Falls

The Financial Cost of Falls among Older Adults

In 2000, falls among older adults cost the U.S. health care system over $19 billion dollars. With the population aging, both the number of falls and the costs to treat fall injuries are likely to increase.

How big is the problem?

• One in three adults age 65 and older falls each year.
• Of those who fall, 20% to 30% suffer moderate to severe injuries that make it hard for them to get around or live independently, and increase their risk of early death.
• Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.
• In 2009, emergency departments treated 2.2 million nonfatal fall injuries among older adults; more than 582,000 of these patients had to be hospitalized.

How are costs calculated?

The costs of fall-related injuries are often shown in terms of direct costs.

• Direct costs are what patients and insurance companies pay for treating fall-related injuries. These costs include fees for hospital and nursing home care, doctors and other professional services, rehabilitation, community-based services, use of medical equipment, prescription drugs, changes made to the home, and insurance processing.
• Direct costs do not account for the long-term effects of these injuries such as disability, dependence on others, lost time from work and household duties, and reduced quality of life.

How costly are fall-related injuries among older adults?

• In 2000, the total direct medical costs of all fall injuries for people 65 and older exceeded $19 billion: $0.2 billion for fatal falls, and $19 billion for nonfatal falls. 
• By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 billion (in 2007 dollars).
• Among community-dwelling older adults, fall-related injury is one of the 20 most expensive medical conditions.
• In 2002, about 22% of community-dwelling seniors reported falling in the previous year.  Medicare costs per fall averaged between $9,113 and $13,507.
• Among community-dwelling seniors treated for fall injuries, 65% of direct medical costs were for inpatient hospitalizations; 10% each for medical office visits and home health care, 8% for hospital outpatient visits, 7% for emergency room visits, and 1% each for prescription drugs and dental visits. About 78% of these costs were reimbursed by Medicare.
• In a study of people age 72 and older, the average health care cost of a fall injury totaled $19,440, which included hospital, nursing home, emergency room, and home health care, but not doctors’ services.
  

How do these costs break down?

Age and sex

• The costs of fall injuries increase rapidly with age.
• In 2000, the costs of both fatal and nonfatal falls were higher for women than for men.
• Medical costs in 2000 for women, who comprised 58% of older adults, were two to three times higher than for men.

Type of injury and treatment setting

• In 2000, traumatic brain injuries (TBI) and injuries to the hips, legs, and feet were the most common and costly fatal fall injuries, and accounted for 78% of fatalities and 79% of costs.  
• Injuries to internal organs caused 28% of deaths and accounted for 29% of costs from fatal falls. 
• Fractures were both the most common and most costly type of nonfatal injuries. Just over one third of nonfatal injuries were fractures, but they accounted for 61% of costs—or $12 billion.
• Hospitalizations accounted for nearly two thirds of the costs of nonfatal fall injuries, and emergency department treatment accounted for 20%. 
• On average, the hospitalization cost for a fall injury is $17,500.
• Hip fractures are the most frequent type of fall-related fractures. The cost of hospitalization for hip fracture averaged about $18,000.  Hospitalization costs accounted for 44% of direct medical costs for hip fractures.

Content source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention

Falls Among Older Adults- The Statistics

Each year, one in every three adults age 65 and older falls. Falls can lead to moderate to severe injuries, such as hip fractures and head traumas, and can even increase the risk of early death. Fortunately, falls are a public health problem that is largely preventable.

How big is the problem?

• One out of three adults age 65 and older falls each year.
• Among those age 65 and older, falls are the leading cause of injury death. They are also the most common cause of nonfatal injuries and hospital admissions for trauma.
• In 2007, over 18,000 older adults died from unintentional fall injuries.
• The death rates from falls among older men and women have risen sharply over the past decade. 
• In 2009, 2.2 million nonfatal fall injuries among older adults were treated in emergency departments and more than 581,000 of these patients were hospitalized.
• In 2000, direct medical costs of falls totaled a little over $19 billion—$179 million for fatal falls and $19 billion for nonfatal fall injuries

What outcomes are linked to falls?

