Background The older adult (65+) population in the USA is increasing and with it the number of medically treated falls. In 2015, healthcare spending attributable to older adult falls was approximately US$50 billion. We aim to update the estimated medical expenditures attributable to older adult non-fatal falls.Methods Generalised linear models using 2017, 2019 and 2021 Medicare Current Beneficiary Survey and cost supplement files were used to estimate the association of falls with healthcare expenditures while adjusting for demographic characteristics and health conditions in the model. To portion out the share of total healthcare spending attributable to falls versus not, we adjusted for demographic characteristics and health conditions, including self-reported health status and certain comorbidities associated with increased risk of falling or higher healthcare expenditure. We calculated a fall-attributable fraction of expenditure as total expenditures minus total expenditures with no falls divided by total expenditures. We applied the fall-attributable fraction of expenditure from the regression model to the 2020 total expenditures from the National Health Expenditure Data to calculate total healthcare spending attributable to older adult falls.Results In 2020, healthcare expenditure for non-fatal falls was US$80.0 billion, with the majority paid by Medicare.Conclusion Healthcare spending for non-fatal older adult falls was substantially higher than previously reported estimates. This highlights the growing economic burden attributable to older adult falls and these findings can be used to inform policies on fall prevention efforts in the USA.

Objective Describe rates of hip fracture-related emergency department (ED) visits, hospitalizations, and deaths among older adults (aged ≥65 years) in the United States. Methods Data from the 2019 Healthcare Cost and Utilization Project and National Vital Statistics System were used to calculate rates of hip fracture-related ED visits, hospitalizations, and deaths among older adults by select characteristics and mechanism of injury. Results In 2019, there were 318,797 ED visits, 290,130 hospitalizations, and 7731 deaths related to hip fractures among older adults. About 88% of ED visits and hospitalizations and approximately 83% of deaths related to hip fractures were caused by falls. Rates were highest among older adults living in rural areas and among those aged ≥85 years. Discussion Most hip fractures among older adults are fall-related. Healthcare providers can prevent falls among their older patients by screening for fall risk, assessing modifiable risk factors, and offering evidence-based interventions.

Our aim was to identify latent factors underlying multiple observed risk factors for older adult falls and to examine their effects on falls by age and sex. We performed exploratory factor analysis on 13 risk factors in the Behavioral Risk Factor Surveillance System. We used log-linear regression models to measure the association between the identified factors and older adults reporting falls. We identified two underlying factors: physical and mental health limitations. These shared a 50% correlation. Physical health limitations were more strongly associated with falls among men (prevalence ratio = 1.68, 95% CI = 1.65–1.71) than women (prevalence ratio = 1.51, 95% CI = 1.49–1.54). As physical health limitations increased, men aged 65–74 had a greater association with falls compared with other age-sex subgroups. Our findings highlight the composite relationship between age, sex, and physical and mental health limitations in association with older adult falls, and support the evidence for individually tailored, multifactorial interventions.

In the United States, unintentional falls are the leading cause of injury and injury death among adults aged ≥65 years (older adults). Patterns of nonfatal and fatal falls differ by sex and state. To describe this variation, data from the 2020 Behavioral Risk Factor Surveillance System and 2021 National Vital Statistics System were used to ascertain the percentage of older adults who reported falling during the previous year and unintentional fall-related death rates among older adults. Measures were stratified by demographic characteristics, U.S. Census Bureau region, and state. In 2020, 14 million (27.6%) older adults reported falling during the previous year. The percentage of women who reported falling (28.9%) was higher than that among men (26.1%). The percentage of older adults who reported falling ranged from 19.9% (Illinois) to 38.0% (Alaska). In 2021, 38,742 (78.0 per 100,000 population) older adults died as the result of unintentional falls. The unintentional fall-related death rate was higher among men (91.4 per 100,000) than among women (68.3). The fall-related death rate among older adults ranged from 30.7 per 100,000 (Alabama) to 176.5 (Wisconsin). CDC's Stopping Elderly Accidents, Deaths and Injuries (STEADI) initiative recommends that health care providers screen and assess older adults for fall risk and intervene using effective preventive strategies.

