Department of Health and Human Services, Centers for Disease Control and Prevention

Older Adult Falls from a National Perspective

Judy A. Stevens, Ph.D.Division of Unintentional Injury Prevention

National Center for Injury Prevention & Control

ASTHO/NACCHO TeleconferenceMay 25, 2004

Department of Health and Human Services, Centers for Disease Control and Prevention

Overview

Background & Impact Epidemiology Fall risk factors Prevention strategies Current activities Resources

Department of Health and Human Services, Centers for Disease Control and Prevention

Projected Growth in Older U.S. Population

0

100

200

300

400

500

2000 2010 2020 2030 2040

Year

Po

pu

lati

on

(m

illi

on

s)

34.839.7 53.7 70.3

77.2

Department of Health and Human Services, Centers for Disease Control and Prevention

Leading Causes of Unintentional Injury Death Among People 65+, 2001

Unspecified18%

Suffocation10%

Poisoning2%

Other7%

Drowning1%

Fire/Burn4%

Falls35%

M.V.23%

___________

NCHS, Vital Records, 2001

Department of Health and Human Services, Centers for Disease Control and Prevention

Falls

35%-40% of people 65+ fall each year1

Those who fall are 2-3 times more likely to fall again2

10%-20% of falls cause serious injuries3

__________

1. Hornbrook, Gerontologist, 1994; Hausdorff, Arch Phys Med & Rehab, 2001 2. Tinetti, New Eng J Med, 1988; Teno, JAGS,19903. Sterling, J Trauma-Inj Infection & Critical Care, 2001

Department of Health and Human Services, Centers for Disease Control and Prevention

Data Sources

Fatal falls – NCHS death certificate data

Nonfatal injuries – NEISS-AIP

Department of Health and Human Services, Centers for Disease Control and Prevention

Fatal & Nonfatal Fall Injuries Among People Age 65+, 2001

11,600

373,000

1,260,000

? Millions

1% - Died

23% - Treated in ED & Hospitalized

76% - Treated in ED & released

Fall-related injuries

__________

Nonfatal falls: NEISS-AIP, 2001Fall deaths: NCHS, Vital Records, 2001

{ 1.6 million

Department of Health and Human Services, Centers for Disease Control and Prevention

Impact

Department of Health and Human Services, Centers for Disease Control and Prevention

Financial Cost (current dollars)

In 1994, total cost of fall injuries among people 65+ $27.3 billion1

Medicare costs for hip fractures$4.7 billion in 19912

$240 billion projected for 20403

__________

1. Englander F, J Forensic Science, 1996 2. CDC, MMWR, 1996 3. Cummings SR, Orthopaedics & Related Res,1990

Department of Health and Human Services, Centers for Disease Control and Prevention

Quality of Life

20% - 30% fear falling1

20% die within a year afterhip fracture2 25% in a nursing home one year later3

___________

1. Vellas BJ, Age & Aging, 1997; Friedman SM, JAGS, 2002 2. Lu-Yao GL, AJPH, 19943. Magaziner, J Gerontology: Medical Sciences, 2000

Department of Health and Human Services, Centers for Disease Control and Prevention

Fall Death Rates for Men & Women 65+ by Age Groups, 2001

0

25

50

75

100

125

150

175

65-69 70-74 75-79 80-84 85+

Age groups

Per

100,0

00

Women

Men

__________

NCHS, Vital Records, 2001

Department of Health and Human Services, Centers for Disease Control and Prevention

Trends in Age Adjusted Fall Death Rates Men & Women 65+, 1990-2001

0

5

10

15

20

25

30

35

40

Year

Per

100,0

00

Men

Women

___________

NCHS, Vital Records, 2001

Department of Health and Human Services, Centers for Disease Control and Prevention

Leading Causes of Nonfatal Unintentional Injuries Among People 65+

Struck by/Against7%

MV Occupant7%

Overexertion6%

Cut/pierce5%

Other transport2%

Foreign body1%

Unknown2%

Bite/sting2%

Poisoning1%

Falls63%

All others4%

__________

NEISS-AIP, 2001

Department of Health and Human Services, Centers for Disease Control and Prevention

Nonfatal Fall Injury Rates for Men & Women 65+ by Age Group, 2001

0

2500

5000

7500

10000

12500

15000

65-69 70-74 75-79 80-84 85+

Age groups

Per

100,0

00

Women

Men

__________

NEISS-AIP, 2001

Department of Health and Human Services, Centers for Disease Control and Prevention

Hip Fractures

95% of hip fractures caused by falls 2000 - 321,000 hospital admissions

76% were women 40% were age 85+

Rates increase with age Rates higher among women

__________

Nyberg, JAGS, 1996 NCHS, National Hospital Discharge Survey, 2000

Department of Health and Human Services, Centers for Disease Control and Prevention

Risk Factors for Falls

Personal Environmental

Department of Health and Human Services, Centers for Disease Control and Prevention

Personal Risk Factors

Older age Female Chronic diseases Mental impairment

Department of Health and Human Services, Centers for Disease Control and Prevention

Personal Risk Factors (modifiable)

Muscle weakness 4.4 x Gait & balance problems 2.9 x Vision problems 2.5 x Psychoactive medications 1.7 x

Relative Risk

___________

American Geriatrics Society, JAGS, 2001

Department of Health and Human Services, Centers for Disease Control and Prevention

Environmental Factors (modifiable)

Clutter in walkways No stair railings or

grab bars Loose rugs Dim lighting

Department of Health and Human Services, Centers for Disease Control and Prevention

Interventions – What Works? Comprehensive clinical

assessment1

Exercise for balance & strength2

Medication management3 Vision correction4

Reducing home hazards5

___________

1. American Geriatrics Society, JAGS, 2001 2. Lord SR, JAGS, 2001 3. Cumming RG, Drugs & Aging, 1998 4. Ray W, Topics in Geriatric R Rehab,1990 5. Day L, BMJ 2002; Gill TM, JAGS, 1999

Department of Health and Human Services, Centers for Disease Control and Prevention

Current Activities

Cooperative Agreements California Michigan Washington State Wisconsin

Extramural Grants North Carolina - UNC Tennessee - Vanderbilt

Department of Health and Human Services, Centers for Disease Control and Prevention

Resources for Fall Prevention Programs

Department of Health and Human Services, Centers for Disease Control and Prevention

National Resource Center for Safe Aging

• San Diego State University • Collect, organize, disseminate injury

prevention information• Serve public health professionals &

aging service providers

www.safeaging.org (being updated)

Department of Health and Human Services, Centers for Disease Control and Prevention

Publication No. NIH 99-4258www.nih.gov/nia

Department of Health and Human Services, Centers for Disease Control and Prevention

Department of Health and Human Services, Centers for Disease Control and Prevention

www.cdc.gov/injury

Department of Health and Human Services, Centers for Disease Control and Prevention

WISQARSTM (Web-based Injury Statistics Query and Reporting System)

• An interactive database system

• Provides customized reports of fatal & nonfatal injury data

www.cdc.gov/ncipc/wisqars/default.htm

Department of Health and Human Services, Centers for Disease Control and Prevention

Tool Kit to Prevent Senior Falls

Fall prevention brochure Home safety checklist Fact sheets & graphs Summary of research

www.cdc.gov/ncipc/pub-res/toolkit/toolkit.htm

Department of Health and Human Services, Centers for Disease Control and Prevention

US Fall Prevention Programs for Seniors

18 comprehensive programs in 12 states

Program descriptions & contact information

Contact information for 22 additional programs

www.cdc.gov/ncipc/falls/default.htm

Department of Health and Human Services, Centers for Disease Control and Prevention