Nebraska Special Emphasis Report: Fall Injuries among Older Adults 2014

This document was produced in conjunction with CDC's Core Violence and Injury Prevention Program Under Cooperative Agreement 11-1101.

Released [October, 2016]

Unintentional falls among older adults are a leading cause of fatal and nonfatal injury in the U.S. and Nebraska. Hospital costs associated with injuries sustained by falls account for a substantial share of health care dollars spent on injury-related care.

In 2014, 184 Nebraska residents ages 65 and older died and over 15,681 fall injuries were treated at hospitals and emergency departments (Figure 1).

This report provides recent data on unintentional fall injuries and deaths among Nebraska residents ages 65 and older. It includes information about groups with the highest rates, associated costs and current prevention strategies and activities in Nebraska.

FIGURE 1. Burden of Fall Injuries among Residents Ages 65 and o lder—Nebraska, 2014

184Deaths

3,585Hospitalizations

12,096Emergency Department Visits

QUICK FACTS

Residents ages 65 and older account for 85% of all fall deaths and 75% of nonfatal fall hospitalizations in Nebraska.

Falls are a leading cause of traumatic brain injury (TBI) in Nebraska residents ages 65 and older, accounting for 60% of TBI deaths and 83% of TBI hospitalizations. 78% of fall deaths and hospitalizations among older adults were associated with a TBI.

Projected lifetime costs associated with fall injuries in 2014 among Nebraska residents ages 65 and older are estimated to be $335 million.

Each week, there are 233 emergency department visits among residents ages 65 and older, 70 hospitalizations, and 4 deaths due to fall injuries in Nebraska.

In 2014, 59% fall deaths among this age group occurred in the home, while 23% occurred in a residential facility such as a nursing home.

A GROWING CONCERN

Nebraska Special Emphasis Report: Fall Injuries among Older Adults 2014

FALL DEATHS

FIGURE 2. Age-adjusted Rate of Fall Deaths by Sex, Ages 65 and older—Nebraska, 2007-2014

• From 2007 to 2014, the age-adjusted rate of fall deaths increased from 7.2 per 100,000 in 2007 to 9.4 per 100,000 in 2014.

• Fall death rates increased among both males and females during this time period.

• In 2014, the fall death rate in males was approximately 35% higher than in females.

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FIGURE 3. Age-specific Rate of Fall Deaths by Age Group, Ages 65 and older—Nebraska, 2007-2014

• Fall death rates increased only among those ages 85 and older.

• The highest increase was among persons ages 85 and older.

• Rates for persons ages 85 and older increased, from 167 per 100,000 in 2007 to 270 per 100,000 in 2014.

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Nebraska Special Emphasis Report: Fall Injuries among Older Adults 2014

NONFATAL FALL HOSPITALIZATIONS

FIGURE 4. Age-adjusted Rate of Nonfatal Fall Hospitalizations by Sex, Ages 65 and older—Nebraska, 2007-2014

• Nonfatal fall hospitalizations have remained relatively stable. From 2007 through 2010 rates increased slightly, but have been steadily declining since 2010.

• In 2014, rates among females are approximately 1.25 times that of males.

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FIGURE 5. Percent of Nonfatal Fall Hospitalizations by Discharge Disposition, Ages 65 and older—Nebraska, 2014

• 56% of all fall hospitalizations were discharged to a skilled nursing facility.

• Among falls resulting in a hip fracture, 67% were discharged to a skilled nursing facility and 4% discharged to a rehabilitation facility.1

• Among those with a hip fracture, only 3% had a routine discharge to home and 1% were discharged home with home health services. 0%

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All HospitalizedFalls

Hospitalized Fallswith Hip Fracture

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Other discharge type

Routine discharge tohome

Discharged home withhome health careservicesDischarged torehabilitationunit/facilityDischarged to skillednursing facility

1Rehabilitation includes inpatient hospital rehab units as well as other outside facilities.

Nebraska Special Emphasis Report: Fall Injuries among Older Adults 2014

DEMOGRAPHIC DATA TABLE 1. Number and Rate of Fall Deaths and Nonfatal Fall Hospitalizations and Emergency Department (ED) Visits,

Ages 65 and older—Nebraska, 2014

Fall Deaths Nonfatal Fall Hospitalizations and Emergency Department (ED) Visits

Number of Deaths

Death Rate per 100,0002

Number of Hospitalizations

Nonfatal Hospitalization

Rate per 100,0002

Number of ED Visits

Nonfatal ED Visit Rate per

100,0002

TOTAL Sex

Male 83 9.3 1,091 120.5 4,041 441.2 Female 101 6.9 2,494 186.3 8,054 627.8

Age Group Ages 65-74 17 11.7 745 512.6 3769 2593.2 Ages 75-84 54 64.4 1,223 1459.5 4,074 4862.0 Ages 85+ 113 270.0 1,617 3863.6 4,253 10162.0

Race/Ethnicity White, NH3 182 20.3 N/A * N/A * Black, NH 0 0 N/A * N/A * Hispanic 0 0 N/A * N/A * Asian/PI4, NH <5 unreliable N/A * N/A * AI/AN5, NH 0 0 N/A * N/A *

● Males had a higher rate of fall deaths than females (9.3 per 100,000 and 6.9 per 100,000, respectively).

