Falls Increasingly Lead to Death in Older Americans

By John Henry Dreyfuss, MDalert.com staff.

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  • In 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries.
  • Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015
  • During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized
  • The projected 2030 population would result in an estimated 48.8 million falls and 11.9 million fall injuries.

Falls are the leading cause of injury (Figure 1) and death among older people in the U.S., according to data published recently by the Centers for Disease Control and Prevention (CDC) in Mortality and Morbidity Weekly Report (MMWR). The frequency of injury and death resulting from falls is likely to increase given that approximately 10,000 Americans reach age 65 every day, according to the CDC.

 

Figure 1. Falls are a common cause of pelvic fractures in the elderly.
(Sources: Wikipedia/© Nevit Dilmen/GNU Free/Creative Commons.)

“In 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries. Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015. Fall incidence as well as total cost increased with age and were higher among women,” according the results of a study published recently in the Journal of Safety Research. Falls are a leading cause of traumatic brain injury (Figure 2.)

 

Figure 2. Falls are responsible for nearly 30% of all traumatic brain injuries.
(Sources: Wikipedia/By Delldot - Self made, based U.S. Government data/Creative Commons.)

The authors estimated annual Medicare costs due to falls in older Americans at $31.3 billion. Given that the older adult population is expected to increase 55% by 2030, according the U.S. Census Bureau, the projected 2030 population would result in an estimated 48.8 million falls and 11.9 million fall injuries.

“During 2014, approximately 27,000 older adults died because of falls; 2.8 million were treated in emergency departments for fall-related injuries, and approximately 800,000 of these patients were subsequently hospitalized. To estimate the numbers, percentages, and rates of falls and fall injuries among older adults by selected characteristics and state, CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) survey. In 2014, 28.7% of older adults reported falling; the estimated 29.0 million falls resulted in 7.0 million injuries,” according to the report in MMWR.

In 2014, 28.7% of older adults reported falling at least once in the preceding 12 months, resulting in an estimated 29.0 million falls. Of those who fell, 37.5% reported at least one fall that required medical treatment or restricted activity for at least 1 day, resulting in 7.0 million fall injuries, according to the CDC. The CDC also reported the following statistics on falls:

  • Women (30.3%) were more likely to report falling than men (26.5%) (P<0.01)
  • Women were more likely to report a fall injury (12.6% compared with 8.3%; P<0.01).
  • The percentage of older adults who fell increased with age (P<0.01), from 26.7% among persons aged 65 to 74 years, to 29.8% among persons aged 75 to 84 years, to 36.5% among persons aged ≥85 years.
  • The percentage of older adults who fell was higher among whites (29.6%) and American Indian/Alaska Natives (AI/ANs) (34.2%) than among blacks (23.1%) and Asian/Pacific Islanders (19.8%).
  • The percentage of older adults who reported a fall injury also increased with age (P<0.01), from 9.9% among persons aged 65 to 74 years to 11.4% among persons aged 75 to 84 years, to 13.5% among persons aged ≥85 years.
  • AI/ANs were more likely to report a fall-related injury (16.8%) than were whites (10.9%), Hispanics (10.7%), and blacks (7.8%).
  • The rate of fall-related injuries was significantly higher in the population reporting poor health (480 per 1,000) than the population reporting excellent health (69 per 1,000). (Figure 3)

Figure 3. Physical fitness prevents falls in the elderly.
(Sources: Wikimedia Commons/National Institutes of Health/Public Domain.)
 
Physicians Can Help Prevent Falls

"Older adult falls are increasing and, sadly, often herald the end of independence," CDC Director Dr. Tom Frieden said in an agency news release. "Healthcare providers can make fall prevention a routine part of care in their practice, and older adults can take steps to protect themselves."

There are a number of effective strategies for reducing the number of falls. For one, there is a multifactorial clinical approach that includes gait and balance assessment, strength, and balance exercises, and a medication review. Stabilization devices such as walkers and canes can help prevent falls (Figure 4). Properly fitted footwear can also help to prevent falls (Figure 5.)

“Healthcare providers can play an important role in fall prevention by screening older adults for fall risk, reviewing and managing medications linked to falls, and recommending vitamin D supplements to improve bone, muscle, and nerve health and reduce the risk for falls,” the authors wrote in MMWR.

 

 

Figure 4. Safety devices like this front-wheeled walker can prevent falls.
However, the thick shag carpeting in this images puts the elderly at higher risk of falls.
(Sources: Wikipedia/By High Plains Drifter/Public Domain.)

Specific Actions that Physicians Can Take

  • Be aware of all the medications that an older person is taking.
  • Make fall prevention part of every routine office visits.
  • Refer patients for ophthalmological exam annually
  • Verify that the patient has current eyeglass prescription.
  • Urge patients to stay active and take part in programs to boost strength and balance, such as walking, resistance exercise, yoga, tai chi, and others.
  • Suggest that the patient have all trip-and-fall hazards removed from the home.
  • Prescribe vitamin D supplements.
  • Stop, switch or reduce doses of medications that could increase the risk of falls.

Intrinsic Factors

A number of intrinsic factors can predispose older people to falls, according to a Wikipedia article on the subject:

  • Balance and Gait
  • Stroke, Parkinsonism, arthritic changes, neuropathy, neuromuscular disease, or vestibular disease
  • Visual and motor reaction time problems
  • Delayed reaction times
  • Medications
  • Polypharmacy
  • Sedatives and cardiovascular medications
  • Visual impairment
  • Cognitive problems
  • Cardiovascular disease/cardiac arrhythmias/valvular heart disease
  • Orthostatic hypotension
  • Postprandial hypotension
  • Carotid sinus syndrome
  • Neurocardiogenic syncope
  • Urinary incontinence

 

Figure 5. Properly fitted shoes can prevent falls in the elderly.
(Sources: Wikipedia/By Joe Mabel/Creative Commons.)

Extrinsic Factors

The same article addresses a number of extrinsic factors that can contribute to a tendency to fall in older people:

  • Poor lighting
  • Stairs with inadequate handrails, or are too steep
  • Doorways with low headroom (less than about 2 metres)
  • Rugs/floor surfaces with low friction, causing poor traction and individual instability. All surfaces should have a high friction coefficient with shoe soles.
  • Clothing or footwear that is poorly fitted, shoes of low friction against floor. Rubber soles with ribs normally have a high friction coefficient, so are preferred for most purposes. Clothing should fit the user well, without trailing parts (hems falling below the heel and loose shoe strings) which could snag with obstacles
  • Lack of equipment/aids such as walking sticks, walking frames, canes, and walkers. Grab bars and hanging straps should be supplied plentifully, especially in critical areas where users may be vulnerable.
  • Injury rates from falls are seven times higher for seniors with medical issues than for those who are healthy, the CDC reported. Taking multiple medications adds to the danger.

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