Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years — United States, 2012–2018

Abstract

Falls are the leading cause of injury among adults aged ≥65 years (older adults) in the United States. In 2018, an estimated 3 million emergency department visits, more than 950,000 hospitalizations or transfers to another facility (e.g., trauma center), and approximately 32,000 deaths resulted from fall-related injuries among older adults.* Deaths from falls are increasing, with the largest increases occurring among persons aged ≥85 years (1). To describe the percentages and rates of nonfatal falls by age group and demographic characteristics and trends in falls and fall-related injuries over time, data were analyzed from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and were compared with data from 2012, 2014, and 2016. In 2018, 27.5% of older adults reported falling at least once in the past year, and 10.2% reported an injury from a fall in the past year. The percentages of older adults reporting a fall increased between 2012 and 2016 and decreased slightly between 2016 and 2018. Falls are preventable, and health care providers can help their older patients reduce their risk for falls. Screening older patients for fall risk, assessing modifiable risk factors (e.g., use of psychoactive medications or poor gait and balance), and recommending interventions to reduce this risk (e.g., medication management or referral to physical therapy) can prevent older adult falls (https://www.cdc.gov/steadi). BRFSS is a landline and mobile telephone survey conducted annually in all 50 U.S. states, the District of Columbia (DC), and U.S. territories, with a median response rate of 49.9% in 2018. The survey collects information on health-related behavioral risk factors and chronic conditions among nonin-stitutionalized U.S. adults aged ≥18 years. † Information on falls and fall-related injuries is recorded every 2 years from adults aged ≥45 years by asking "In the past 12 months, how many times have you fallen?" If the response was one or more times, the respondent was asked "How many of these falls caused an injury? By an injury, we mean the fall caused you to limit your regular activities for at least a day or to go see a doctor." Responses to each of these questions ranged from 0 to 76 falls or fall-related injuries. Rates were calculated as the average number of falls and fall-related injuries per 1,000 older adults. Both questions were dichotomized to calculate the percentage of older adults who reported having at least one fall or fall-related injury. * www.cdc.gov/injury/wisqars. † https://www.cdc.gov/brfss. Using 2018 BRFSS data, percentages and rates were calculated by age group for demographic (sex and race/ethnicity) and geographic (urban/rural status) characteristics. Functional characteristics (blind/difficulty seeing, difficulty dressing/ bathing, difficulty walking/climbing stairs, difficulty doing errands alone, and difficulty concentrating/making decisions) also were compared, as were self-reported health status and data on taking part in any physical activity/exercise in the past month. Analysis was restricted to respondents aged ≥65 years residing in the 50 states and DC. Any respondents with missing values or responses of "Don't know/Not sure" or "Refused" for falls or fall-related injuries were excluded. Overall, 4.8% of respondents were excluded from the analysis of falls, leaving 142,834; and 4.9% were excluded from the analysis of fall-related injuries, leaving 142,591. Two-sample t-tests were used to compare percentages across characteristics. Linear trend tests were conducted for age group and self-reported health status. BRFSS data from 2012, 2014, 2016, and 2018 were used to examine trends in the percentages of adults aged ≥65 years who had fallen or had a fall-related injury and rates of falls overall and by age group. Polynomial linear regression was used to assess linearity of trends (2). Where nonlinear trends were detected, two-sample t-tests with Bonferroni adjustments for multiple comparisons were performed to determine differences between years (2). Because the BRFSS questions about falls differed in three states (Michigan, Oregon, and Wisconsin) for 2012, compared with other years, the trend analysis was limited to 47 states and DC. All results presented are weighted to represent the U.S. population. Analysis was conducted using SAS-callable SUDAAN (version 11; RTI International) to account for the complex survey design. In 2018, 27.5% of adults aged ≥65 years reported at least one fall in the past year (Table 1), and 10.2 % of adults aged ≥65 years reported at least one fall-related injury (Table 2). In the preceding year, an average of 714 falls (Table 1) and an average of 170 fall-related injuries were reported per 1,000 older adults (Table 2), or approximately 35.6 million falls and 8.4 million fall-related injuries. The percentage of adults aged ≥65 years reporting a fall or a fall-related injury increased with age (p<0.001). Among adults aged ≥85 years, 33.8% reported a fall (Table 1) and 13.9% reported a fall-related injury (Table 2). Overall, a higher percentage of women reported at least one fall (29.1%; p<0.001) or fall-related injury (11.9%; p<0.001)