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FALLS
- Falls are the leading cause of injury-related visits to emergency departments in the United States and the primary cause of accidental deaths in persons over the age of 65 years.
- The mortality rate for falls increases dramatically with age in both sexes and in all racial and ethnic groups, with falls accounting for 70 percent of accidental deaths in persons 75 years of age and older.
- More than 90 percent of hip fractures occur as a result of falls, with most of these fractures occurring in persons over 70 years of age.
- One third of community-dwelling elderly persons and 60 percent of nursing home residents fall each year.
- Risk factors for falls in the elderly include increasing age, medication use, cognitive impairment and sensory deficits.
- From 1992 through 1995, 147 million injury-related visits were made to emergency departments in the United States. Burt CW, Fingerhut LA. Injury visits to hospital emergency departments: United States, 1992-95. Vital Health Stat 13 1998:1-76.
- Falls were the leading cause of external injury, accounting for 24 percent of these visits. Emergency department visits related to falls are more common in children less than five years of age and adults 65 years of age and older. Compared with children, elderly persons who fall are 10 times more likely to be hospitalized and eight times more likely to die as the result of a fall. Runge JW. The cost of injury. Emerg Med Clin North Am 1993;11:241-53.
- Trauma is the fifth leading cause of death in persons more than 65 years of age, and falls are responsible for 70 percent of accidental deaths in persons 75 years of age and older. Weigelt JA. Trauma. In: Advanced trauma life support for doctors: ATLS. 6th ed. Chicago: American College of Surgeons, 1997:26.
- The elderly, who represent 12 percent of the population, account for 75 percent of deaths from falls. Greenhouse AH. Falls among the elderly. In: Albert ML, Knoefel JE, eds. Clinical neurology of aging. 2d ed. New York: Oxford University Press, 1994:611-26.
- The number of falls increases progressively with age in both sexes and all racial and ethnic groups. Tibbits GM. Patients who fall: how to predict and prevent injuries. Geriatrics 1996;51:24-8,31.
- Elderly persons who survive a fall experience significant morbidity. Hospital stays are almost twice as long in elderly patients who are hospitalized after a fall than in elderly patients who are admitted for another reason. Dunn JE, Rudberg MA, Furner SE, Cassel CK. Mortality, disability, and falls in older persons: the role of underlying disease and disability. Am J Public Health 1992;82:395-400.
- Compared with elderly persons who do not fall, those who fall experience greater functional decline in activities of daily living (ADLs) and in physical and social activities. Kiel DP, O'Sullivan P, Teno JM, Mor V. Health care utilization and functional status in the aged following a fall. Med Care 1991;29:221-8.
- Major injuries, including head trauma, soft tissue injuries, fractures and dislocations, occur in 5 to 15 percent of falls in any given year. Fractures account for 75 percent of serious injuries, with hip fractures occurring in 1 to 2 percent of falls. King MB, Tinetti ME. A multi-factorial approach to reducing injurious falls. Clin Geriatr Med 1996: 12:745-59.
- Every year, one-third to one half of the population age 65 and over experience falls Coogler, C.E. Falls and Imbalance. Rehab Management, April/May 1992
From 1970 to 1995, the age-adjusted incidence of falling has increased over 124%:
1970 5,622 falls 494 per 100,000 population
1995 21,574 falls 1,398 per 100,000 population - The overall incidence of deaths resulting from falls increased by 80% in this same time period. Journal of the AMA, May 26, 99.
One half of the elderly people who fall do so repeatedly. -Tinetti and Speechley, Prevention of falls among the elderly. New England Journal of Medicine 1989,320 (16) 1055-1059. - The cost of imbalance and falling is estimated at $20.2 Billion annually for the treatment of fall-related injuries. The majority of the cost is for the treatment of hip fractures, which average $35,000 per patient. American Academy of Orthopedic Surgeons, Don't let a fall be your last trip, 1998.
- Falls are prevalent, dangerous, and costly. Even falls that do not result in injury can have serious consequences. Psychological trauma and fear-of-falling produce a downward spiral of self-imposed activity reduction leading to loss of strength, flexibility and mobility, thereby increasing the risk of future falls.
- However, falls are not a normal part of aging. Current research indicates that elderly fallers are different than their healthy, age-matched counterparts. It has been suggested that dizziness may be a geriatric syndrome, similar to delirium and falling. Some have medical diagnoses such as diabetes or Parkinson's disease that contribute to falling, but not many have one large problem within a single system that would "earn" them a diagnosis. Instead, they often have many small problems across multiple systems, which interact to produce instability. Each of these impairments is a risk factor for falls. Individually, none of these factors would cause a fall, but in combination they can. The more risk factors a person has, the greater the likelihood that they will fall.
- As falls are not a normal part of aging, they may be preventable to a large degree. Risk factors for falls have been identified and there are many screening tools available to determine the presence of balance and mobility disorders. While "low-tech" or non-technology assessments provide a gross idea of who may be at risk, they do not identify impairments within specific body systems or why that problem exists. In addition, many of these tools are not sensitive to changes that may occur through interventions.
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