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How Governments Are Tackling a Deadly Threat to Seniors: Falling

Fall injuries among older adults cost Medicare almost as much as cancer treatment last year.

Falls are the leading cause of injury and injury-related deaths among older adults and cost more than $30 billion a year in medical charges.

A recent report by the Centers for Disease Control and Prevention (CDC) found that nationally just over 10 percent of older Americans reported an injury from a fall in the past year. The report tracked falls and fall injuries for adults age 65 and over in each state, discovering sizable variation across different regions of the country.

About 13 percent of older adults in Missouri reported suffering a fall-related injury -- the highest rate nationally -- with California, Oregon and Montana not too far behind. Other states like Hawaii, Louisiana, Maryland and Mississippi record significantly lower rates between 7 and 8.9 percent.

Demographics play a key role as some groups are more prone to falls than others. Women and those who are 85 years and older suffer fall-related injuries at higher rates.

It’s also likely a greater problem in states with more low-income residents since, according to the report, injures are more prevalent among older adults in households reporting annual incomes of less than $25,000. The poor are more likely to suffer from diseases or other conditions that increase the risk of falling and often lack access to care, according to Kathleen Cameron, who heads the National Falls Prevention Resource Center. 

Hawaii posted the lowest rate of any state for both falls and fall-related injures, with 7 percent of adults age 65 and up reporting fall injuries. Cameron says the state’s falls prevention coalition is one of the more robust such efforts nationally and has played a large role in limiting injuries. Nearly all states maintain falls prevention coalitions, typically led by state health departments or other public agencies. 

The health department in Hawaii teamed up with health providers and grocery stores to push public awareness campaigns that included advertising on buses and at bus stops as well as adding pamphlets at pharmacies. Pharmacists at participating stores further offered free balance tests and reviewed and identified medications of seniors that could contribute to falls. Hawaii is also one of the few states, according to Cameron, to employ a dedicated falls prevention specialist. 

At the federal level, the Administration for Community Living has in recent years awarded grants supporting evidence-based falls prevention programs to several state and local health agencies and nonprofit groups. “Nationally, there’s a lot more interest in falls prevention, and awareness is increasing because of the high cost,” said Cameron.

Medicare costs for nonfatal falls nearly equaled expenses for cancer treatments in 2015, according to the CDC. A recent study published in the Journal of Safety Research estimated that medical costs stemming from fatal and nonfatal fall injuries amounted to $32 billion nationally in 2015. The CDC estimates that figure will swell to more than $67 billion by 2020.

Neighborhoods with both older housing stocks and aging populations might also see more fall-related injuries. Older homes with poor lighting and no bathrooms on the main floor, for example, lead to greater risks. Research has found that modifying living environments using multifaceted intervention approaches has yielded promising results. To this end, a few local jurisdictions offer funding to support home modifications. The District of Columbia, for example, initiated a program where occupational therapists conduct home assessments then develop a list of changes aimed at mitigating the risk of falls and other safety concerns.

A growing number of localities are pushing fall prevention as part of larger efforts to become more “age-friendly.” In Los Angeles, Mayor Eric Garcetti ordered department heads to consider the city’s aging population when developing new strategic plans or policy changes. A city task force is developing plans to better align public infrastructure and public services with the needs of older residents.

In addition, leaders from the public, private and nonprofit sectors are further developing a three-year action plan aimed at making the region more age-friendly. They recognize the issue isn't going away -- the Los Angeles metro area’s population of older adults is expected to double between 2010 and 2030.

State Fall Injury Data for Age 65+ Population

This map shows percentages of surveyed adults age 65 and over who reported suffering a fall injury over the preceeding 12 months. Data was reported as part of the CDC's Behavioral Risk Factor Surveillance System telephone survey. Results are subject to a few limitations, such as the data being all self-reported and not including individuals in long-term care facilities.

SOURCE: CDC 2014 Behavioral Risk Factor Surveillance System

Mike Maciag is Data Editor for GOVERNING.
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