Falls and Fall-Related Injuries among Community-Dwelling Adults in the United States

Introduction Falls are the leading cause of unintentional injuries in the U.S.; however, national estimates for all community-dwelling adults are lacking. This study estimated the national incidence of falls and fall-related injuries among community-dwelling U.S. adults by age and gender and the trends in fall-related injuries across the adult life span. Methods Nationally representative data from the National Health Interview Survey (NHIS) 2008 Balance and Dizziness supplement was used to develop national estimates of falls, and pooled data from the NHIS was used to calculate estimates of fall-related injuries in the U.S. and related trends from 2004–2013. Costs of unintentional fall-related injuries were extracted from the CDC’s Web-based Injury Statistics Query and Reporting System. Results Twelve percent of community-dwelling U.S. adults reported falling in the previous year for a total estimate of 80 million falls at a rate of 37.2 falls per 100 person-years. On average, 9.9 million fall-related injuries occurred each year with a rate of 4.38 fall-related injuries per 100 person-years. In the previous three months, 2.0% of older adults (65+), 1.1% of middle-aged adults (45–64) and 0.7% of young adults (18–44) reported a fall-related injury. Of all fall-related injuries among community-dwelling adults, 32.3% occurred among older adults, 35.3% among middle-aged adults and 32.3% among younger adults. The age-adjusted rate of fall-related injuries increased 4% per year among older women (95% CI 1%–7%) from 2004 to 2013. Among U.S. adults, the total lifetime cost of annual unintentional fall-related injuries that resulted in a fatality, hospitalization or treatment in an emergency department was 111 billion U.S. dollars in 2010. Conclusions Falls and fall-related injuries represent a significant health and safety problem for adults of all ages. The findings suggest that adult fall prevention efforts should consider the entire adult lifespan to ensure a greater public health benefit.

[1]  S. Kivelä,et al.  Incidence of Injury‐Causing Falls Among Older Adults by Place of Residence: A Population‐Based Study , 1995, Journal of the American Geriatrics Society.

[2]  Barbara Sternfeld,et al.  Outdoor falls among middle-aged and older adults: a neglected public health problem. , 2006, American journal of public health.

[3]  Jian Liu,et al.  Comparison of Slip Training in VR Environment And on Moveable Platform. , 2015, Biomedical sciences instrumentation.

[4]  A. Hanff,et al.  Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men , 2016 .

[5]  Yi-Chung Pai,et al.  Repeated-Slip Training: An Emerging Paradigm for Prevention of Slip-Related Falls Among Older Adults , 2007, Physical Therapy.

[6]  T. Weiss,et al.  Predictors of falls among postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA) , 2009, Osteoporosis International.

[7]  S. Blair,et al.  Falls among adults: the association of cardiorespiratory fitness and physical activity with walking-related falls. , 2010, American journal of preventive medicine.

[8]  Current trends and update on injury prevention , 2011, International journal of critical illness and injury science.

[9]  L A Fingerhut,et al.  Injury and poisoning episodes and conditions: National Health Interview Survey, 1997. , 2000, Vital and health statistics. Series 10, Data from the National Health Survey.

[10]  S. Ameratunga,et al.  Association between prescription medications and falls at home among young and middle-aged adults , 2012, Injury Prevention.

[11]  Johanna Gustavsson,et al.  Investigating the fall-injury reducing effect of impact absorbing flooring among female nursing home residents: initial results , 2015, Injury Prevention.

[12]  Hasanat Alamgir,et al.  Trends in fall-related injuries among older adults treated in emergency departments in the USA , 2014, Injury Prevention.

[13]  P. Era,et al.  Postural balance and health-related factors in middle-aged and older women with injurious falls and non-fallers , 2004, Aging clinical and experimental research.

[14]  C. Becker,et al.  Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus , 2005, Journal of the American Geriatrics Society.

[15]  H Harvey Cohen,et al.  The science behind codes and standards for safe pedestrian walkways: lighting and visual cues. , 2016, Applied ergonomics.

[16]  L. Gillespie,et al.  Hip protectors for preventing hip fractures in older people. , 2010, The Cochrane database of systematic reviews.

[17]  J. Nitz,et al.  Normal Values of Balance Tests in Women Aged 20–80 , 2004, Journal of the American Geriatrics Society.

[18]  P. F. Adams,et al.  Summary health statistics for the U.S. population: National Health Interview Survey, 2008. , 2009, Vital and health statistics. Series 10, Data from the National Health Survey.

[19]  J. Miller,et al.  Cross-sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle-aged African Americans. , 2006, The Gerontologist.

[20]  Gordon S. Smith,et al.  DAILY SLEEP, WEEKLY WORKING HOURS, AND RISK OF WORK-RELATED INJURY: US NATIONAL HEALTH INTERVIEW SURVEY (2004–2008) , 2010, Chronobiology international.

[21]  Christianna S. Williams,et al.  Falls, injuries due to falls, and the risk of admission to a nursing home. , 1997, The New England journal of medicine.

[22]  G. Hu,et al.  Trends in unintentional injury deaths, U.S., 1999-2005: age, gender, and racial/ethnic differences. , 2009, American journal of preventive medicine.

[23]  J. Duysens,et al.  Martial arts fall techniques reduce hip impact forces in naive subjects after a brief period of training. , 2008, Journal of electromyography and kinesiology : official journal of the International Society of Electrophysiological Kinesiology.

[24]  P. F. Adams,et al.  Summary health statistics for the U.S. population: National Health Interview Survey, 2012. , 2013, Vital and health statistics. Series 10, Data from the National Health Survey.