● Females had higher rates for nonfatal hospitalizations and ED visits.

● Persons ages 85 and older had the highest rates of fatal and nonfatal fall injuries. This age group had 24 times the rate of deaths than those aged 65-74.

● White Non-Hispanic residents had the highest rates of fall deaths.

2Rates are age-adjusted except for rates by age group. 3Non-Hispanic 4Pacific Islander 5American Indian/Alaskan Native

Nebraska Special Emphasis Report: Fall Injuries among Older Adults 2014 PROJECTED LIFETIME COSTS

Lifetime costs4 associated with unintentional fall injuries in 2014 among Nebraska residents ages 65 and older are estimated to be over $335 million. Most of these costs were associated with injuries requiring hospitalizations.

Number of Injuries Medical Cost Work Loss Cost Combined Cost

Deaths 184 $5,631,000 $18,014,000 $23,645,000 Hospitalizations 3,585 $147,312,000 $108,153,000 $255,465,000 ED Visits 12,096 $39,307,000 $17,100,000 $56,407,000 TOTAL 15,865 $192,250,000 $143,267,000 $335,517,000

SURVEY DATA • The Behavioral Risk Factor Surveillance Survey

(BRFSS) is a statewide phone survey of community dwelling (i.e. non-institutionalized) Nebraska adults. It provides self-reported data on a variety of topics, including falls, fall-related injuries, and medical conditions.

• In 2014, an estimated 15,671 of Nebraska adults ages 45 and older reported having fallen and 9% reported a fall-related injury in the past 12 months.

• Older Nebraska adults (65 and older) who reported the following conditions were significantly more likely5 to report falls and fall-related injuries in the past 12 months:

poor mental health/depression coronary artery disease (CAD)

diabetes stroke

no exercise disability6

asthma

FIGURE 6. Self-Reported Falls and Fall Injuries in the Past 12 Months, Ages 45 and older--Nebraska, 2014

28.2%

40.3%

9.9%

18.1%

0%

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50%

All Respondents Respondents Reporting aDisability

Perc

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FallsFalls with Injury

• Older adults who reported a physical, cognitive and/or emotional disability6 had particularly high fall rates, with an estimated 40% reporting having fallen and 18% reporting fall-related injuries in the past 12 months.

4Costs were calculated using the CDC’s WISQARS Cost Module application which provides cost estimates for medical and work loss for injury-related deaths, hospitalizations, and emergency department visits. http://www.cdc.gov/injury/wisqars/ . 5These conditions are statistically significant at the (P<.05 level). However, causality shouldn’t be assumed. Selected chronic health conditions: respondents reported “Yes” to EVER having been diagnosed with: Diabetes; Asthma; Stroke; Cancer; Depression; Chronic obstructive pulmonary disease (COPD); Coronary artery disease (CAD)/Angina or with Myocardial infarction. Poor mental health includes persons who reported experiencing 14+ days of poor mental health in the past month. Respondents are asked their height and weight to calculate BMI. Obesity is defined as a BMI greater than or equal to 30.0. Exercise is defined as respondents reporting “No” to ANY leisure-time physical activity. 6Disability is defined as having one or more of the following conditions for at least one year; (1) impairment or health problem that limited activities or caused cognitive difficulties, (2) used special equipment or required help from others to get around.

Nebraska Special Emphasis Report: Fall Injuries among Older Adults 2014

FALL PREVENTION RESOURCES STEADI (Stopping Elderly Accidents Deaths & Injuries): The Centers for Disease Control and Prevention (CDC) is working to make fall prevention a routine part of clinical care. STEADI uses established clinical guidelines and effective strategies to help primary care providers address their older patients' fall risk and identify modifiable risk factors: www.cdc.gov/steadi.

PREVENTION ACTIVITIES IN NEBRASKA

• TAI CHI – MOVING FOR BETTER BALANCE O The Nebraska Injury Prevention Program works in partnership with

local/district health departments to implement Tai Chi in the communities they serve.

• STEPPING ON O Local/district health departments are working with community

partners, including the Area Agency on Aging, to implement Stepping On, an evidence-based fal l prevention program that addresses fall r isks and how to prevent them. They receive support and assistance from the Nebraska Injury Prevention Program.

• NEBRASKA OLDER ADULT FALLS COALITION O Community partners interested in older adult fal l prevention meet

to share resources. Activit ies are planned and implemented each year in observance of Older Adult Fall Prevention Day.

DATA SOURCES and DEFINITIONS Nebraska Death Certificate Data, 2007-2014 Nebraska Hospital Discharge Data, 2007-2014 Nebraska BRFSS data 2014

Nebraska Dept. of Health and Human Services

Injury Prevention Program dhhs.ne.gov/injuryprevention Released October, 2016