Background: Falls are the leading cause of injuries among older adults in the United States (US). Falls are preventable and clinicians are advised to screen for fall risk yearly. There are many falls screening tools and not all have been validated for their ability to predict future falls.Methods: We enrolled 1905 community-dwelling older adults into a 13-month study using a probability-based representative panel of the US population recruited from NORC at the University of Chicago's National Frame. Respondents completed a baseline survey, 11 monthly fall calendars, and a final survey. The baseline survey included six falls screening tools (the Stay Independent, Three Key Questions (3KQ), a modified American Geriatric/British Geriatric tool, the short Falls Efficacy-1[FES-I]) and two single screening questions ("I have fallen in the past year" and "How many times did you fall in the past 12 months?"). The baseline and final survey collected demographic and health information, including falls. Sensitivity, specificity, positive and negative likelihood ratios, and corresponding 95% confidence intervals were calculated in SAS using weighted proportions.Results: There were 1563 respondents who completed the final survey (completion rate 82%). Sensitivity estimates ranged from 22.5% for the short FES-I to 68.7% for the 3KQ. Specificity estimates ranged from 57.9% for the 3KQ to 89.4% for the short FES-I. Conclusions: Falls screening tools have varying sensitivity and specificity for predicting the occurrence of a fall in the following 12 months.

Background: Falls, with or without an injury, often affect the health of older adults (65+). Methods: We used the 2018 Healthcare Cost and Utilization Project to describe older adults' fall-related ED visits. We defined fall-related ED visits as those with a fall external cause of morbidity code and fall-injury related ED visits as those with an injury diagnosis code and a fall external cause of morbidity code. Percentages of fall-related and fall-injury related ED visits were analyzed by select characteristics. Results: Over 86% of fall-related ED visits were fall-injury related. A higher percentage of females (87%) and rural (88%) older adults' fall-related ED visits were fall-injury related compared to males (85%) and urban older adults (86%). A higher percentage of fall-related ED visits without a coded injury (33%) were hospitalized compared to those with a coded injury (29%). Conclusion: The majority of fall -related ED visits included an injury diagnosis. Practical applications: Researchers can consider which method of measuring ED visits related to falls is most appropriate for their study. Limiting fall-related ED visits to only those where an injury diagnosis is also present may underestimate the number of fall-related ED visits but may be appropriate for researchers specifically interested in fall injuries. (c) 2022 National Safety Council and Elsevier Ltd. All rights reserved.

Background This study describes rates of non-fatal fall-injury emergency department (ED) visits and hospitalisations before and after the US 2015 transition from the 9th to 10th revision of the International Classification of Diseases, Clinical Modification (ICD-9-CM to ICD-10-CM). Methods ED visit and hospitalisation data for adults aged 65+ years were obtained from the 2010–2016 Healthcare Cost and Utilisation Project. Differences in fall injury rates between 2010 and 2014 (before transition), and 2014 and 2016 (before and after transition) were analysed using t-tests. Results For ED visits, rates did not differ significantly between 2014 and 2016 (4288 vs 4318 per 100 000, respectively). Hospitalisation rates were lower in 2014 (1232 per 100 000) compared with 2016 (1281 per 100 000). Conclusion Increased rates of fall-related hospitalisations could be an artefact of the transition or may reflect an increase in the rate of fall-related hospitalisations. Analyses of fall-related hospitalisations across the transition should be interpreted cautiously.

Abstract Falls are a leading cause of injury among older men and women (≥65 years) in the United States. Vital Statistics and Behavioral Risk Factor Surveillance System data were analyzed to determine the age-adjusted fall death rate, the rates of older adults reporting a fall and fall injury, and associated trends. The fall death rate increased 16% from 55.3/100,000 in 2012 to 64.4/100,000 in 2018 (p≤0.05). Like the rates in 2012, the rate of falls reported in 2018 was 713/1000 older adults and the rate of fall injuries reported was 171/1000 older adults. When assessing the rates of older adults reporting a fall or fall injury by sex, the rates among men increased from 2012 to 2016 from 637/1000 to 773/1000 (21% increase, p≤0.05) for falls and from 120/1000 to 153/1000 (28% increase, p≤0.05) for fall injuries. Understanding how these data change over time can inform targeted interventions to reduce falls.

This study assessed differences in clinical fall risk assessment of older adults (aged 65 and older) and clinical resources used by primary care providers (PCP). Porter Novelli 's 2016 DocStyles survey was used to examine clinical behavior data from PCPs (n = 1128). Compared with other practitioners, nurse practitioners (NP) reported that a higher percentage of their patients were older adults. The majority of NPs reported screening for falls risk routinely, but most did not use standardized fall-risk assessments to assess risk factors. There were also differences in the types of clinical resources used by NPs and other PCPs to evaluate the safety pro file of medications. (c) 2020 Elsevier Inc. All rights reserved.

