Burden of Falls Among Older Adults in Ohio

Violence and Injury Prevention Program

Ohio Department of Health

Key Points



Falls among older adults have reached epidemic proportions and rates continue to rise.



Falls among older adults are costly… in terms of direct costs and quality of life.



Older adults account for a disproportionate share of fall

‐

related injury.



The likelihood of falling and the severity of fall

‐

related injury increases with age, and therefore the risk for hospitalization and death.



Older adults with poor health status and those who are isolated are at greater risk for falling.

Epidemic Proportions of Falls

Each year, 1 in 3 older adults falls.*

Older Adults Who Fall Each Year 33% 67%

*Source: Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community–dwelling older persons: results from a randomized trial. The Gerontologist 1994:34(1):16–23.

Proportional distribution of Ohio population

1,

vs. fall-related ED visits

2

, inpatient discharges

2

and deaths

3

, by age group, 2009

<1-64 years 65 years+ 13,7% 20,4% 70,3% 82,2% 79,6% 86,3% ED Visits 29,7% Hospitalizations 17,8% Deaths Population

Sources: 1 US Census; 2 Ohio Hospital Association; 3 ODH, Office of Vital Statistics

Consequences of Falls

 Injury and Death  Fear of Future Falls  Restriction of Activities/Social Isolation  Inability to Regain Pre-fall level of Functioning  Lack of Independence  Depression

Number of fall-related deaths, 1 reported injured fallers 3,4 HIDs and fallers, 2 and ER visits, 3,5 2 and self for ages 65 and older, Ohio, 2009 1,2 (2006 BRFSS 3,4,5 ) 827 Deaths 1 16,454 Hospitalizations 2

2.3 Deaths per Day 1.9 Hospitalizations per hour

63,964 ER visits 2 67,448 Self-reported Injured Fallers 3, 4 214,596 Self-reported Fallers or 14.3% of population 65+ 3, 5 Unreported Falls - Unknown

ER Visit every 8 minutes Fall every 2.5 minutes Sources: 1 ODH Office of Vital Statistics, 2009 data 2 Ohio Hospital Association, 2009 data 3 BRFSS Survey, 2006 4 Self-reported fallers (estimated) whose fall in preceding 3 months resulted in a doctor’s visit or restricted activities for at least one day 5 BRFSS respondents who reported experiencing a fall in the preceding 3 months

Costs of Fall-related Injury

Total charges (in millions) for inpatient treatment 1 of leading causes of injury, by type of injury, Ohio, 2002-05

falls MV traffic assault self harm MV nontraffic unintentional poisoning struck by/against fire/burn other land transport machinery overexertion bicyclist, other cut/pierce unintentional firearms pedestrian, other suffocation drowning $0 $72 $71 $48 $44 $30 $28 $20 $18 $17 $17 $6 $4 $4 $194 $168 $741 Falls charges represent of the $2.6 billion total for all leading causes of injury combined.

Other Injuries 55% 45 percent Falls 45% charges in millions of dollars $1,194 (or $300 million per year)

$400 $800 $1 200

1 Source: Ohio Hospital Association

Average Annual Cost of Non-fatal, Hospital-admitted Falls Among Older Adults, Ages 65+ Ohio, 2003 1,2 Incidence Medical Work-Loss Quality-of-Life Total Costs 65+ yrs Total 19,137 $ 327 million $ 116 million $ 3.7 billion $ 4.2 billion Proportion of Ohio Population Percent of All Fall Costs 71% 67% 22% 72% 68% 13%

1 Source: Children’s Safety Network Economics & Data Analysis Resource Center

Average Annual Cost of Fatal Falls Among Older Adults, Ohio, 2005-07

1,2 Incidence Medical Work-loss 65+ Total 751 (average) $15 million $52 million Percent of All Fatal Fall Costs 82% 77% 20% Quality of Life $456 million Total Costs $524.8 million Proportion of Ohio Population >65 years 53% 46% 13%

