Falls Among Older Adults by State: 14 Million Fell in 2020, 38,742 Died in 2021

The report's visual summary. CDC, MMWR.

In brief

• Unintentional falls are the leading cause of injury and of injury deaths among adults 65 and older.
• In 2020, 14 million (27.6%) older adults said they had fallen in the past year — from 19.9% in Illinois to 38.0% in Alaska.
• In 2021, 38,742 older adults died from falls — 78.0 per 100,000 — at rates from 30.7 in Alabama to 176.5 in Wisconsin.
• Falls are common but preventable. Health care providers can talk with patients about their fall risk and how to prevent falls.

Falls grow more common with age, but they are not an inevitable part of aging: addressing the risk factors that can be changed prevents them. Nonfatal and fatal falls in this age group cost about $50 billion in medical care every year.

How the study was done

The authors used the 2020 Behavioral Risk Factor Surveillance System (BRFSS) — a phone survey of noninstitutionalized adults, which asks those 45 and older, "In the past 12 months, how many times have you fallen?" — and 2021 death certificates from the National Vital Statistics System, the latest data from each. Falls deaths were those with a fall (ICD-10 codes W00–W19) as the underlying cause. Percentages and rates were age-adjusted. The survey sample was 127,724 people aged 65 and older in the 50 states and DC.

Who falls, and who dies

Women were more likely to fall; men were more likely to die from a fall. Falls were reported most among White and American Indian or Alaska Native adults, and death rates were highest among White and American Indian or Alaska Native adults too. By county type, falls were reported most in noncore (nonmetropolitan) counties (31.4%), and death rates — crude rather than age-adjusted — were highest in medium metro counties (76.9 per 100,000).

By state

Age-adjusted percentage of adults 65 and older reporting a fall in the past year (2020) and fall death rate (2021), by state. CDC, MMWR.

The share reporting a fall was significantly above the national 27.6% in 18 states — about half the Western and Midwestern states and a quarter of the Northeastern and Southern states and DC. Women reported falls significantly more often than men in five states. Death rates were significantly above the national 78.0 in 26 states — about 60% of Western, Midwestern and Northeastern states and 30% of Southern states and DC — and significantly higher for men than women in 34 states.

What it means

About one in four older adults reported a fall in 2020 — and one in five even in Illinois, the lowest state. The 2020 figure, in the pandemic's first year, was similar to earlier years. In 2021, on average 100 older adults died from falls every day; the death rate was the highest in 20 years, and it has risen every year for at least two decades. A trend analysis through 2023 could show whether the pandemic affected it.

Similar sex differences appeared in earlier years, and their causes are not fully understood. Earlier studies suggest men may be less receptive to fall-prevention messages and less likely to join prevention programs, are more likely to be hurt falling on ice or snow or from ladders, and may have different modifiable risk factors. State differences may reflect how many people at high risk live there; research into state variation in chronic conditions, disability, alcohol use, access to prevention and care, and social determinants of health could help explain them.

Limitations: survey answers are self-reported; BRFSS leaves out people in long-term care, who are at higher risk; small samples after dividing by sex and state may hide differences; the 2020 BRFSS median response rate was 47.9%, though the data are weighted for nonresponse; nonfatal and fatal figures come from different years; and death certificates may misclassify race or ethnicity.

Preventing falls

CDC's STEADI initiative (Stopping Elderly Accidents, Deaths and Injuries) asks providers to screen older adults for fall risk, assess those at risk for risk factors that can be changed, and intervene — with physical therapy, home modification and medication management, for example. In New York, at-risk older adults who received such strategies were less likely to be hospitalized for a fall. Providers can use motivational interviewing to understand patients' attitudes and ask about daily activities that raise their risk. Health departments and organizations serving older adults can help people check their own risk with the online Falls Free CheckUp and encourage them to talk to their provider.

Sources

Based on Ramakrishna Kakara, Gwen Bergen, Elizabeth Burns and Mark Stevens, "Nonfatal and Fatal Falls Among Adults Aged ≥65 Years — United States, 2020–2021," MMWR Morbidity and Mortality Weekly Report, volume 72, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The state tables here list the five highest and lowest from the report's Table 2, which gives every state, with confidence intervals and figures for women and men.