[25]  D. Hoyert,et al.  Trends in causes of death among older persons in the United States. , 2005, Aging trends.

[26]  M. Schroll,et al.  Incidence and characteristics of falls leading to hospital treatment: a one-year population surveillance study of the Danish population aged 45 years and over , 2003, Scandinavian journal of public health.

[27]  Foreman,et al.  The state of US health, 1990-2010: burden of diseases, injuries, and risk factors. , 2013, JAMA.

[28]  C. Blaum,et al.  The epidemiologic data on falls, 1998-2010: more older Americans report falling. , 2015, JAMA internal medicine.

[29]  F. Porell,et al.  Risk of Mortality and Nursing Home Institutionalization After Injury , 2012, Journal of the American Geriatrics Society.

[30]  B E Groen,et al.  Martial arts fall techniques decrease the impact forces at the hip during sideways falling. , 2007, Journal of biomechanics.

[31]  Prakriti Parijat,et al.  Effects of Perturbation-Based Slip Training Using a Virtual Reality Environment on Slip-induced Falls , 2015, Annals of Biomedical Engineering.

[32]  Susan P Baker,et al.  An Explanation for the Recent Increase in the Fall Death Rate among Older Americans: A Subgroup Analysis , 2012, Public health reports.

[33]  S. Brauer,et al.  Changes in postural stability in women aged 20 to 80 years. , 2003, The journals of gerontology. Series A, Biological sciences and medical sciences.

[34]  John R. Geddes,et al.  The Cochrane database of systematic reviews , 1996 .

[35]  J.,et al.  The New England Journal of Medicine , 2012 .

[36]  B. L. Beattie,et al.  A cost-benefit analysis of three older adult fall prevention interventions. , 2015, Journal of safety research.

[37]  G. Hu,et al.  Age, Gender, and Racial/Ethnic Differences , 2009 .

[38]  Theodore K Courtney,et al.  Injuries at work in the US adult population: contributions to the total injury burden. , 2005, American journal of public health.

[39]  C. Murray,et al.  The state of US health, : burden of diseases, injuries, and risk factors. , 2013 .

[40]  S. Ameratunga,et al.  Unintentional falls at home among young and middle-aged New Zealanders resulting in hospital admission or death: context and characteristics. , 2010, The New Zealand medical journal.

[41]  P. Tugwell,et al.  Etidronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. , 2024, The Cochrane database of systematic reviews.

[42]  Keith Vidal,et al.  The science behind codes and standards for safe walkways: changes in level, stairways, stair handrails and slip resistance. , 2016, Applied ergonomics.

[43]  C. Orces.  Trends in fall-related mortality among older adults in Texas. , 2008, Texas medicine.

[44]  P. Tugwell,et al.  Exercise for preventing and treating osteoporosis in postmenopausal women. , 2011, The Cochrane database of systematic reviews.

[45]  Sarah E Lamb,et al.  Interventions for preventing falls in older people living in the community. , 2012, The Cochrane database of systematic reviews.

[46]  S. Cummings,et al.  Forgetting Falls , 1988, Journal of the American Geriatrics Society.

[47]  Laura A Talbot,et al.  Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury , 2005, BMC public health.

[48]  E. Finkelstein,et al.  Incidence and Economic Burden of Injuries in the United States , 2006 .

[49]  A. Mitchell,et al.  Recent patterns of medication use in the ambulatory adult population of the United States: the Slone survey. , 2002, JAMA.

[50]  Richard Y. Calvo,et al.  The epidemiology of trauma-related mortality in the United States from 2002 to 2010 , 2014, The journal of trauma and acute care surgery.

[51]  P. Tugwell,et al.  Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. , 2008, The Cochrane database of systematic reviews.

[52]  P. F. Adams,et al.  Summary health statistics for the U.S. population: National Health Interview Survey, 2007. , 2008, Vital and health statistics. Series 10, Data from the National Health Survey.

[53]  Jeffrey M. Hausdorff,et al.  Gait variability and fall risk in community-living older adults: a 1-year prospective study. , 2001, Archives of physical medicine and rehabilitation.

[54]  N Schenker,et al.  The effects of recall on reporting injury and poisoning episodes in the National Health Interview Survey , 2005, Injury Prevention.

[55]  M. Tinetti,et al.  Risk factors for falls among elderly persons living in the community. , 1988, The New England journal of medicine.

[56]  M. Borrie,et al.  Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. , 1990, Age and ageing.

[57]  Jiaquan Xu,et al.  Deaths: final data for 2010. , 2013, National vital statistics reports : from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System.

[58]  Jackline L Vickerie,et al.  Summary health statistics for the U.S. population: National Health Interview Survey, 2010. , 2011, Vital and health statistics. Series 10, Data from the National Health Survey.

[59]  J. Nitz,et al.  Medial–lateral postural stability in communitydwelling women over 40 years of age , 2003, Clinical rehabilitation.

[60]  D. Jacobs,et al.  Residential Light and Risk for Depression and Falls: Results from the LARES Study of Eight European Cities , 2011, Public health reports.

[61]  D. Christiani,et al.  Leisure-Time Physical Activity, Falls, and Fall Injuries in Middle-Aged Adults. , 2015, American journal of preventive medicine.

[62]  N. Santesso.  Hip protectors for preventing hip fractures in older people , 2014, The Cochrane database of systematic reviews.

[63]  E Zaloshnja,et al.  Incidence and lifetime costs of injuries in the United States , 2006, Injury Prevention.