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Falls and Hip Fractures Among Older Adults

By: the National Center for Injury Prevention and Control

How serious is the problem?

  • More than one-third of adults ages 65 years and older fall each year (Hornbrook 1994; Hausdorff 2001).

  • Among older adults, falls are the leading cause of injury deaths (Murphy 2000) and the most common cause of nonfatal injuries and hospital admissions for trauma (Alexander 1992).

  • In 2003 more than 1.8 million seniors age 65 and older were treated in emergency departments for fall-related injuries and more than 421,000 were hospitalized (CDC 2005).

What outcomes are linked to falls?

  • In 2002, nearly 13,000 people ages 65 and older died from fall-related injuries (CDC 2004). More than 60% of people who die from falls are 75 and older (Murphy 2000).

  • Of those who fall, 20% to 30% suffer moderate to severe injuries such as hip fractures or head traumas that reduce mobility and independence, and increase the risk of premature death (Sterling 2001).

  • Among people ages 75 years and older, those who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald 1999).

  • Falls are a leading cause of traumatic brain injuries (Jager 2000).

  • Among older adults, the majority of fractures are caused by falls (Bell 2000).

  • Approximately 3% to 5% of older adult falls cause fractures (Cooper 1992; Wilkins 1999). Based on the 2000 census, this translates to 360,000 to 480,000 fall-related fractures each year.

  • The most common fractures are of the vertebrae, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990).

  • In 2000, direct medical costs totaled $179 million dollars for fatal and $19.3 billion dollars for nonfatal fall injuries (Stevens 2005, in press).

Who is at risk?

  • White men have the highest fall-related death rates, followed by white women, black men, and black women (CDC 2004).

  • Women sustain about 80% of all hip fractures (Stevens 2000).

  • Among both sexes, hip fracture rates increase exponentially with age (Samelson 2002). People ages 85 years and older are 10 to15 times more likely to sustain hip fractures than are people ages 60 to 65. (Scott 1990).

What is the effect of hip fractures?

  • Of all fall-related fractures, hip fractures cause the greatest number of deaths and lead to the most severe health problems and reduced quality of life (Wolinsky 1997; Hall 2000).

  • In 1999 in the United States, hip fractures resulted in approximately 338,000 hospital admissions (Popovic 2001).

  • Most patients with hip fractures are hospitalized for about one week (Popovic 2001). Up to 25% of community-dwelling older adults who sustain hip fractures remain institutionalized for at least a year (Magaziner 2000).

  • In 1991, Medicare costs for hip fractures were estimated to be $2.9 billion (CDC 1996).

  • From 2000 to 2040, the number of people age 65 or older is projected to increase from 34.8 million to 77.2 million. For people over 85, the relative growth rate is even faster (U.S. Bureau of the Census 1998). Given our aging population, by the year 2040, the number of hip fractures is expected to exceed 500,000 (Cummings 1990).

How can seniors reduce their risk of falling?

Through careful scientific studies, researchers have identified a number of modifiable risk factors:

  • Lower body weakness (Graafmans 1996)

  • Problems with walking and balance (Graafmans 1996; AGS 2001)

  • Taking four or more medications or any psychoactive medications (Tinetti 1989; Ray 1990; Lord 1993; Cumming 1998).

Seniors can modify these risk factors by:

  • Increasing lower body strength and improving balance through regular physical activity (Judge 1993; Lord 1993; Campbell 1999). Tai Chi is one type of exercise program that has been shown to be very effective (Wolf 1996; Li 2005).

  • Asking their doctor or pharmacist to review all their medicines (both prescription and over-the-counter) to reduce side effects and interactions. It may be possible to reduce the number of medications used, particularly tranquilizers, sleeping pills, and anti-anxiety drugs (Ray 1990).

Strong studies have shown that some other important fall risk factors are Parkinson’s Disease, history of stroke, arthritis (Dolinis 1997), cognitive impairment (Tromp 2001), and visual impairments (Dolinis 1997; Ivers 1998; Lord 2001). To reduce these risks, seniors should see a health care provider regularly for chronic conditions and have an eye doctor check their vision at least once a year.

What other things may help reduce fall risk?

Because seniors spend most of their time at home, one-half to two-thirds of all falls occur in or around the home (Nevitt 1989; Wilkins 1999). Most fall injuries are caused by falls on the same level (not from falling down stairs) and from a standing height (for example, by tripping while walking) (Ellis 2001). Therefore, it makes sense to reduce home hazards and make living areas safer.

  • Researchers have found that simply modifying the home does not reduce falls. However, environmental risk factors may contribute to about half of all home falls (Nevitt 1989).

  • Common environmental fall hazards include tripping hazards, lack of stair railings or grab bars, slippery surfaces, unstable furniture, and poor lighting (Northridge 1995; Connell 1996; Gill 1999).

To make living areas safer, seniors should:

  • Remove tripping hazards such as throw rugs and clutter in walkways;

  • Use non-slip mats in the bathtub and on shower floors;

  • Have grab bars put in next to the toilet and in the tub or shower;

  • Have handrails put in on both sides of stairways;

  • Improve lighting throughout the home.


Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3.

American Geriatrics Society, et al. Guideline for the prevention of falls in older persons. Journal of the American Geriatrics Society 2001;49:664–672.

Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7.

Campbell AJ, Robertson MC, Gardner MM, Norton RN, Buchner DM. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age and Aging 1999;28:513–18.

Centers for Disease Control and Prevention. Incidence and costs to Medicare of fractures among Medicare beneficiaries aged >65 years—United States, July 1991–June 1992. MMWR 1996;45(41):877–83.

Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2005). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Available from: URL: [Cited 7 Aug 2005].

