Unintentional Fall Injuries and Deaths Among MA Older Adults,

Ages 65 Years and OverCarrie Huisingh, MPH, Epidemiologist

Holly Hackman, MD, MPH, EpidemiologistInjury Prevention and Control Program

Massachusetts Department of Public Health October 2008

BackgroundFalls are the leading cause of injury death and disability among older adults in the United States and in Massachusetts. Fall deaths are increasing.

Gaining national, state and local interest. Priority area in MA Injury Prevention Plan.

Enormous social, health and economic costs.

The proportion of the Massachusetts population 65+ years and older is expected to increase from 13.5% in 2000 to 20.9% in 2030.

Fall injuries are largely preventable!

Data Sources

Death Certificate Data, Registry of Vital Records and Statistics, MDPH

Acute Care Hospital Data (Inpatient, Observation Stay, Emergency Department), MA Division of Health Care Finance and Policy

Behavioral Risk Factor Surveillance Survey (BRFSS), MDPH

CDC/National Center for Health Statistics

Magnitude and TrendsMagnitude and Trends

Unintentional Fall Injuries and Deaths, MA Residents Ages 65 Years and Over:

Magnitude of the Public Health Problem, 2006

340 Deaths

20,209 Acute Care Hospital Stays

36,751 Emergency Department Discharges

One out of 6 (16.6%) community-dwelling older adults reported falling in the past 3 months. Of these, 29% reported that they were injured.

Sources: Registry of Vital Records and Statistics, MDPH; MA Inpatient, Observation Stay and ED Databases, MDHCFP; BFRSS, MDPH

Age Adjusted Unintentional Fall Death Rates MA and US Residents

Ages 65 Years and Older, 2000-2006

0

5

10

15

20

25

30

35

40

45

50

2000 2001 2002 2003 2004 2005 2006

Year

Ra

te p

er

10

0,0

00

Re

sid

en

ts

MA Age-Adjusted

US Age Adjusted

Sources: Registry of Vital Records and Statistics, MDPH; Web-based Injury Statistics Query and Reporting System; http://www.cdc.gov/ncipc/wisqars

17.0

29.5

40.6

35.3

U.S: 37% increase

MA: 25% increase 2000-2005 66% increase 2005-2006

Investigation of MA Fall Death Increase, 2005-2006Investigation of MA Fall Death Increase, 2005-2006

Meetings with staff at Office of the Chief Medical Examiner Meetings with staff at Office of the Chief Medical Examiner and the Registry of Vital Records and Statistics; changes and the Registry of Vital Records and Statistics; changes identified.identified.– Increase in ME Certified DeathsIncrease in ME Certified Deaths– A series of trainings provided to staff at the OCME by A series of trainings provided to staff at the OCME by

Registry of Vital Records and StatisticsRegistry of Vital Records and Statistics– Improved identification/ascertainment of deaths Improved identification/ascertainment of deaths

involving falls at the OCMEinvolving falls at the OCME

Investigation of MA Fall Death Increase, 2005-2006 Investigation of MA Fall Death Increase, 2005-2006 (Continued)(Continued)

Hard copies of over 500 death certificates examined for Hard copies of over 500 death certificates examined for information on circumstances and place of fall deathsinformation on circumstances and place of fall deaths

Additional Analyses of the DataAdditional Analyses of the Data– No specific month, geographic place of residence, sex, No specific month, geographic place of residence, sex,

age subgroupage subgroup– Decrease in deaths due to unspecified cause of injuryDecrease in deaths due to unspecified cause of injury– Analysis of nonfatal data sourcesAnalysis of nonfatal data sources

          

Discussions with leading experts on fall surveillance at the Discussions with leading experts on fall surveillance at the Centers for Disease Control and PreventionCenters for Disease Control and Prevention

  

MA Acute Care Hospital Stays and Emergency Department Discharges

Associated with Nonfatal Unintentional Fall Injuries: Trends

Age adjusted hospital stay rates increased 5% Age adjusted hospital stay rates increased 5% from FY2000-FY2006from FY2000-FY2006

Age adjusted emergency department discharge Age adjusted emergency department discharge rates increased 4% from FY2002-FY2006rates increased 4% from FY2002-FY2006

Risk GroupsRisk Groups

Unintentional Fall Injuries, MA Residents Ages 65 Years and Older: Age, Sex, Race

Death and hospital visit rates increase with increasing Death and hospital visit rates increase with increasing age subgroup. age subgroup. – Lowest in residents 65-69 years of age and highest Lowest in residents 65-69 years of age and highest

among residents 95+ years of age. among residents 95+ years of age.

