How serious is the problem?

• In the United States, one of every three adults 65 years old or older falls each year.^1,2
• Falls are the leading cause of injury deaths among people 65 years and older.³
• In 1997, about 9,000 people over the age of 65 died from fall-related injuries.³
• Of all fall deaths, more than 60% involve people who are 75 years or older.³
• Fall-related death rates are higher among men than women and differ by race. White men have the highest death rate, followed by white women, black men and black women.³

What other health outcomes are linked with falls?

• Among older adults, falls are the most common cause of injuries and hospital admissions for trauma.⁴
• Falls account for 87% of all fractures for people 65 years and older.⁴ They are also the second leading cause of spinal cord and brain injury among older adults.⁵
• Each year in the United States, one person in 20 receives emergency department treatment because of a fall.⁶ Advanced age greatly increases the chance of a hospital admission following a fall.
• Among older adults, fractures are the most serious health outcomes associated with falls. About 3% of all falls cause fractures.⁷ The most common are fractures of the pelvis, hip, femur, vertebrae, humerus, hand, forearm, leg and ankle.⁸

Where are people most likely to fall?

• For adults 65 years old or older, 60% of fatal falls happen at home, 30% occur in public places, and 10% occur in health care institutions.⁹

What is the impact of hip fractures?

• Of all fractures from falls, hip fractures cause the greatest number of deaths and lead to the most severe health problems.¹⁰
• In 1996, there were approximately 340,000 hospital admissions for hip fractures in the United States.¹¹
• Women sustain 75% - 80% of all hip fractures.¹²
• People who are 85 years or older are 10-15 times more likely to experience hip fractures than are people between the ages of 60 and 65.⁸
• Most patients with hip fractures are hospitalized for about 2 weeks.¹³
• Half of all older adults hospitalized for hip fractures cannot return home or live independently after their injuries.^8,12
• In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion.¹⁴
• Because the U.S. population is aging, the problem of hip fractures will likely increase substantially over the next four decades. By the year 2040, the number of hip fractures is expected to exceed 500,000.¹⁵

What factors increase older adults' risk of falling?

• Factors that contribute to falls include problems with gait and balance, neurological and musculoskeletal disabilities, psychoactive medication use, dementia, and visual impairment.¹⁶
• Environmental hazards such as slippery surfaces, uneven floors, poor lighting, loose rugs, unstable furniture, and objects on floors may also play a role.¹

What can older adults do to reduce their risk of falling?

• Maintain a regular exercise program. Exercise improves strength, balance, and coordination.^17,18
• Take steps to make living areas safer. Remove tripping hazards and use non-slip mats in the bathtub and on shower floors. Have grab bars put in next to the toilet and in the tub or shower, and have handrails put in on both sides of all stairs.¹⁹
• Ask their doctor to review all of their medicines in order to reduce side effects and interactions.²⁰
• Have an eye doctor check their vision each year. Poor vision can increase the risk of falling.¹⁶

References

1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. New England Journal of Medicine 1988;319(26):1701-7.
2. Sattin RW. Falls among older persons: A public health perspective. Annual Review of Public Health 1992;13:489-508.
3. Hoyert DL, Kochanek KD, Murphy SL. Deaths: Final Data for 1997. National vital statistics reports; vol. 47 no. 19. Hyattsville, Maryland: National Center for Health Statistics, 1999.
4. Fife D, Barancik JI. Northeastern Ohio Trauma Study III: Incidence of fractures. Annals of Emergency Medicine 1985; 14:244-8.
5. Kraus KF, Black MA, Hessol N et al. The incidence of acute brain injury and serious impairment in a defined population. American Journal of Epidemiology 1984;119:186-201.
6. Cummings SR, Kelsey JL, Nevitt MC et al. Epidemiology of osteoporosis and osteoporotic fractures. Epidemiology Review 7;1985:178-208.
7. Cooper C; Campion G; Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporosis International 1992;2(6):285-9.
8. Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990;16(3):717-40.
9. Sorock GS. Falls among the elderly: Epidemiology and prevention. American Journal of Preventive Medicine 1988;4(5):282-8.
10. Barancik JI, Chatterjee BF, Greene YC et al. Northeastern Ohio Trauma Study: I. Magnitude of the problem. American Journal of Public Health 1983;73:746-51.
11. Graves EJ, Owings MF. 1996 Summary: National Hospital Discharge Survey. Advance data from vital and health statistics; no. 301. Hyattsville, Maryland: National Center for Health Statistics, 1998.
12. Melton LJ III, Riggs BL. Epidemiology of age-related fractures, in Avioli LV (ed): The Osteoporotic Syndrome. New York, Grune & Stratton, 1983, pp 45-72.
13. Graves, EJ. 1988 Summary: National Hospital Discharge Survey. Advance Data from vital and health statistics; no.185:1-12. Hyattsville, Maryland: National Center for Health Statistics, 1990. CDC. Incidence and costs to Medicare of fractures among Medicare beneficiaries aged >65 years--United States, July 1991-June 1992. MMWR 1996;45(41):877-83.
14. Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clinical Orthopaedics and Related Research 1990;252:163-66.
15. Tinetti ME, Speechley M. Prevention of falls among the elderly. New England Journal of Medicine 1989;320(16):1055-9.
16. Judge JO, Lindsey C, Underwood M, et al. Balance improvements in older women: effects of exercise training. Physical Therapy 1993;73(4):254-62, 263-5.
17. Lord SR, Caplan GA, Ward JA. Balance, reaction time, and muscle strength in exercising older women: a pilot study. Archives of Physical and Medical Rehabilitation 1993;74(8):837-9.
18. Tideiksaar R. Preventing falls: home hazard checklists to help older patients protect themselves. Geriatrics 1986;41(5):26-8.
19. Ray W, Griffin MR. Prescribed medications and the risk of falling. Topics in Geriatric Rehabilitation 1990;5:12-20.