Transcript ASTHO-NACCHO teleconf 5-04.ppt

Older Adult Falls
from a National Perspective
Judy A. Stevens, Ph.D.
Division of Unintentional Injury Prevention
National Center for Injury Prevention & Control
ASTHO/NACCHO Teleconference
May 25, 2004
Department of Health and Human Services, Centers for Disease Control and Prevention
Overview
Background & Impact
Epidemiology
Fall risk factors
Prevention strategies
Current activities
Resources
Department of Health and Human Services, Centers for Disease Control and Prevention
Population (millions)
Projected Growth in Older
U.S. Population
500
400
300
34.8
39.7
53.7
70.3
2010
2020
2030
77.2
200
100
0
2000
2040
Year
Department of Health and Human Services, Centers for Disease Control and Prevention
Leading Causes of Unintentional
Injury Death Among People 65+, 2001
M.V.
23%
Falls
35%
Unspecified
18%
Suffocation
10%
___________
Other
7%
Fire/Burn
4%
Drowning
1%
Poisoning
2%
NCHS, Vital Records, 2001
Department of Health and Human Services, Centers for Disease Control and Prevention
Falls
35%-40% of people 65+ fall
each year1
Those who fall are 2-3 times
more likely to fall again2
10%-20% of falls cause serious
injuries3
__________
1. Hornbrook, Gerontologist, 1994; Hausdorff, Arch Phys Med & Rehab, 2001
2. Tinetti, New Eng J Med, 1988; Teno, JAGS,1990
3. Sterling, J Trauma-Inj Infection & Critical Care, 2001
Department of Health and Human Services, Centers for Disease Control and Prevention
Data Sources
Fatal falls – NCHS death
certificate data
Nonfatal injuries – NEISS-AIP
Department of Health and Human Services, Centers for Disease Control and Prevention
Fatal & Nonfatal Fall Injuries
Among People Age 65+, 2001
11,600
{
1.6
million
373,000
1,260,000
? Millions
1% - Died
23% - Treated in ED
& Hospitalized
76% - Treated in ED
& released
Fall-related
injuries
__________
Nonfatal falls: NEISS-AIP, 2001
Fall deaths: NCHS, Vital Records, 2001
Department of Health and Human Services, Centers for Disease Control and Prevention
Impact
Department of Health and Human Services, Centers for Disease Control and Prevention
Financial Cost (current dollars)
In 1994, total cost of fall injuries
among people 65+
$27.3 billion1
Medicare costs for hip fractures
$4.7 billion in 19912
$240 billion projected for 20403
__________
1. Englander F, J Forensic Science, 1996
2. CDC, MMWR, 1996
3. Cummings SR, Orthopaedics & Related Res,1990
Department of Health and Human Services, Centers for Disease Control and Prevention
Quality of Life
20% - 30% fear falling1
20% die within a year after
hip fracture2
25% in a nursing home one
year later3
___________
1.
2.
3.
