David C. Schwartz, Ph.D.
Cofounder, The ElderCare Companies, Inc.
Fall-caused injuries among elders have become a huge, growing, costly, deadly public health crisis in America. This brief note provides some key facts which may help Emergency Departments initiate or intensify fall prevention activities. Two suggestions are offered as to the ways in which ED physicians can achieve better fall prevention outcomes.
A1. At least 2.5 million geriatric ED visits per year are caused by fall-related injuries.1 AHRQ reports that about 17% of all ED visits are for injuries; 21% are geriatrics; 71% of these elders are in the ED for fall injuries.2
A2. While the number of persons 65+ went up 27% in America3 from 2002-2013, the majority of fall-caused geriatric injury visits to U.S. emergency departments jumped by 52%; ED arranged admission of fall-injured elders leap by 87%; and, the rate of visits ending in hospitalizations (compared to treat and release) went up by 28%. These skyrocketing numbers exceed but parallel those of all geriatric injury visits to U.S. EDs. Fall-caused ED visits have ranged from 58% to 61% of all geriatric ED injury visits in the recent past. Hospitalizations are about 28% higher for falls then for “all injuries”; the percent increase in hospitalizations from 2002 to 2013 is almost identical for elder fall injuries as to all geriatric injuries.4
A3. The importance or centrality of the ED in any meaningful geriatric fall prevention effort in the United States can be seen in the following facts:
- 75% of all fall injury hospitalizations come through the ED5
- 54% of these hospitalized elders are discharged to nursing homes (compared to 29% for ‘all causes’)6
- Of CDC’s estimated $30 billion per year in the cost of fall injuries, 65% are due to hospitalizations and 20% are due to ED visits.7
A4. The rapid increase in the population of the “old, old” (i.e., persons at or above age 85) is important to note here because the rate of all injuries doubles for every decade over 65 (such that elders 75-84 are fall-injured 200% more frequently and those over 85 are 400% more likely to be fall-injured than the 65-74 year old cohort). Costs are 175% higher for those 75-84 and 200% higher for those 85+ than for the 65-75 year old cohort.)8
A5. Fractures accounted for 41% of elder ED visits; contusions approximated 33%; open wounds about 21%. Women represent about 70% of ED fall-injured elders and approximately 75% of geriatric fall-caused fracture victims. Men are significantly higher in the percent of fall-caused TBI patients in US EDs.9
A6. Focus groups and face-to-face interviews with leading ED physicians indicated the following:
a) Few fall-injured geriatric patients receive rigorous observations on the reasons for their fall. Modern observations of balance, gait, vision,
hearing, lower limb muscle strength, fear of falling, clinical depression (all of them correlate with falling) are rarely employed in most EDs.
b) A significant number of geriatric fall-injured ED patients leave the hospital without follow-up medical appointments.
c) A significant number of geriatric fall-injured ED patients return to the same ED for 2nd or repeat falls.
d) A high percentage of ED physicians would likely refer high fall-risk patients to a nearby Center of Excellence in geriatric fall prevention.
e) An even higher percentage of ED physicians expressed interest in taking an 8-hour on-line course in geriatric fall prevention.
Centers of Excellence on geriatric fall prevention in or near EDs and courses on fall prevention for emergency physicians are seen as useful injury prevention initiatives.