Even Minor Injuries from Falls May Inspire Long-Lasting Fears in Seniors

By John Gever
ATLANTA, March 7 -- Nearly 5% of Americans 65 or older are injured in falls every three months, potentially creating fears that may affect the quality of their lives, according to a CDC report.
In telephone survey of some 93,000 people 65 and older, 15.9% (95% CI 15.4% to 16.4%) said they had fallen in the previous three months, reported Judy A. Stevens, Ph.D., and colleagues at CDC's Division of Unintentional Injury Prevention, in the March 7 issue of Morbidity and Mortality Weekly Report.
Of those, 31.3% (95% CI 29.7% to 32.8%) said they were hurt seriously enough to seek treatment or to limit activity for at least a day.
The findings suggest that about 5.8 million older Americans fell every three months and 1.8 million were injured.
MMWR editors commented that "this report presents the first national estimates of the number and proportion of persons experiencing fall-related injuries associated with either restricted activity or doctor visits."
They said that even minor injuries can be life-changing for older people if they create a long-lasting fear of falling. Such fear can lead to self-imposed activity restrictions, social isolation, and depression, they noted.
Dr. Stevens and colleagues said that although frequency of death and major injury from falls have been studied previously, rates of less serious and non-injurious falls are unknown.
They analyzed data from the 2006 Behavioral Risk Factor Surveillance System, an ongoing telephone survey in all 50 states, the District of Columbia, and certain overseas territories, involving some 350,000 people each year.
Respondents answer dozens of questions covering a wide range of health-related issues. The median state-level response rate in the 2006 survey was 51.4%.
The survey included two questions about falls. It asked how many times the respondent had fallen in the previous three months, and how many of those falls caused an injury that limited regular activities or prompted the respondent to see a doctor.
Among those reporting falls, the mean number of falls was 1.9 and the median was 1.0.
About 23% of those who fell said they had fallen at least three times, and up to 50 falls were reported by some respondents.
Among those reporting injury, the mean number of injurious falls was 1.4 and the median was 1.0.
Rates of falling did not differ significantly between men and women (15.2% and 16.4%, respectively). However, women who fell were more likely to suffer injury than were men: 35.7% (95% CI 33.7% to 37.9%) versus 24.6% (95% CI 22.5% to 26.8%).
Not surprisingly, individuals 80 and older fell more frequently than 65- to 69-year-olds, with reported rates of 20.8% (95% CI 19.7% to 21.9%) versus 13.4% (95% CI 12.7% to 14.2%).
But among those who fell, injury rates did not differ significantly between age groups.
By ethnicity, the lowest fall rates were among blacks (13.0%, 95% CI 11.4% to 14.8%) and the highest were in American Indians and Alaska natives (27.8%, 95% CI 19.1% to 38.5%). Both differed significantly from fall rates for whites (15.8%, 95% CI 15.4% to 16.3%).
There was also significant variation in fall rates among states. Vermont recorded the highest rate at 20.1% (95% CI 18.1% to 22.2%) while Hawaii had the lowest with 12.8% (95% CI 10.8% to 15.1%).
Injury rates among people who fell also varied substantially by state. Some 23.7% of Nebraskans who fell said they had been injured (95% CI 18.7% to 29.6%). Among Rhode Islanders who fell, 48.0% were injured (95% CI 40.5% to 55.7%).
Dr. Stevens and colleagues said they saw no geographic pattern in the results and had no other explanation for the variation.
The MMWR editors identified limitations to the study:
The survey excluded households without a landline phone
It also excluded people in institutions, who are known to be at especially high risk for falling
Falls and injuries were self-reported and hence subject to recall bias
The broad definition of injury could have led respondents to report minor falls as injurious, and also did not discriminate between bruises and fractures
The approximately 50% response rate may limit the data's representativeness.
The editors also noted that the questionnaire's three-month time frame is unusual in research on falling, making it difficult to compare the results with those of earlier studies.
No funding information was disclosed.
No potential conflicts of interest were reported.
Additional source: Morbidity and Mortality Weekly ReportSource reference: Stevens JA, et al "Self-reported falls and fall-related injuries among persons aged ≥ 65 years" MMWR 2008; 57: 225-238.