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

Discussion

In 2014, 28.7% of older adults in the United States reported an estimated 29.0 million falls in the preceding 12 months. Older adult falls can result in death, serious injury, and loss of independence.[1,2] This analysis found that an estimated 7 million falls required medical treatment or caused restricted activity for at least 1 day. Women and those in older age groups were at higher risk for falling and being injured in a fall. Reduced muscle strength is a risk factor for falls, and aging and female sex are associated with reduced muscle mass.[1,2] Women have been found to be more likely to report falls than men.[3] Aging also is associated with changes in gait and balance, increased inactivity, more severe chronic conditions, and more prescription medication use, all of which are risk factors for falls.[1] Limited research exists on the causes for racial/ethnic differences, but these differences might be related to differences in health and behavior.[4,5] Reasons for state differences are unknown; however, even in Hawaii, the state with the lowest incidence, 20.8% of older adults reported a fall.

Annual Medicare costs for older adult falls have been estimated at $31.3 billion,[6] and the older adult population is expected to increase 55% by 2030.** Applying the number of falls from this analysis to the projected 2030 population would result in an estimated 48.8 million falls and 11.9 million fall injuries, unless effective interventions are implemented nationwide.

The findings in this report are subject to at least four limitations. First, BRFSS data are self-reported and subject to recall bias. Second, BRFSS does not include persons in long-term care facilities who are at higher risk for falls.[7] Third, the broad definition of fall injury for this analysis might have resulted in a higher estimate of injurious falls compared with other reports. Finally, the response rate (median = 47%) could have resulted in nonresponse bias; however, weighting and survey methodology are used to adjust the estimates and reduce the effect of nonresponse bias.

Older adult falls are largely preventable, and health care providers (e.g., physicians, nurses, nurse practitioners, physician assistants, pharmacists, physical therapists, and occupational therapists) can play an important part by discussing falls with older adult patients and providing appropriate interventions.[8] The American and British Geriatrics Societies (AGS/BGS) Clinical Practice Guideline recommends that health care providers use a multifactorial approach to prevent falls that includes activities such as asking about falls, assessing gait and balance, reviewing medications, and prescribing interventions such as strength and balance exercises, or taking vitamin D.†† This type of approach has been estimated to be capable of reducing falls by 24%.[8] Based on the AGS/BGS guidelines, CDC has developed the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative§§ to provide resources to help health care providers incorporate fall prevention into primary care.[3] STEADI stresses three initial steps that can be completed in one patient visit: 1) ask patients if they have fallen in the past year, feel unsteady, or worry about falling; 2) review medications and stop, switch, or reduce the dosage of drugs that increase fall risk; and 3) recommend daily vitamin D supplementation for improved bone, muscle, and nerve health (with dosage of vitamin D and decision on whether to co-supplement with calcium to be determined based on the patient's history).

Health care providers should discuss fall prevention with their patients because approximately half of older adults who fall do not discuss it with their health care provider, often because they fear this will lead to a loss of independence.[9] Health care providers cite limited time and cost as barriers to incorporating preventive services, such as those proposed by STEADI, into their clinical practice.[10] However, the Centers for Medicare & Medicaid Services (CMS) now provides incentives for health care providers to conduct fall prevention activities through payment and delivery reforms (e.g., Welcome to Medicare Visit, Medicare Annual Wellness Visit, and the Medicare Shared Savings Accountable Care Organization Program).¶¶ CMS also links health care provider incentives to fall prevention quality measures through the Physician Quality Reporting System (PQRS) in the Merit-Based Incentive Program. PQRS includes two quality measures for falls: Falls Risk Assessment and Falls Plan of Care.*** Mechanisms such as payment and delivery reforms and quality reporting measures are opportunities to make fall prevention a routine part of clinical practice and reduce the barriers to providing services that can prevent falls among older adults.

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