Centers for Disease Control and Prevention. Web-based Injury Statistics Query and Reporting System (WISQARS) [Online]. (2005). National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (producer). Available from: URL: [Cited 7 Aug 2005]

Connell BR. Role of the environment in falls prevention. Clinics in Geriatric Medicine 1996;12(4):859–80.

Cooper C, Campion G, Melton LJ. Hip fractures in the elderly: a world-wide projection. Osteoporosis International 1992;2(6):285–9.

Cumming RG. Epidemiology of medication-related falls and fractures in the elderly. Drugs and Aging 1998;12(1):43–53.

Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Numbers, costs, and potential effects of postmenopausal estrogen. Clinical Orthopaedics and Related Research 1990;252:163–6.

Dolinis J, Harrison JE, Andrews GR. Factors associated with falling in older Adelaide residents. Australian and New Zealand Journal of Public Health 1997;21(5):462–8.

Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5.

Ellis AA, Trent RB. Do the risks and consequences of hospitalized fall injuries among older adults in California vary by type of fall? Journal of Gerontology: Medial Sciences 2001:56A(11):M686–92.

Gill TM, Williams CS, Robison JT, Tinetti ME. A population-based study of environmental hazards in the homes of older persons. American Journal of Public Health 1999;89(4):553–6.

Graafmans WC, Ooms ME, Hofstee HMA, Bezemer PD, Bouter LM, Lips P. Falls in the elderly: a prospective study of risk factors and risk profiles. American Journal of Epidemiology 1996;143:1129–36.

Hall SE, Williams JA, Senior JA, Goldswain PR, Criddle RA. Hip fracture outcomes: quality of life and functional status in older adults living in the community. Australian and New Zealand Journal of Medicine 2000;30(3):327–32.

Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8):1050–6.

Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: Results from a randomized trial. The Gerontologist 1994:34(1):16–23.

Ivers RQ, Optom B, Cumming RG, Mitchell P, Attebo K. Visual impairment and falls in older adults: the Blue Mountains eye study. Journal of the American Geriatrics Society 1998;46:58–64.

Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992–1994. Academic Emergency Medicine 2000;7(2):134–40.

Judge JO, Lindsey C, Underwood M, Winsemius D. Balance improvements in older women: effects of exercise training. Physical Therapy 1993;73(4):254–65.

Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom E, Wilson NL. Tai chi and fall reductions in older adults: A randomized controlled trial. Journal of Gerontology: Medical Sciences 2005;60A(2):187-94.

Lord SR, Caplan GA, Ward JA. Balance, reaction time, and muscle strength in exercising older women: a pilot study. Archives of Physical and Medical Rehabilitation 1993;74(8):837–9.

Lord SR, Dayhew J. Visual risk factors for falls in older people. Journal of the American Geriatrics Society 2001;49:508–15.

Magaziner J, Hawkes W, Hebel JR, Zimerman SI, Fox KM, Dolan M, et al. Recovery from hip fracture in eight areas of function. Journal of Gerontology: Medical Sciences 2000;55A(9):M498–507.

Murphy SL. Deaths: Final data for 1998. National Vital Statistics Reports, vol. 48, no. 11. Hyattsville (MD): National Center for Health Statistics; 2000.

Nevitt MC, Cumming SR, Kidd S, Black D. Risk factors for recurrent nonsyncopal falls: a prospective study. Journal of the American Medical Association 1989;261(18):2663–8.

Northridge ME, Nevitt MC, Kelsey JL, Link B. Home hazards and falls in the elderly—the role of health and functional status. American Journal of Public Health 1995;85(4):509–15.

Popovic JR. 1999 National Hospital Discharge Survey: Annual summary with detailed diagnosis and procedure data. National Center for Health Statistics. Vital Health Statistics 2001:13(151);23,154.

Ray W, Griffin MR. Prescribed medications and the risk of falling. Topics in Geriatric Rehabilitation 1990;5:12–20.

Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990;16(3):717–40.

Samelson EJ, Zhang Y, Kiel DP, Hannan MT, Felson DT. Effect of birth cohort on risk of hip fracture: age-specific incidence rates in the Framingham Study. American Journal of Public Health 2002;92(5):858–62.

Sterling DA, O'Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma-Injury Infection and Critical Care 2001;50(1):116–9.

Stevens JA, Corso PS, Finkelstein EA, Miller TR. CDC Economic Analysis of Fall-Related Injuries among Older Adults. Injury Prevention 2005;11(5). (in press)

Stevens, JA, Olson S. Reducing falls and resulting hip fractures among older women. In: CDC Recommendations Regarding Selected Conditions Affecting Women’s Health. MMWR 2000;49(RR-2):3–12.

Tinetti ME, Speechley M. Prevention of falls among the elderly. New England Journal of Medicine 1989;320(16):1055–9.

Tromp AM, Pluijm SMF, Smit JH, Deeg DJH, Bouter LM, Lips P. Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly. Journal of Clinical Epidemiology 2001;54:837–44.

U.S. Bureau of the Census. Population Projections Program, Population Division, Washington, D.C. Available:, 2002.

Wilkins K. Health care consequences of falls for seniors. Health Reports 1999;10(4):47–55.

Wolinsky FD, Fitzgerald JF, Stump TE. The effect of hip fracture on mortality, hospitalization, and functional status: a prospective study. American Journal of Public Health 1997;87(3):398–403.

Wolf SL, Barnhart HX, Kutner NG, McNeely E, Coogler C, Xu T. Reducing frailty and falls in older persons: an investigation of Tai Chi and computerized balance training. Atlanta FICSIT Group. Frailty and Injuries: Cooperative Studies of Intervention Techniques. Journal of the American Geriatrics Society 1996; 44(5):489–97.


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