1. Unintentional Fall Injuries and Deaths Among MA Older Adults, Ages 65 Years and Over Carrie Huisingh, MPH, Epidemiologist Holly Hackman, MD, MPH, Epidemiologist Injury Prevention and Control Program Massachusetts Department of Public Health October 2008

2. Background Falls 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!

3. 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

4. Magnitude and Trends

5. 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

6. Age Adjusted Unintentional Fall Death Rates MA and US Residents Ages 65 Years and Older, 2000-2006 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

7. Investigation of MA Fall Death Increase, 2005-2006 Meetings with staff at Office of the Chief Medical Examiner and the Registry of Vital Records and Statistics; changes identified. –Increase in ME Certified Deaths –A series of trainings provided to staff at the OCME by Registry of Vital Records and Statistics –Improved identification/ascertainment of deaths involving falls at the OCME

8. Investigation of MA Fall Death Increase, 2005-2006 (Continued) Hard copies of over 500 death certificates examined for information on circumstances and place of fall deaths Additional Analyses of the Data –No specific month, geographic place of residence, sex, age subgroup –Decrease in deaths due to unspecified cause of injury –Analysis of nonfatal data sources Discussions with leading experts on fall surveillance at the Centers for Disease Control and Prevention

9. MA Acute Care Hospital Stays and Emergency Department Discharges Associated with Nonfatal Unintentional Fall Injuries: Trends Age adjusted hospital stay rates increased 5% from FY2000-FY2006 Age adjusted hospital stay rates increased 5% from FY2000-FY2006 Age adjusted emergency department discharge rates increased 4% from FY2002-FY2006

10. Risk Groups

11. Unintentional Fall Injuries, MA Residents Ages 65 Years and Older: Age, Sex, Race Death and hospital visit rates increase with increasing age subgroup. –Lowest in residents 65-69 years of age and highest among residents 95+ years of age. Males have higher fall death rates than females. Females have higher hospital stay and ED discharge rates (all age subgroups). 5 year average annual fall death rates (2002-2006) were highest among Asians and White-NH and lowest among Hispanics and Black-NH (not statistically significant).

12. 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 help (33.6%) than without disability (10.9%). –more prevalent among obese vs. non-obese population (26.7% vs. 14.0%) –more prevalent among those with less than high school vs. college education (25.4% vs. 16.6%) –LESS prevalent among those who reported any exercise vs. no exercise in the past month (14.2% vs. 20.4%).

13. Circumstances and Location of Fall Injuries

14. 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.

15. Types of Injuries Sustained

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

17. 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) 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).

18. Outcomes and Economic Costs

19. Outcomes and Economic Costs, Unintentional Fall Injuries in Older Adults (FY2006) 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) Total charges for acute care hospital events associated with unintentional fall were over $471 million in FY2006. This does not include 911/EMS, nursing home care, lost wages, rehab, outpatient visits, etc. Nationally the total cost exceeded $19 billion in 2000 and is projected to reach $54.9 billion by 2020 (adjusted to 2007 dollars). (CDC; Englander et al.)

20. 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.

21. Questions?