Males have higher fall death rates than females. Males have higher fall death rates than females.

Females have higher hospital stay and ED discharge Females have higher hospital stay and ED discharge rates (all age subgroups). rates (all age subgroups).

5 year average annual fall death rates (2002-2006) were 5 year average annual fall death rates (2002-2006) were highest among Asians and White-NH and lowest among highest among Asians and White-NH and lowest among Hispanics and Black-NH (not statistically significant). Hispanics and Black-NH (not statistically significant).

Unintentional Falls, MA Residents Ages 65 Years and Older: Additional Health Risk

Indicators from 2006 BRFSS

Falls in past 3 months Falls in past 3 months – more prevalent among those disabled and needing more prevalent among those disabled and needing

help (33.6%) than without disability (10.9%). help (33.6%) than without disability (10.9%). – more prevalent among obese vs. non-obese more prevalent among obese vs. non-obese

population (26.7% vs. 14.0%)population (26.7% vs. 14.0%)– more prevalent among those with less than high more prevalent among those with less than high

school vs. college education (25.4% vs. 16.6%) school vs. college education (25.4% vs. 16.6%) – LESS prevalent among those who reported any LESS prevalent among those who reported any

exercise vs. no exercise in the past month (14.2% vs. exercise vs. no exercise in the past month (14.2% vs. 20.4%). 20.4%).

Circumstances and Circumstances and Location of Fall InjuriesLocation of Fall Injuries

Circumstances and Location of Unintentional Fall Injuries, MA Residents

Ages 65 Years and Older

41% of fall deaths (2004-2006), 13% of hospital stays (FY2006) and 8% of emergency department visits (FY2006) associated with fall injury where any specificity of the fall circumstance was known, involved “stairs or steps”.

“Home” was the place of injury in 59% of fall deaths (2006) and 68% of hospital stays* (FY2006); 19% of fall deaths in 2006 occurred in a nursing home and 3% (n=10) occurred in a hospital.

*Place of injury is often missing in the hospital discharge database. The percentage reported is based on cases where information was available.

Types of Injuries SustainedTypes of Injuries Sustained

Hospital Stay Rate Associated with Nonfatal Fall-related Traumatic Brain Injury by Age Group,

MA Residents Ages 65+ Years, FY2000, 2006 (2 year N = 3,249)

0.0

100.0

200.0

300.0

400.0

500.0

600.0

700.0

800.0

Overall65+

65-69 70-74 75-79 80-84 85-89 90-94 95+

Age Group (Years)

Rate/100,000

20002006

• Overall 65+ population experienced a 78% increase. • Unintentional fall deaths associated with a TBI increased 77% among older adults from 2000-2006.

Hospital Stay Rate Associated with Nonfatal Fall-related Hip Fracture by Age Group,

MA Residents Ages 65+ Years, FY2000, 2006 (2 Year N=12,168)

-

1,000.0

2,000.0

3,000.0

4,000.0

5,000.0

6,000.0

Overall65+

65-69 70-74 75-79 80-84 85-89 90-94 95+

Age Group (Years)

Rate/100,000

20002006

Overall 65+ age group 15.8% decline in rate of hip fractures associated with fall-related hospital stay. This is similar to national estimates (15.5% decline from 1993-2003).

Outcomes and Economic CostsOutcomes and Economic Costs

Outcomes and Economic Costs, Unintentional Fall Injuries in Older Adults

56% of hospital stays associated with a fall injury are discharged to an intermediate, long term, skilled care or rest home; 24% are discharged home; 14% to a rehab or chronic hospital; 3% died during their stay. (FY2006) (FY2006)

Total charges for acute care hospital events associated Total charges for acute care hospital events associated with unintentional fall were over $471 million in FY2006. with unintentional fall were over $471 million in FY2006. This does not include 911/EMS, nursing home care, lost This does not include 911/EMS, nursing home care, lost wages, rehab, outpatient visits, etc. wages, rehab, outpatient visits, etc.

Nationally the total cost exceeded $19 billion in 2000 and Nationally the total cost exceeded $19 billion in 2000 and is projected to reach $54.9 billion by 2020 (adjusted to is projected to reach $54.9 billion by 2020 (adjusted to 2007 dollars). (CDC; Englander et al.)2007 dollars). (CDC; Englander et al.)

Conclusion

Fall injuries and deaths among older adults are a serious and increasing public health concern both in MA and nationally.

MA-DPH surveillance data can provide valuable information to monitor the magnitude, trends, risk factors and circumstances of these events in order to efficiently target and evaluate the outcomes of our prevention activities.

Questions?