Falls and Fall Injuries Among Adults Aged ≥65 Years — United States, 2014

Gwen Bergen, PhD; Mark R. Stevens, MA, MSPH; Elizabeth R. Burns, MPH

Disclosures

Morbidity and Mortality Weekly Report. 2016;65(37):993-998. 

In This Article

Introduction

Falls are the leading cause of fatal and nonfatal injuries among adults aged ≥65 years (older adults). 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. Known effective strategies for reducing the number of older adult falls include a multifactorial clinical approach (e.g., gait and balance assessment, strength and balance exercises, and medication review). Health care 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.

BRFSS is an annual, random-digit–dialed telephone survey of the noninstitutionalized U.S. civilian population aged ≥18 years conducted annually in all 50 states, the District of Columbia, Guam, Puerto Rico, and the U.S. Virgin Islands. Detailed information regarding the survey is available online. The median response rate for 2014 was 47.0%.

In 2014, survey respondents were asked, "In the past 12 months, how many times have you fallen?" If the response was one or more times, they were asked, "How many of these falls caused an injury? By an injury, we mean the fall caused you to limit your regular activities for at least a day or to go see a doctor." This analysis was limited to adults aged ≥65 years in all 50 states and the District of Columbia who were asked the questions about falls.

The first question was used to estimate the percentage of older adults who reported one or more falls and the total number of falls; the second question was used to estimate the number of fall injuries. Response options ranged from zero to 76 or more with reported means of 0.67 falls and 0.16 fall injuries. The percentages and numbers of falls and fall injuries included all adults aged ≥65 years in the denominator. Adults with responses of "Don't know/Not sure," "Refused," or "Not asked or missing" for questions about falls, fall injuries, or demographic characteristics were excluded, reducing the sample to 147,319 adults.§

The percentages and numbers were compared across the following subgroups: sex, age group, race/ethnicity, marital status, education, annual household income, health status, and state of residence. Orthogonal polynomial contrasts and pairwise t-tests were used to identify significant increases or decreases where appropriate. The 2014 BRFSS data were weighted by iterative proportional fitting (raking) to represent state-level population estimates and aggregated to represent a nationwide estimate. All results presented are weighted. Analyses were conducted using statistical software to account for the complex sampling design.

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 ( Table 1 ). 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. Women (30.3%) were more likely to report falling than men (26.5%) (p<0.01) and 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 65–74 years, to 29.8% among persons aged 75–84 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 65–74 years to 11.4% among persons aged 75–84 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).

Among states and the District of Columbia, the percentage of older adults who reported a fall ranged from 20.8% in Hawaii to 34.3% in Arkansas. Several states had either significantly higher or lower percentages of reported falls among older adults compared with the national average (Figure) ( Table 2 ). The percentage of older adults experiencing fall injuries ranged from 7.0% in Hawaii to 12.9% in Missouri.

Figure.

Percentages of falls and fall injuries* in the preceding 12 months reported by adults aged ≥65 years (N = 147,319) — Behavioral Risk Factor Surveillance System, United States, 2014
*Injuries resulting from falls that caused respondents to limit their regular activities for ≥1 days or to go see a doctor.

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