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June 11, 2002
Madame Chairwoman and Members of the Subcommittee, the Centers for Disease Control and Prevention welcomes this opportunity to provide this statement for the record on the issue of falls among older Americans. CDC is working with our Federal and non-federal partners in addressing the serious consequences older Americans face as a result of falls; identifying opportunities to improve the health and safety of older Americans; and reducing the negative economic impact that falls produce in our rapidly aging nation.
The Nature of the Problem
Falls represent a serious public health problem in the United States. One of every three older Americans—about 12 million seniors—fall each year.
Data show that falls are the leading cause of injury death among people 65 years and older. In 1999, more than 10,000 older adults died from fall-related injuries. This number will increase as the number of people over age 65 continues to grow.
Nonfatal falls are also significant. Falls are the most common cause of hospital admissions for traumatic injuries. In 2000 alone, 1.6 million seniors were seen in emergency departments for fall injuries. Every year, falls among older people cost the nation more than $20.2 billion in direct medical costs. By 2020, the total annual cost of these injuries is expected to reach $32.4 billion. Annual Medicare costs for hip fractures is almost $3 billion. These economic costs are significant.
Of all fall-related injuries, hip fractures not only cause the greatest number of injury deaths, but they also lead to the most severe health problems and reduced quality of life. Women sustain 75-80% of all hip fractures and the rate increases sharply from age 65 to 85. One out of three women will have a hip fracture by age 90. In 1999, there were over 300,000 hospital admissions for hip fractures, 77% were women.
The impact of hip fractures is significant, both in terms of quality of life and economically. Only half of community-dwelling older adults who sustain a hip fracture can live independently one year later. This contributes to the fear of falling and loss of independence which are a great concern of older adults. In a recently published study, 80% of the older adults in the study said they would rather be dead than experience the loss of independence and quality of life from a bad hip fracture and admission to a nursing home.
What we know about falls
Risk factors for falls include muscle weakness, balance and walking problems, taking four or more medications (and taking certain types of medications), vision problems, certain chronic diseases (such as Parkinson's Disease, arthritis, stroke), previous falls, and having multiple risk factors. In one study, the risk of falling increased from 10% to as high as 69% as the number of risk factors increased from one to four or more. This kind of information is the foundation for developing effective prevention strategies.
Research has demonstrated a number of ways to prevent falls and the negative consequences of the resulting injuries: • Multi-component programs: Several studies have shown that programs that involve multiple components – usually exercise, medication review, vision correction and environmental changes in the home – are effective in reducing falls and fall injuries in people living in the community.
CDC activities to prevent falls
CDC is committed to preventing older adult falls and ensuring healthy aging, and is already investing in a comprehensive approach to tackling this public-health issue. This approach includes:
Understanding the problem of falls among older adults through data collection and analyses
CDC collects data on the number of people who die, are hospitalized or visit emergency departments from falls. National and state-level data about deaths and emergency department visits are available to researchers and the public through CDC's interactive, web-based system called WISQARS (Web-based Injury Statistics Query and Reporting System) at www.cdc.gov/ncipc/wisqars. People can use WISQARS to create reports and maps that help them understand the problem in their communities.
Developing and testing interventions to reduce falls and their consequences
CDC has funded studies to evaluate risk factors for falls and research to explore interventions to prevent falls.
Sharing information on proven strategies
What is needed now?
Use proven interventions – We have interventions that work, but need to learn how best to provide them to older adults who are at risk for falls. The multi-faceted programs that combine exercise, medication review, vision correction and environmental changes in the home are shown to have an impact in trials, but we need to learn how best to provide these on a broad scale. We need to work with health care providers to ensure that people at highest risk are identified and receive interventions, and also evaluate how best to deliver falls prevention services to older adults.
Evaluate promising interventions – Further work is needed to evaluate different exercise programs and to learn how to increase the use of hip pads among frail older adults. Health status varies greatly among older adults, as does the risk of falling. Research is needed to identify which interventions work best in different subgroups of older adults. Research on the cost-effectiveness of different strategies for caring for an older person with a fracture, including whether or not the availability of care at a designated trauma center improves outcomes, could be helpful to decisionmakers.
Develop and test new interventions – New interventions are needed to decrease the risk of falling and decrease the risk of injury when older people fall. These interventions could include those that require behavior change, but also those that result from changes in the environment. Better understanding of the biomechanics – that is, what happens to the human body during a fall – may lead to new environmental interventions to decrease fall and injury risk, such as improved flooring. Better understanding of how older people interact with their environment may also provide new avenues for prevention.
Because of major strides in medicine and public health, we Americans are continuing to live longer—and healthier—lives. As a result, injuries among older Americans now ranks with heart disease and stroke as a major contributor to death and disability among this population.
Fortunately, we have made great strides in learning how to reduce the chances of falling and to mitigate the impact of a fall that occurs. We know, for example, there are many steps people can take themselves to prevent falls. Older adults can reduce their risk by doing certain kinds of exercise. They can make their living spaces safer by removing tripping hazards, using nonslip mats in the tub and shower, improving lighting in the house and installing grab bars and stair rails. They can have their doctor review their medications for side effects and interactions and have their eyes examined each year.
Still, there is a compelling need to identify and eliminate barriers to implementing proven interventions and new interventions need to be developed which are appropriate to the many different subgroups of older adults. Those that work with older Americans in the community, in nursing homes, and where elders receive counseling services need to have knowledge of, and access to, the best information on programs and interventions. As our society ages, the burden of falls in older adults will increase. We as a nation must act now to prevent falls and fall injuries among older adults.
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Last revised: June 12, 2002