Abstract Certain demographics, health conditions, and functional limitations are associated with increased older adult falls. Health conditions and functional limitations are potentially modifiable and may have underlying factors in common. This study’s objective is to understand whether health conditions and functional limitations related to increased fall risk have common underlying factors that could be useful in designing interventions. Factor analysis and multivariate logistic regression were used to analyze 2016 Behavioral Risk Factor Surveillance Survey data for adults aged 65+ years. About half of those who reported difficulty dressing (58%), difficulty running errands alone (53%), difficulty remembering (51%) and depression (48%) reported falling compared to 30% of the general older adult population. Two common factors of cognitive and physical limitations were identified and scales created for each. When controlling for demographic characteristics, both cognitive and physical limitations scales were significantly related to a higher odds of falling (Odds ratios=1.5, 1.4 respectively).

Each year, more than 1 in 4 older adults in the United States report a fall and 1 in 10 a fall injury. Using nationally representative data from the 2016 US Behavioral Risk Factor Surveillance System, we evaluated demographic, geographic, functional, and health characteristics associated with falls and fall injuries among adults aged 65 years and older. Analyses included descriptive statistics and multivariable logistic regression to produce crude and adjusted percentages by characteristic. Characteristics most strongly associated with increased fall risk in order of adjusted percentage were depression, difficulty doing errands alone, and difficulty dressing or bathing. Characteristics most strongly associated with fall injury risk in order of adjusted percentage were depression, difficulty dressing or bathing, and being a member of an unmarried couple. The diverse health and functional characteristics associated with increased falls and fall injuries confirm the importance of screening and assessing older adult patients to determine their individual unique risk factors. Health care providers can use tools and resources from the Centers for Disease Control and Prevention’s STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to screen their older adult patients for fall risk, assess at-risk patients’ modifiable risk factors, and intervene to reduce risk by prescribing evidence-based interventions.

Abstract The STEADI initiative recommends screening older adults for falls annually using either the 12-item “Stay Independent” or the “three-key questions” screening tools. Both tools ask about falling in the preceding year. However, the comparative predictability of each tool has not been assessed. In response, CDC and NORC, assessed both tools’ ability to predict falls at six and twelve months. Adults 65+ (n=1900), were recruited from a nationally representative panel and were screened for fall risk at baseline using both tools and then followed for a year to determine if they fell. At baseline, 38% of older adults were categorized at-risk of falling based on the 12-item “Stay Independent” and 56% were considered at-risk based on the three-key questions. The history of falling question was excluded for the six month analyses. The “Stay Independent” identified 60% of fallers and the remaining two questions of the three-key questions identified 57% of fallers.

Teresa Liu-Ambrose, PT, PhD; Jennifer C. Davis, PhD; John R. Best, PhD; Larry Dian, MD; Kenneth Madden, MD; Wendy Cook, MD; Chun Liang Hsu, PhD; Karim M. Khan, MD, PhD

Abstract Falls among older adults (age 65 and older) cause roughly 3 million emergency department visits and $50 billion in medical costs annually. The Centers for Disease Control and Prevention (CDC) developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to increase clinical fall prevention. STEADI encourages screening for fall risk annually, assessing modifiable risk factors, and intervening to reduce risk using effective strategies like medication management. Medication management is critical given new data on the increased use of medications linked to falls. In 15 years, opioid use among older adults increased from 15% to 35% and anticonvulsant use tripled from 4% to 14%. To address the issue, CDC partnered with the University of North Carolina who 1) adapted STEADI tools for use in community pharmacies and 2) piloted and assessed their use in 31 North Carolina pharmacies. The adapted tools and processes were branded STEADI-Rx. Community pharmacists following the STEADI-Rx initiative, screen older patients for fall risk in the pharmacy, perform a medication review to identify medications that could increase fall risk, and intervene to reduce risk by sharing information with the patients’ healthcare providers. Providers can then optimize medications to reduce fall risk and improve health. STEADI-Rx tools include 1) a community pharmacy algorithm, outlining how pharmacists can conduct fall risk screening, assessment, and care coordination; 2) a community pharmacy fall risk checklist; and 3) communication materials to help pharmacists share information with patients’ providers. STEADI-Rx was launched in July 2019. More information is available at www.cdc.gov/STEADI.

跌倒是造成65岁及以上老年人致命和非致命伤害的主要原因. 在2014 年, 美国约27000名老年人因跌倒而死亡, 280万名老年人因为与跌倒相关的伤害而入急诊, 其中约80 万名老年人随后入院进行治疗. 为评估美国不同州老年人跌倒跌伤的人数、 发生率和人次率等特征, 美国疾病预防控制中心( CDC )对2014年行为危险因素监测系统( Behavioral Risk Factor Surveillance System, BRFSS)中的调查数据进行了分析. 2014年, 28. 7％的老年人报告跌倒, 估计2900 万次跌倒造成了700万次伤害. 已知减少老年人跌倒的有效策略, 包括多因素的临床途径(例如, 步态和平衡评估、 力量和平衡练习以及药物评估).医疗保健工作人员在预防跌倒中发挥着重要作用, 他们对老年人跌倒危险因素进行筛查, 对跌倒相关的药物进行评估与管理, 并且向老年人推荐补充维生素D以改善骨骼、 肌肉、 神经健康并减少跌倒的风险.

