Tip Sheets

The high cost of falls: Tips for covering this story

By Liz Seegert

Falls in older adults are common — one in every four elders experiences a fall every year, according to the CDC. Because of underlying conditions such as frailty or osteoporosis, falls can lead to broken bones, hospitalizations, loss of independence and the ability to age in place and even death. Falls are the leading cause of injury or death among people 65 and older, and prevalence is increasing to what some researchers call epidemic levels. Safer living environments and fall prevention programs can mitigate much suffering and save the health system money long-term.

The CDC reports that in 2019:

  • Falls among adults 65 and older caused over 34,000 deaths, making it the leading cause of injury death for that group.

  • Three million visits to an emergency department by older adults were fall-related.  

  • One out of five falls causes a serious injury such as broken bones or a head injury.

  • Over 800,000 patients a year are hospitalized because of a fall injury, most often because of a head injury or hip fracture.

  • At least 300,000 older people are hospitalized for hip fractures annually; more than 95% of hip fractures are caused by falling, usually by falling sideways.

  • Older adult falls cost $50 billion in medical costs annually, with 3/4 paid by Medicare and Medicaid.

  • From 2007 to 2016, fall death rates among older adults increased by 30%; at this rate, there could be seven fall deaths per hour by 2030, the CDC projects.

  • Falls are also a leading cause of traumatic brain injury, research shows.

Risk factors for falls include:

  • Age-related changes in the nervous system

  • Frailty (See our tip sheet on frailty for more information.)

  • Osteoporosis (weakened bones)

  • Changes in vision and hearing

  • Changes in gait

  • Balance problems

  • Hypotension (low blood pressure)

  • Cognitive decline, which can double or triple the risk

  • Sleep apnea

  • Slowing of reflexes

  • Post-hospital discharge

  • Medication side effects or interactions

  • Environmental hazards such as area rugs, loose objects on the floor or even pets

  • History of prior falls

Multiple risk factors are often at work, including both extrinsic and intrinsic factors. However, various interventions can help reduce the risk of falls, either individually or in combination, such as  

The STEADI Initiative from the CDC. STEDI offers a coordinated approach to implementing the American and British Geriatrics Societies’ Clinical Practice Guidelines for fall prevention. STEADI consists of the following three core elements:

  • Screening patients for fall risk.

  • Assessing modifiable risk factors.

  • Intervening to reduce risk by using effective clinical and community strategies.

Clinicians and other experts like occupational therapists can proactively take steps to substantially impact fall reduction, improve health outcomes and reduce health care expenditures such as:

  • Treating causative disorders, correcting the environmental hazards, adjusting or stopping medications that might lead to a fall.

  • Muscle strengthening and gait training exercises, which are crucial for people who have fallen before and have problems with their gait and balance.

  • Implementing additional exercises to improve coordination and functional tasks.

  • Monitoring ongoing medical problems and taking corrective action to improve vision, hearing, hypotension and other health issues.

  • Treating osteoporosis to reduce the risk of fractures.

  • Reviewing current living conditions and potential hazards.

  • Installing grab handles, high friction floors, and other assistive devices; using low power lighting at night.

  • Changing footwear, particularly for outdoor activities.

  • Supplementing the diet with additional Vitamin D  particularly if given in doses of 800 IU/d or more in long-term care settings, according to some research.

Note that the U.S. Preventive Services Task Force gives exercise a “B” grade for fall prevention; multifactorial interventions received a “C” and Vitamin D supplementation, a “D,” as this JAMA article explains.

Story ideas

  • Which hospitals or health systems in your area are implementing fall prevention programs? What data can they provide on outcomes?

  • Do any local community organizations offer free or low-cost fall prevention programs? If so, have they been effective?

  • How has the pandemic affected falls among older adults? What’s behind the results? What interventions are being used to mitigate risk?

  • What programs are nursing homes and assisted living facilities undertaking to minimize fall risk among residents?

  • What tips can occupational health experts offer on how older adults, or their family caregivers can make even simple home modifications to improve safety and reduce fall risk?

Resources

Experts

  • Geoffrey Hoffman, Ph.D., assistant professor in the Department of Systems, Populations, and Leadership at the University of Michigan School of Nursing, Ann Arbor, Michigan

  • Joanne Lynn, M.D., director of the Program to Improve Eldercare, Altarum Institute

  • Julie A Switzer, M.D., associate professor of orthopedic surgery at the University of Minnesota.

  • Maria Mora Pinzon, M.D., M.S., a primary care research fellow and scientist II in the Department of Medicine, Division of Geriatrics and Gerontology at the School of Medicine and Public Health at the University of Wisconsin – Madison.

  • Carrie Castel, Ph.D., professor and director of the Injury Prevention Research Center at the University of Iowa’s Department of Occupational and Environmental Health.