Vellas BJ, Age & Aging, 1997; Friedman SM, JAGS, 2002
Lu-Yao GL, AJPH, 1994
Magaziner, J Gerontology: Medical Sciences, 2000
Department of Health and Human Services, Centers for Disease Control and Prevention
Fall Death Rates for Men & Women 65+
by Age Groups, 2001
175
Per 100,000
150
125
100
Men
75
Women
50
25
0
65-69
70-74
75-79
80-84
85+
Age groups
__________
NCHS, Vital Records, 2001
Department of Health and Human Services, Centers for Disease Control and Prevention
Trends in Age Adjusted Fall Death Rates
Men & Women 65+, 1990-2001
40
35
Men
Per 100,000
30
25
Women
20
15
10
5
19
90
19
91
19
92
19
93
19
94
19
95
19
96
19
97
19
98
19
99
20
00
20
01
0
Year
___________
NCHS, Vital Records, 2001
Department of Health and Human Services, Centers for Disease Control and Prevention
Leading Causes of Nonfatal Unintentional
Injuries Among People 65+
Poisoning
Foreign body 1%
1%
Other transport
2%
Bite/sting
2%
Cut/pierce
5%
Unknown
2%
All others
4%
Overexertion
6%
MV Occupant
7%
Struck by/Against
7%
Falls
63%
__________
NEISS-AIP, 2001
Department of Health and Human Services, Centers for Disease Control and Prevention
Nonfatal Fall Injury Rates for
Men & Women 65+ by Age Group, 2001
15000
Per 100,000
12500
10000
Women
7500
Men
5000
2500
0
65-69
70-74
75-79
80-84
85+
Age groups
__________
NEISS-AIP, 2001
Department of Health and Human Services, Centers for Disease Control and Prevention
Hip Fractures
95% of hip fractures caused by falls
2000 - 321,000 hospital admissions
76% were women
40% were age 85+
Rates increase with age
Rates higher among women
__________
Nyberg, JAGS, 1996
NCHS, National Hospital Discharge Survey, 2000
Department of Health and Human Services, Centers for Disease Control and Prevention
Risk Factors for Falls
Personal
Environmental
Department of Health and Human Services, Centers for Disease Control and Prevention
Personal Risk Factors
Older age
Female
Chronic diseases
Mental impairment
Department of Health and Human Services, Centers for Disease Control and Prevention
Personal Risk Factors
(modifiable)
Relative Risk
Muscle weakness
Gait & balance problems
Vision problems
Psychoactive medications
4.4 x
2.9 x
2.5 x
1.7 x
___________
American Geriatrics Society, JAGS, 2001
Department of Health and Human Services, Centers for Disease Control and Prevention
Environmental Factors
(modifiable)
Clutter in walkways
No stair railings or
grab bars
Loose rugs
Dim lighting
Department of Health and Human Services, Centers for Disease Control and Prevention
Interventions – What Works?
Comprehensive clinical
assessment1
Exercise for balance &
strength2
Medication management3
Vision correction4
Reducing home hazards5
___________
1. American Geriatrics Society, JAGS, 2001
2. Lord SR, JAGS, 2001
3. Cumming RG, Drugs & Aging, 1998
4. Ray W, Topics in Geriatric R Rehab,1990
5. Day L, BMJ 2002; Gill TM, JAGS, 1999
Department of Health and Human Services, Centers for Disease Control and Prevention
Current Activities
Cooperative Agreements
California
Michigan
Washington State
Wisconsin
Extramural Grants
 North Carolina - UNC
 Tennessee - Vanderbilt
Department of Health and Human Services, Centers for Disease Control and Prevention
Resources for
Fall Prevention Programs
Department of Health and Human Services, Centers for Disease Control and Prevention
National Resource Center
for Safe Aging
• San Diego State University
• Collect, organize, disseminate injury
prevention information
• Serve public health professionals &
aging service providers
www.safeaging.org (being updated)
Department of Health and Human Services, Centers for Disease Control and Prevention
Publication No. NIH 99-4258
www.nih.gov/nia
Department of Health and Human Services, Centers for Disease Control and Prevention
Department of Health and Human Services, Centers for Disease Control and Prevention
www.cdc.gov/injury
Department of Health and Human Services, Centers for Disease Control and Prevention
WISQARSTM (Web-based Injury
Statistics Query and Reporting System)
• An interactive
database system
• Provides
customized reports
of fatal & nonfatal
injury data
www.cdc.gov/ncipc/wisqars/default.htm
Department of Health and Human Services, Centers for Disease Control and Prevention
Tool Kit to Prevent Senior Falls
Fall prevention brochure
Home safety checklist
Fact sheets & graphs
Summary of research
www.cdc.gov/ncipc/pub-res/toolkit/toolkit.htm
Department of Health and Human Services, Centers for Disease Control and Prevention
US Fall Prevention Programs for Seniors
18 comprehensive
programs in 12 states
Program descriptions &
contact information
Contact information for 22
additional programs
www.cdc.gov/ncipc/falls/default.htm
Department of Health and Human Services, Centers for Disease Control and Prevention
Department of Health and Human Services, Centers for Disease Control and Prevention