The Problem

• Falls are a serious public health problem among older adults. In the United States, one of every three people 65 years and older falls each year.^1,2
• Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.³
• Of those who fall, 20-30% suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death.³

Calculating Cost Estimates

• The cost of fall-related injuries is usually expressed in terms of direct costs.
• Direct costs include out-of-pocket expenses and charges paid by insurance companies for the treatment of fall-related injuries. These include costs and fees associated with hospital and nursing home care, physician and other professional services, rehabilitation, community-based services, the use of medical equipment, prescription drugs, local rehabilitation, home modifications, and insurance administration.
• Direct costs do not account for the long term consequences of these injuries, such as disability, decreased productivity, or quality of life.

The Costs of Fall-Related Injuries

• In 1994, the average direct cost for a fall injury was $1,400 for a person over the age of 65.⁴
• The total direct cost of all fall injuries for people age 65 and older in 1994 was $20.2 billion.⁴
• By 2020, the cost of fall injuries is expected to reach $32.4 billion.⁴

Fall-related Fractures

• The most common fall-related injuries are osteoporotic fractures. These are fractures of the hip, spine, or forearm.
• In the United States in 1986, the direct medical costs for osteoporotic fractures were $5.15 billion. By 1989, these costs exceeded $6 billion.⁵
• Over the next 10 years, total direct medical costs for osteoporotic fractures among postmenopausal women will be more than $45.2 billion.⁶

Hip Fractures

• Of all fall-related fractures, hip fractures are the most serious and lead to the greatest number of health problems and deaths.
• In the United States, hospitalization accounts for 44% of direct health care costs for hip fracture patients.⁷
• In 1991, Medicare costs for this injury were estimated to be $2.9 billion.⁵
• Hospital admissions for hip fractures among people over age 65 have steadily increased, from 230,000 admissions in 1988 to 340,000 admissions in 1996.8 The number of hip fractures is expected to exceed 500,000 by the year 2040.9,¹⁰
• A recent study found that the cost of a hip fracture, including direct medical care, formal nonmedical care, and informal care provided by family and friends, was between $16,300 and $18,700 during the first year following the injury.¹⁰
• Assuming 5% inflation and the growing number of hip fractures, the total annual cost of these injuries may reach $240 billion by the year 2040.¹¹

References

1. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. New England Journal of Medicine 1988;319(26):1701-7.
2. Sattin RW. Falls among older persons: A public health perspective. Annual Review of Public Health 1992;13:489-508.
3. Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health 1992;82(7):1020-3.
4. Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996;41(5):733-46.
5. CDC. Incidence and costs to Medicare of fractures among Medicare beneficiaries aged >65 years--United States, July 1991-June 1992. MMWR 1996;45(41):877-83.
6. Chrischilles E, Shireman T, Wallace R. Costs and health effects of osteoporotic fractures. Bone 1994;15(4):377-86.
7. Barrett-Connor, Elizabeth. The economic and human costs of osteoporotic fracture. American Journal of Medicine 1995;98 (suppl 2A):2A-3S to 2A-8S.
8. Graves EJ, Owings MF. 1996 summary: National hospital discharge survey. Advance data from vital and health statistics; no. 301. Hyattsville, MD: National Center for Health Statistics, 1998.
9. Cooper C, Campion G, Melton LJ III. Hip fractures in the elderly; a world-wide projection. Osteoporosis International 1992;2:285-9.
10. Brainsky GA, Lydick E, Epstein R, Fox KM, Hawkes W, Kashner TM, Zimmerman SI, Magaziner J. The economic cost of hip fractures in community-dwelling older adults: A prospective study. Journal of the American Geriatrics Society 1997;45:281-7.
11. Schneider EL, Guralnick JM. The aging of America: Impact on health care costs.
12. Journal of the American Medical Association 1990;263(17):2335-40.