• Twenty percent to 30% of people who fall suffer moderate to severe injuries such as lacerations, hip fractures, or head traumas. These injuries can make it hard to get around or live independently, and increase the risk of early death.
• Falls are the most common cause of traumatic brain injuries, or TBI. In 2000, TBI accounted for 46% of fatal falls among older adults.
• Most fractures among older adults are caused by falls. The most common are fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand.
• Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and loss of physical fitness, which in turn increases their actual risk of falling.  

Who is at risk?

Fatal falls

• In 2007, 81% of fall deaths were among people 65 and older.
• Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2007 was 46% higher for men than for women.
• Older whites are 2.5 times more likely to die from falls as their black counterparts.
• Older non–Hispanics have higher fatal fall rates than Hispanics.

Nonfatal falls

• The chances of falling and of being seriously injured in a fall increase with age. In 2009, the rate of fall injuries for adults 85 and older was almost four times that for adults 65 to 74.
• People age 75 and older who fall are four to five times more likely than those age 65 to 74 to be admitted to a long-term care facility for a year or longer.
• Women are more likely than men to be injured in a fall. In 2008, women were 46% more likely than men to suffer a nonfatal fall injury.
• Rates of fall-related fractures among older women are more than twice those for men.
• Falls may lead to hip fractures. In 2006, the hip fracture rate for older women was almost twice the rate for men.
• White women have significantly higher hip fracture rates than black women.

How can older adults prevent falls?

Older adults can take several steps to protect their independence and reduce their chances of falling. They can:

• Exercise regularly. It’s important that the exercises focus on increasing leg strength and improving balance. Tai Chi programs are especially good.
• Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to reduce side effects and interactions that may cause dizziness or drowsiness.
• Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision.
• Make their homes safer by reducing tripping hazards, adding grab bars and railings, and improving the lighting in their homes.

Additional ways to lower hip fracture risk include:

• Getting adequate calcium and vitamin D in your diet.
• Undertaking a program of weight bearing exercise.
• Getting screened and treated for osteoporosis.

Content source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention

Falls and Hip fractures Among Older People

Hip fractures are serious fall injuries that often result in long-term functional impairment, nursing home admission and increased mortality. As our population ages, the number of hip fractures is likely to increase.

How big is the problem?

• In 2006, there were 316,000 hospital admissions for hip fractures in people age 65 and older. That is an increase of 7% from the previous year.
• Over 90% of hip fractures are caused by falling, most often by falling sideways onto the hip.
• In 1990, researchers estimated that by the year 2040, the number of hip fractures would exceed 500,000.
• Although the number of hip fractures is increasing, hip fracture rates per population since 1990 have declined significantly. It is not known what factors are contributing to this trend.
• In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion.

What outcomes are linked to hip fractures?

• A large proportion of fall deaths are due to complications following a hip fracture. One out of five hip fracture patients dies within a year of their injury.
• Treatment typically includes surgery and hospitalization, usually for about one week, frequently followed by admission to a nursing home and extensive rehabilitation.
• Up to one in four adults who lived independently before their hip fracture has to stay in a nursing home for at least a year after their injury.

Who is at risk?

• Women sustain three quarters of all hip fractures.
• White women are much more likely to sustain hip fractures than are African-American or Asian women.
• Hip fracture rates increase exponentially with age in both men and women. People 85 and older are 10 to 15 times more likely to sustain hip fractures than are those age 60 to 65.
• Osteoporosis increases a person’s risk of sustaining a hip fracture. The National Osteoporosis Foundation estimates that more than 10 million people over age 50 in the U.S. have osteoporosis and another 34 million are at risk for the disease.

How can hip fractures be prevented?

Hip fractures can be prevented by preventing falls. Fall prevention strategies include:

• Exercising regularly. It’s important that the exercise focuses on increasing leg strength and improving balance. Tai Chi programs are especially good.
• Asking your doctor or pharmacist to review medicines—both prescription and over-the counter—to reduce side effects and interactions that may cause dizziness or drowsiness.
• Having a vision check by an eye doctor at least once a year and updating eyeglasses to maximize vision.
• Making home safety improvements by reducing tripping hazards, adding grab bars and railings, and improving lighting.

Additional ways to lower hip fracture risk include:

• Getting adequate calcium and vitamin D in your diet.
• Undertaking a program of weight bearing exercise.
• Getting screened and treated for osteoporosis.

The most effective way to prevent fall injuries such as hip fractures is to combine exercise with the other fall prevention strategies.

Content source: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention