1. Department of Health and Human Services, Centers for Disease Control and Prevention 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

2. Department of Health and Human Services, Centers for Disease Control and Prevention Overview  Background & Impact  Epidemiology  Fall risk factors  Prevention strategies  Current activities  Resources

3. Department of Health and Human Services, Centers for Disease Control and Prevention Projected Growth in Older U.S. Population 34.8 39.7 53.7 70.3 77.2

4. Department of Health and Human Services, Centers for Disease Control and Prevention Leading Causes of Unintentional Injury Death Among People 65+, 2001 ___________ NCHS, Vital Records, 2001

5. Department of Health and Human Services, Centers for Disease Control and Prevention Falls  35%-40% of people 65+ fall each year 1  Those who fall are 2-3 times more likely to fall again 2  10%-20% of falls cause serious injuries 3 __________ 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

6. Department of Health and Human Services, Centers for Disease Control and Prevention Data Sources  Fatal falls – NCHS death certificate data  Nonfatal injuries – NEISS-AIP

7. Department of Health and Human Services, Centers for Disease Control and Prevention Fatal & Nonfatal Fall Injuries Among People Age 65+, 2001 11,600 373,000 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 { 1.6 million

8. Department of Health and Human Services, Centers for Disease Control and Prevention Impact

9. 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 billion 1 Medicare costs for hip fractures  $4.7 billion in 1991 2  $240 billion projected for 2040 3 __________ 1. Englander F, J Forensic Science, 1996 2. CDC, MMWR, 1996 3. Cummings SR, Orthopaedics & Related Res,1990

10. Department of Health and Human Services, Centers for Disease Control and Prevention Quality of Life  20% - 30% fear falling 1  20% die within a year after hip fracture 2  25% in a nursing home one year later 3 ___________ 1.Vellas BJ, Age & Aging, 1997; Friedman SM, JAGS, 2002 2.Lu-Yao GL, AJPH, 1994 3.Magaziner, J Gerontology: Medical Sciences, 2000

11. Department of Health and Human Services, Centers for Disease Control and Prevention Fall Death Rates for Men & Women 65+ by Age Groups, 2001 Women Men __________ NCHS, Vital Records, 2001

12. Department of Health and Human Services, Centers for Disease Control and Prevention Trends in Age Adjusted Fall Death Rates Men & Women 65+, 1990-2001 Men Women ___________ NCHS, Vital Records, 2001

13. Department of Health and Human Services, Centers for Disease Control and Prevention Leading Causes of Nonfatal Unintentional Injuries Among People 65+ __________ NEISS-AIP, 2001

14. Department of Health and Human Services, Centers for Disease Control and Prevention Nonfatal Fall Injury Rates for Men & Women 65+ by Age Group, 2001 Women Men __________ NEISS-AIP, 2001

15. 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

16. Department of Health and Human Services, Centers for Disease Control and Prevention Risk Factors for Falls  Personal  Environmental

17. Department of Health and Human Services, Centers for Disease Control and Prevention Personal Risk Factors  Older age  Female  Chronic diseases  Mental impairment

18. Department of Health and Human Services, Centers for Disease Control and Prevention Personal Risk Factors ( modifiable)  Muscle weakness4.4 x  Gait & balance problems2.9 x  Vision problems2.5 x  Psychoactive medications1.7 x Relative Risk ___________ American Geriatrics Society, JAGS, 2001

19. 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

20. Department of Health and Human Services, Centers for Disease Control and Prevention Interventions – What Works?  Comprehensive clinical assessment 1  Exercise for balance & strength 2  Medication management 3  Vision correction 4  Reducing home hazards 5 ___________ 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

21. 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

22. Department of Health and Human Services, Centers for Disease Control and Prevention Resources for Fall Prevention Programs

23. 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)

24. Department of Health and Human Services, Centers for Disease Control and Prevention Publication No. NIH 99-4258 www.nih.gov/nia www.nih.gov/nia

25. Department of Health and Human Services, Centers for Disease Control and Prevention

26. www.cdc.gov/injury

27. Department of Health and Human Services, Centers for Disease Control and Prevention WISQARS TM (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

28. 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

29. 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

30. Department of Health and Human Services, Centers for Disease Control and Prevention