Nearly One Third of Older Adults Fall, Some to their Deaths

ATLANTA, Nov. 17 --The rate of fatal falls among men and women ages 65 years and older rose significantly in a decade, reported CDC investigators here.

Accidental falls account for an estimated 1.8 million annual emergency department visits for older Americans, and falls are the leading cause of trauma deaths in this age group, accounting for more than 13,700 fatalities among seniors, wrote Judy A. Stevens, Ph.D., and colleagues in the Nov. 17 issue of Morbidity and Mortality Weekly Report.

"Fall death rates have increased faster than fall injury rates. In large part, this is because people are living longer, and many of our seniors now are older and frailer," said Dr. Stevens. "They need our help to prevent potentially fatal fall injuries."

In addition to death, injuries sustained in a fall can lead to disability, nursing-home admissions, and direct medical costs, the investigators reported. In 2000 the direct medical cost associated with falls among adults in the United States were about billion.

Yet many falls could have been prevented if older adults exercised regularly, had their medications reviewed to reduce side effects and interactions that could lead to falls, had yearly eye exams, and took steps to reduce fall hazards in the home, wrote MMWR editors in a postscript to the study.

The CDC investigators examined trends in both fatal and nonfatal falls among older Americans by studying rates of fatalities from falls and hospitalizations for hip fractures from 1993 to 2003, and nonfatal injuries caused by falls treated in emergency departments from 2001 to 2005.

They collected data on fatal falls from annual mortality data of the Vital Statistics of the United States, and based cause-of-death on information from death certificates completed by attending physicians, medical examiners, or coroners.

They obtained estimates of hospital admissions for hip fractures from the National Hospital Discharge Survey, and data on nonfatal injuries from falls from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). The latter, operated by the Consumer Product Safety Commission, collects data on initial ED visits for all types and causes of injuries.

In their summary of the results, Dr. Stevens and colleagues found that from the early 1990s to the early 2000s, the overall rate of fatal falls among adults 65 and older increased, while the rate of hospitalizations for hip fractures dropped. There was no significant change in the overall rate of nonfatal injuries from falls from 2001 to 2005.

From 1993 to 2004 the age-adjusted rate of fatalities from falls increased significantly, and rates were significantly higher among men compared with women.

Death rates from falls among men increased 45.3% over the period, from 31.8/100,000 in 1993, to 46.2/100,000 in 2003 (P<0.01).

Overall fall-related fatality rates among women, while smaller in number, also rose dramatically, from 19.5/100,000 in 1993, to 31.1/100,000 in 2003, an increase of 59.5% (P<0.01).

Fall-related deaths increased in all races for both sexes, except for black men, whose death rate from falls did not change.

Although fall-related deaths were on the rise in the 1990s, the overall age-adjusted hospitalization rate for hip fractures decreased by 15.5%, from 917.6/100,000 to 775.7/100,000 (P=0.001 test for trend).

From 1993-2003, the annual rate of hospitalization among women was 52%-119% higher than among men.

Overall rates of hospitalizations for hip fractures among women dropped by 20.8% (P<0.001) over the period study, and while they rose by 5.8% among men, the change was not significant (P=0.53).

When the authors looked at nonfatal injuries from falls, they found that there were no significant changes either in the overall rate or among subcategories by race and gender. Women had a 48.4% higher risk for nonfatal injuries from falls compared with men.

"Injuries from falls and the fear of falling, lead older adults to limit their activities, which can interfere with independent living," said Ileana Arias, Ph.D., director of the CDC's Injury Center.

"But we know that falls are not inevitable. CDC and its partners have simple strategies that can help seniors and caregivers. Working with the CDC Foundation and MetLife Foundation, we have updated and revised information that we believe can play a critical role in reversing the trend in fall deaths and injuries among our nation's older adults."

The editors noted several limitations of the study. "The rate of nonfatal injuries from falls likely was underestimated because only persons treated in hospital emergency departments were included and not those treated in outpatient settings such as clinics or physician offices," they said. "The National Hospital Discharge Survey reports the number of hospital admissions, not patients; therefore, certain persons seeking treatment for hip fractures might have been counted more than once."

The CDC offers free electronic and print information about preventing falls at www.cdc.gov/ncipc/duip/fallsmaterial.htm.