Deaths From Falls Among Older Adults Rose 31%, 2007–2016

Falls are the leading cause of injury deaths among Americans aged 65 and older. About one in four older adults reports falling each year, and falls lead to an estimated 3 million emergency department visits a year. A CDC analysis of death certificates found that fall deaths among older adults climbed steadily over the decade from 2007 to 2016.

The national picture

• 2007: 18,334 deaths, an age-adjusted rate of 47.0 per 100,000.
• 2016: 29,668 deaths, a rate of 61.6 per 100,000.

The rate rose 31% over the period, an average of 3.0% a year.

CDC chart: deaths from falls and age-adjusted death rates, adults 65 and older, 2007–2016.

Who is most affected

In 2016, fall death rates were higher among adults 85 and older (257.9 per 100,000), men (72.3) and white adults (68.7) than among other groups. From 2007 to 2016 the rate rose in every demographic group studied except American Indians and Alaska Natives. It rose fastest among those 85 and older (3.9% a year), compared with 1.8% a year among people aged 65–74 and 2.3% among those 75–84.

Men had higher fatal fall rates even though women have more nonfatal falls. That may reflect differences in how men fall — from a ladder, say, or while drinking — leading to more serious injuries such as head trauma, or more complications afterward. Age itself is a risk factor for falls and is linked to others: reduced activity; chronic conditions such as arthritis, neurologic disease and incontinence; more prescription medicines, which may act together on the central nervous system; and changes in gait and balance.

State by state

In 2016, state rates ranged from 24.4 per 100,000 in Alabama to 142.7 in Wisconsin.

• Rising: the rate increased significantly from 2007 to 2016 in 30 states and the District of Columbia. The largest average annual increases were in Maine (11.0% a year), Oklahoma (10.9%) and West Virginia (7.8%).
• No significant change: 11 states — Alabama, Delaware, Georgia, Hawaii, Mississippi, Nebraska, New Hampshire, New Mexico, North Dakota, Texas and Vermont.
• Mixed: rates rose and then stabilized in Colorado, Oregon and Tennessee; held steady and then rose in Arizona, Nevada and Wisconsin; fell and then rose in Missouri; and rose and then fell in Utah.

CDC chart: fall death rates by state, 2007 and 2016.

Differences among states may partly reflect the racial makeup and general health of their residents — the higher rate among older white adults, for instance, may help explain why Wisconsin's rate exceeds Alabama's — and differences in how causes of injury are coded on death certificates. A 2012 study found that coroners recorded 14% fewer fall deaths than medical examiners, and states differ in which they use.

Looking ahead

Adults 85 and older are the fastest-growing age group in the United States and are expected to number about 8.9 million in 2030. Longer survival with common diseases such as heart disease, cancer and stroke may be one reason fall deaths are rising. If the rate holds steady, an estimated 43,000 older adults will die from falls in 2030; if it keeps rising, the toll could reach 59,000.

Prevention

Falls are preventable. The authors urge health care providers to discuss falls at annual wellness visits: ask whether patients have fallen, check gait and balance, review medications, and prescribe interventions such as strength and balance exercises or physical therapy. Interventions that address several risk factors at once can reduce falls, and CDC's STEADI initiative (Stopping Elderly Accidents, Deaths, and Injuries) helps providers assess risk, educate patients and choose interventions.

Limitations

• Changes in cause-of-death coding over the period may have contributed to the rise.
• Race and ethnicity on death certificates, often recorded by funeral directors, may undercount deaths among Hispanic, Asian/Pacific Islander and American Indian/Alaska Native people.
• The census may undercount people 65 and older, which would overstate rates.
• Some deaths may be misclassified.
• Standard age adjustment may not fully account for differences among the oldest adults.

Sources

• Elizabeth Burns and Ramakrishna Kakara, "Deaths from Falls Among Persons Aged ≥65 Years — United States, 2007–2016," Morbidity and Mortality Weekly Report, CDC: https://www.cdc.gov/mmwr/volumes/67/wr/mm6718a1.htm