Falls and injuries from falls among older adults

Key points
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By Douglas J Lanska MD MS MSPH

Key points concerning falls among older adults (aged 65 years and older) in the United States:

  • More than one third of older adults fall each year (Tinetti 1988; 2003; Nevitt et al 1989; Hornbrook et al 1994; Hausdorff et al 2001) and at least 10% of these falls result in serious injury (Tinetti 2003).
     
  • Falls are the leading cause of injury-related deaths, accounting for approximately 14,000 deaths among older adults in the United States each year (Centers for Disease Control and Prevention 2006a). The risk of fatal falls increases with age; indeed, approximately 6 of 7 deaths from falls in the United States were among those aged 75 years and older (Centers for Disease Control and Prevention 2006a). Fatal falls are more common among older men than older women, after adjusting for age differences (Stevens and Sogolow 2005; Centers for Disease Control and Prevention 2006b). Rates of fall-related deaths have increased significantly over the past decade (Stevens and Dellingder 2002; Stevens 2006).
     
  • Falls are the leading cause of nonfatal injuries and hospital admissions for trauma among older adults (Alexander et al 1992), accounting for 1.7 to 1.8 million emergency room visits and more than 420,000 hospitalizations in the United States annually (Centers for Disease Control and Prevention 2006a; Schiller et al 2007). The risk of being seriously injured in a fall increases with age (Stevens et al 2005), and nonfatal falls with injury as well as nonfatal falls with injury requiring hospitalization are significantly more frequent in women than men (Centers for Disease Control and Prevention 2006a; 2006b).
     
  • Falls are the leading cause of traumatic brain injuries in older adults (Jager et al 2000). Traumatic brain injuries are responsible for approximately half of all fatal falls among older adults (Stevens et al 2006).
     
  • Most fractures among older adults are caused by falls (Bell et al 2000). Fall-related fractures can lead to reduced quality of life and premature death (Wolinsky et al 1997; Hall et al 2000). The most common fracture sites are the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990). More than 95% of hip fractures among older adults are caused by falls (Grisso et al 1991), and 80% of these occur among women (Stevens et al 2000). Among both sexes, hip fracture rates increase markedly with age (Samuelson et al 2002), so that people aged 85 years and older are 10 to 15 times more likely to fracture a hip than are people aged 60 to 65 years (Scott et al 1990), a gender difference that in part reflects a much higher rate of osteoporosis among women (Greenspan et al 1994). Men also fracture their hips, but most commonly after age 80 years (Centers for Disease Control and Prevention 2006a). A quarter of older adults who lived independently before fracturing a hip spend at least a year in a nursing home and more than 20% of older adults who fracture a hip die within a year of their injury (Leibson et al 2002).
     
  • Fall-related fractures among older adults are more than 2 times higher in women than men (Centers for Disease Control and Prevention 2005).
     
  • Many older people who fall, even if uninjured, develop a fear of falling, which causes them to limit their activities, which results in reduced mobility and physical fitness and an increased risk of further falls (Vellas et al 1997).
     
  • Older adults who fall are 4 or 5 times more likely to be admitted to a long-term care facility for at least a year (Donald et al 1999).