1 Source: Children’s Safety Network Economics & Data Analysis Resource Center, 2 ODH Office of Vital Statistics

Location and Types of Falls Among Older Adults

Location of Falls among Older Adults

1,2

Other locations 25% In or Around Home 75%

1 among those with known location 2 Source: Ohio Hospital Association

Proportion of fall-related inpatient hospitalizations 1 by type of fall, ages 65 and older, Ohio, 2002-05 unspecified 19,480 stairs/steps 3,740 all other level* 1,609 all same level 18,424 furniture 3,799 commode 370 other furniture 150 chair 995 wheelchair 747 bed 1,537

1 Source: Ohio Hospital Association

Fall-related Injuries and Consequences/Severity among Older Adults

No. of fall-related inpatient hospitalizations with TBI* of Ohio residents, by sex, age group, 2002-2005

3000 2500

2663 2587

Male Female 50% of the fall related hospitalizations with TBI diagnosis were among those 65 and older (4,543 total) 2000 1500 1000

1880 1080

500 15 0 1 Source: Ohio Hospital Association 65+ years

Age group

<65 years

* traumatic brain injury

Proportion of fall-related inpatient hospitalizations who suffered a TBI*, by gender, year, 2002-05

25% 20% For persons 65+ hospitalized after a fall, 16% (n=1,880) of males and 8% (n=2,663) of females suffered TBIs, which are on the rise among older adults 15% 10% 5% 0% male 2002 16 1 Source: Ohio Hospital Association 2003 2004 female 2005 * traumatic brain injury

Falls and Hip Fractures*

• • • • • Older adults account for more than 90 percent of all fall related hip fractures.

Hips were the bones most frequently fractured during a fall. In Ohio, more than 25,000 fall-related hip fractures occurred from 2002 to 2005.

Overall, 63.5 percent of all hip fractures among those 65 and older were associated with a fall. Nearly half (48.7 percent) of fall-related discharges among those 65 and older had a hip fracture. Women are disproportionately susceptible to hip fractures: from 2002-2005, 75 percent of hip fracture hospitalizations were among women (n=26,793). Biological factors such as osteoporosis that increase the risk of injury after a fall may play a role. * Source: Ohio Hospital Association

Fall Risk Factors and Self-report Falls Data

Fall Risk Factors



Co-morbidities

–  Lower limb arthritis  Osteoporosis  Stroke/heart disease  Cancer  Diabetes  Eye diseases  Obesity  Vision problems.

 Inappropriate footwear.

 Impaired balance and coordination.

 Gait instability, slow walking speed.

 Medication interactions (polypharmacy).

 Impaired cognitive function.

 Use of alcohol/other drugs.

 Hazardous home environment.

 Physical inactivity.

 Living alone/social isolation.

 Fear of Falling  History of previous falls.

H

OW TO PREVENT FALLS

Five Ways to Help Prevent Falls

Increase your physical activity.

especially good.

Simple exercise, like walking or swimming at least 15 minutes a day can help build muscle strength and improve balance, which can prevent falls. Exercise programs like Tai Chi that increase strength and improve balance are

See your eye doctor once each year.

Age-related eye diseases, such as cataracts, macular degeneration and diabetic retinopathy, can increase the risk of falling. Early detection is key to minimizing the effects of these conditions.

Review your medications.

Talk to your doctor or pharmacist about the medicines you are taking and whether they may cause drowsiness or dizziness. Discuss things you can do to ensure you are taking your medicines safely.

Remove environmental hazards.

Look around the house for anything that could increase the risk of falls, including poor lighting, loose rugs, slippery floors and unsteady furniture. Remove or modify these hazards.

Think, plan and slow down.

through the task you are performing. Be mindful of possible falls risks and act accordingly.

Many falls are caused by hurrying. Slow down and think

For more information

Contact the Ohio Department of Health Injury Prevention Program at

614-466-2144 or http://www.healthyohioprogram.org/vipp/oipp/oipp.aspx

Or Email [email protected]

Or Ohio Public Health Association (ohiopha.org)

.