures and the rate for women was almost three times the rate for men.15
• White women have significantly higher hip fracture rates than black women.15

Older adults can remain independent and reduce their chances of falling.  They can:

• Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good.
• Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.
• Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision. Consider getting a pair with single vision distance lenses for some activities such as walking outside.
• Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways and improving the lighting in their homes.

To lower their hip fracture risk, older adults can:

• Get adequate calcium and vitamin D—from food and/or from supplements.
• Do weight bearing exercise.
• Get screened and, if needed, treated for osteoporosis.

References

1. Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community–living older adults: a 1–year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8):1050–6.
2. Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community–dwelling older persons: results from a randomized trial. The Gerontologist 1994:34(1):16–23.
3. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online].   Accessed November 30, 2010.
4. Stevens JA.  Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005. MMWR 2006a;55(45).
5. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006b;12:290–5.
6. Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall–related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3.
7. Sterling DA, O'Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma–Injury, Infection and Critical Care 2001;50(1):116–9.
8. Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992–1994. Academic Emergency Medicine 2000&359;7(2):134–40.
9. Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7.
10. Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990; 16(3): 717–40.
11. Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing 1997;26:189–193.
12. Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 1990–98: sex, race, and ethnic disparities. Injury Prevention 2002;8:272–5.
13. Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5.
14. Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevention 2005b;11:115–9.
15. National Hospital Discharge Survey (NHDS), National Center for Health Statistics. Available at: www.cdc.gov/nchs/hdi.htm.  Assessed September 14, 2011.
16. Stevens JA. Falls among older adults–risk factors and prevention strategies. NCOA Falls Free: Promoting a National Falls Prevention Action Plan. Research Review Papers. Washington &340;DC)&358; The National Council on the Aging; 2005a.