Fall Risk Among the Elderly

How big is the problem?

• More than one third of adults 65 years and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001)
• Among older adults, falls are the leading cause of injury deaths along with being the most common cause of nonfatal injuries and hospital admissions for trauma (CDC 2005)
• In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (CDC 2005)
• The rates of fall-related deaths among older adults rose significantly over the past decade (Stevens 2006)

What outcomes are linked to falls?

• Twenty percent to 30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. These injuries can make it hard to get around and limit independent living. They also can increase the risk of early death (Alexander et al. 1992; Sterling et al. 2001).
• Falls are the most common cause of traumatic brain injuries, or TBI (Jager et al. 2000). In 2000, TBI accounted for 46% of fatal falls among older adults (Stevens et al. 2006).
• Most fractures among older adults are caused by falls (Bell et al. 2000).
• The most common fractures are of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990).
• Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997).
• In 2000, direct medical costs totaled $0.2 billion ($179 million) for fatal falls and $19 billion for nonfatal fall injuries (Stevens et al. 2006).

Who is at risk?

Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women (CDC 2005).

Women are 67% more likely than men to have a nonfatal fall injury (CDC 2005).

Rates of fall-related fractures among older adults are more than twice as high for women as for men (Stevens et al. 2005).

In 2003, about 72% of older adults admitted to the hospital for hip fractures were women (CDC 2005).

The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens et al. 2005)

Nearly 85% of deaths from falls in 2004 were among people 75 and older (CDC 2005).

People 75 and older who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald et al. 1999).

There is little difference in fatal fall rates between whites and blacks, ages 65 to 74 (CDC 2006).

After age 75, white men have the highest fatality rates, followed by white women, black men, and black women (CDC 2005).

White women have significantly higher rates of fall–related hip fractures than black women (Stevens 2005).

Among older adults, non–Hispanics have higher fatal fall rates than Hispanics (Stevens et al. 2002).