Falls are the leading cause of injury among adults aged 65 and older and cost $50 billion/year in medical expenditures. The age-adjusted rate of fatal falls increased 31% nationally and in most states during the past decade. However, the corresponding change in the prevalence of self-reported falls and fall injuries is unknown and has not been compared to the increasing fall fatality rate. Any increase in the prevalence of falls would translate to a greater burden to the healthcare system. Data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System were used to calculate fall and fall injury prevalence, controlling for age. Year-to-year differences in fall and fall injury prevalence were detected using two-sample t-tests. Data from Vital Statistics were used to calculate fall fatality rates and were age-adjusted with the 2000 U.S. Census. Joinpoint was used to determine significant change for fall fatalities from 2012–2016. State-specific estimates of fall and fall injury prevalence and fatality rates were compared to the national prevalence and rate using two-sample t-tests. From 2012–2016 the fall prevalence increased nationally and in nine states. The prevalence of fall injuries increased in five states and decreased in one but did not change nationally. The fall fatality rate increased nationally and in 17 states and decreased in 1 state. In 2016, only New Mexico had a higher prevalence of self-reported falls and fall injuries, and a higher rate of fall fatalities compared to the national average.

Background Falls are projected to be the 17th leading cause of death globally by 2030. Older adults are disproportionately affected. In the United States (U.S.), one in four adults 65+fall annually. By 2030, there will be 49 million falls among older adults and 12 million injuries in the U.S. each year. Description of the problem When not fatal, falls can cause brain injury, hip fracture, and loss of independence. In the U.S., there are more than 3 million emergency department visits, and over 8 00 000 hospitalizations each year due to falls. However, falls can be prevented. This presentation describes the overall cost of older adult falls in the U.S. and innovative approaches the U.S. Centers for Disease Control and Prevention (CDC) is pursuing to address this major health threat. Cost of older adult falls In total, $50 billion was spent to treat nonfatal falls in 2015, with government-funded programs (Medicare, Medicare) paying 75% of the total. Medical spending for fatal falls was $750 million. Most U.S. adults age 65+receive healthcare coverage through Medicare, a federally funded program. On average, Medicare pays approximately $10 000 per emergency department visit and $30 000 per fall-related hospital stay. CDC approach Given the health and economic burden, CDC encourages healthcare providers to screen, assess, and intervene to reduce patient’s multiple fall-risk factors. Interventions that address multiple modifiable risk factors can reduce falls by 24%. The CDC is evaluating the effectiveness of clinical fall prevention in primary care, upon hospital discharge, and within community pharmacies. In primary care, older adults at risk for a fall who received a treatment plan to reduce their fall-risk were 40% less likely to have a fall-related hospitalization compared to those at-risk without a treatment plan. Conclusion Fall interventions offered in clinical settings can reduce healthcare expenditures and prevent falls worldwide.

Deaths from unintentional injuries are the seventh leading cause of death among older adults (1), and falls account for the largest percentage of those deaths. Approximately one in four U.S. residents aged ≥65 years (older adults) report falling each year (2), and fall-related emergency department visits are estimated at approximately 3 million per year.* In 2016, a total of 29,668 U.S. residents aged ≥65 years died as the result of a fall (age-adjusted rate† = 61.6 per 100,000), compared with 18,334 deaths (47.0) in 2007. To evaluate this increase, CDC produced age-adjusted rates and trends for deaths from falls among persons aged ≥65 years, by selected characteristics (sex, age group, race/ethnicity, and urban/rural status) and state from 2007 to 2016. The rate of deaths from falls increased in the United States by an average of 3.0% per year during 2007-2016, and the rate increased in 30 states and the District of Columbia (DC) during that period. In eight states, the rate of deaths from falls increased for a portion of the study period. The rate increased in almost every demographic category included in the analysis, with the largest increase per year among persons aged ≥85 years. Health care providers should be aware that deaths from falls are increasing nationally among older adults but that falls are preventable. Falls and fall prevention should be discussed during annual wellness visits, when health care providers can assess fall risk, educate patients about falls, and select appropriate interventions.

Falls are the leading cause of fatal and non-fatal injuries among older adults. The American and British Geriatric Societies recommend a fall risk assessment to identify risk factors and guide interventions to prevent these falls. This study describes the self-reported discussion of fall prevention approaches used by primary care providers (PCPs)—family practitioners, internists and nurse practitioners—who treat older adults. Results are described overall and by PCP type.