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A Tool Kit to Prevent Senior Falls: The Costs of Fall Injuries Among Older Adults


By: the National Center for Injury Prevention and Control


The Problem

  • Falls are a serious public health problem among older adults. More than a third of adults aged 65 years or older fall each year (Hornbrook 1994; Hausdorff 2001).
  • Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes (Alexander 1992).
  • Of those who fall, 20% to 30% suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death (Alexander 1992).


Calculating Cost Estimates

  • The cost of fall-related injuries is often expressed in terms of direct costs.
    • Direct costs include out-of-pocket expenses and charges paid by insurance companies for the treatment of fall-related injuries. These include costs and fees associated with hospital and nursing home care, physician and other professional services, rehabilitation, community-based services, the use of medical equipment, prescription drugs, local rehabilitation, home modifications, and insurance administration (Englander 1996).
    • Direct costs do not account for the long-term consequences of these injuries, such as disability, decreased productivity, or reduced quality of life.
      The Costs of Fall-Related Injuries
  • A recent study of people aged 72 and older found that the average health care cost of a fall injury was $19,440 (including hospital, nursing home, emergency room, and home health care, but not physician services)(Rizzo 1998).
  • The total cost of all fall injuries for people age 65 or older in 1994 was $27.3 billion (in current dollars) (Englander 1996). By 2020, the cost of fall injuries is expected to reach $43.8 billion (in current dollars) (Englander 1996).


Fall-related Fractures

  • The most common fall-related injuries are osteoporotic fractures. These are fractures of the hip, spine, or forearm.
  • In the United States in 1986, the direct medical costs for osteoporotic fractures were $11.3 billion. By 1989, these costs exceeded $11.5 billion (Norris 1992).
  • A study published in 1994 estimated that total direct medical costs for osteoporotic fractures among postmenopausal women in the next 10 years would be more than $61.2 billion (Chrischilles 1994).


Hip Fractures

  • Of all fall-related fractures, hip fractures are the most serious and lead to the greatest number of health problems and deaths.
  • In the United States, hospitalization accounts for 44% of direct health care costs for hip fracture patients (Barrett-Connor 1995). In 1991, Medicare costs for this injury were estimated to be $4.7 billion (CDC 1996).
  • Hospital admissions for hip fractures among people over age 65 have steadily increased, from 230,000 admissions in 1988 to 338,000 admissions in 1999 (Popovic 2001). The number of hip fractures is expected to exceed 500,000 by the year 2040 (Cooper 1992; Brainsky 1997).
  • Assuming 5% inflation and the growing number of hip fractures, the total annual cost of these injuries is projected to reach $240 billion by the year 2040 (Cummings 1990).


References

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.

Barrett-Connor E. The economic and human costs of osteoporotic fracture. American Journal of Medicine 1995;98 (suppl 2A):2A–3S to 2A–8S.

Brainsky GA, Lydick E, Epstein R, Fox KM, Hawkes W, Kashner TM, et al. The economic cost of hip fractures in community-dwelling older adults: a prospective study. Journal of the American Geriatrics Society 1997;45:281–7.

CDC. 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.

Chrischilles E, Shireman T, Wallace R. Costs and health effects of osteoporotic fractures. Bone 1994;15(4):377–86.

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

Cummings SR, Rubin SM, Black D. The future of hip fractures in the United States. Clinical Orthopaedics and Related Research 1990;252:163-6.

Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996;41(5):733–46.

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.

Norris RJ. Medical costs of osteoporosis. Bone 1992;13:S11–6.

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):154.

Rizzo JA, Friedkin R, Williams CS, Nabors J, Acampora D, Tinetti ME. Health care utilization and costs in a Medicare population by fall status. Medical Care 1998;36(8): 1174–88.

 
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