Unintentional falls mortality among elderly in the United States: Time for action

Abstract

Fall injury is a leading cause of death and disability among older adults. The objective of this study is to identify the groups among the ≥65 population by age, gender, race, ethnicity and state of residence which are most vulnerable to unintentional fall mortality and report the trends in falls mortality in the United States.

Using mortality data from the Centers for Disease Control and Prevention, the age specific and age-adjusted fall mortality rates were calculated by gender, age, race, ethnicity and state of residence for a five year period (2003–2007). Annual percentage changes in rates were calculated and linear regression using natural logged rates were used for time-trend analysis.

There were 79,386 fall fatalities (rate: 40.77 per 100,000 population) reported. The annual mortality rate varied from a low of 36.76 in 2003 to a high of 44.89 in 2007 with a 22.14% increase (p = 0.002 for time-related trend) during 2003–2007. The rates among whites were higher compared to blacks (43.04 vs. 18.83; p = 0.01). While comparing falls mortality rate for race by gender, white males had the highest mortality rate followed by white females. The rate was as low as 20.19 for Alabama and as high as 97.63 for New Mexico. The relative attribution of falls mortality among all unintentional injury mortality increased with age (23.19% for 65–69 years and 53.53% for 85+ years), and the proportion of falls mortality was significantly higher among females than males (46.9% vs. 40.7%: p < 0.001) and among whites than blacks (45.3% vs. 24.7%: p < 0.001).

The burden of fall related mortality is very high and the rate is on the rise; however, the burden and trend varied by gender, age, race and ethnicity and also by state of residence. Strategies will be more effective in reducing fall-related mortality when high risk population groups are targeted.

Introduction

The World Health Organization estimates that around 424,000 fatal falls occur globally each year and another 37.3 million falls are severe enough to require medical attention.¹ Fall-related injuries are the leading cause of deaths and disabilities among older adults.² Reports from neighbouring Canada suggest that the number of Canadians aged ≥65 years who died as a direct result of a fall increased from 3209 during 1997–1999 to 4110 during 2000–2002 with a statistically significant increase in the rate.³ In addition, almost 62% of injury-related hospitalizations for seniors in Canada were the result of falls.³ Other developed countries noted a similar upward trend—one study in Finland followed the nationwide trends of fall-related deaths among older people and reported the increasing trends of both the numbers and rates.⁴

Among all injury causes, falls impose a high burden to the United States (U.S.) society. Nationwide, in the U.S., data on injury-related death, death rates, and years of potential life lost are made available through the Centers for Disease Control and Prevention (CDC)⁵ and their injury statistics are widely cited in epidemiological studies on injury6, 7 and falls.2, 8, 9, 10, 11 According to CDC injury statistics, for the year 2006, there were a total of 36,689 unintentional injury mortality cases among the elderly population (≥65 years) and among those 10,650 (29%) were due to falls mortality.¹² In addition, unintentional falls mortality was the leading cause of emergency department visits among elderly population, i.e., 2.1 million incidents in 2008, and approximately 560,000 of these patients needed hospitalization.¹³

Falls continue to impose a high social and economic burden for the injured, their family members and the community. Falls among older adults cost the U.S. healthcare system over $19 billion: $0.2 billion for fatal falls and $19 billion for nonfatal falls.¹⁴ By 2020, the annual direct and indirect costs of fall injuries are expected to reach $54.9 billion.¹⁵ Studies have looked at the trend and associated risk factors of falls mortality16, 17, 18 and the social and economic burden resulting from falls.14, 15, 19, 20 Though progress has been made in developing falls interventions in nursing homes,21, 22 community living,23, 24 and hospitals,²⁵ falls mortality still remain an alarming public health problem, especially among the elderly.

The enormous growth in the size of the elderly population in the U.S.26, 27 necessitates incessant efforts from epidemiologists to look into the recent trends by population groups and catalogue the burden of falls in the U.S. and understand its variation by common characteristics. With the number of elderly persons increasing faster than any other age groups, the prevention of falls among them remains a pressing need and challenge for public health.28, 29 Strategies to reduce fall related morbidity and mortality will have to target the population group most at risk so that resources are better targeted and utilized. The vulnerability of the elderly to serious fall varies by certain demographic characteristics like age, gender, race, ethnicity and geographic location. The population groups most vulnerable to falls will benefit the most from public health interventions. Further the trend of the burden of falls can be better understood when the relative distribution of falls out of all injury can be monitored as any progress made in preventing falls should show a decline in the proportionate mortality from falls.

Using CDC's publicly available injury database, the most comprehensive source of injury information, this study describes the recent trends of falls fatalities during 2003–2007 (the most recent 5 years of data available) and examines the variation in the number and rate of deaths by age, gender, race, ethnicity, and state of residence. This study also reports trends of all unintentional injury mortality in the U.S. stratified by the same characteristics (age, gender, race, ethnicity and geographic location) to delineate the relative attribution of falls in the total unintentional injury mortality burden. The intentional injuries were not included in this study as they differ from unintentional injuries with respect to the risk factors and outcome.

The objective of this investigation is to draw attention of the elderly health advocates, public health professionals and other stakeholders who have an interest in fall prevention to the current state of the burden of falls mortality, describe the existing disparity by demographics, report changes in trends in recent years, and thereby identify the population most vulnerable to falls who may benefit from population level interventions.