Falls are the leading cause of injury among adults aged ≥65 years (older adults) in
the United States. In 2018, an estimated 3 million emergency department visits, more
than 950,000 hospitalizations or transfers to another facility (e.g., trauma center),
and approximately 32,000 deaths resulted from fall-related injuries among older adults.*
Deaths from falls are increasing, with the largest increases occurring among persons
aged ≥85 years (
1
). To describe the percentages and rates of nonfatal falls by age group and demographic
characteristics and trends in falls and fall-related injuries over time, data were
analyzed from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) and were
compared with data from 2012, 2014, and 2016. In 2018, 27.5% of older adults reported
falling at least once in the past year, and 10.2% reported an injury from a fall in
the past year. The percentages of older adults reporting a fall increased between
2012 and 2016 and decreased slightly between 2016 and 2018. Falls are preventable,
and health care providers can help their older patients reduce their risk for falls.
Screening older patients for fall risk, assessing modifiable risk factors (e.g., use
of psychoactive medications or poor gait and balance), and recommending interventions
to reduce this risk (e.g., medication management or referral to physical therapy)
can prevent older adult falls (https://www.cdc.gov/steadi).
BRFSS is a landline and mobile telephone survey conducted annually in all 50 U.S.
states, the District of Columbia (DC), and U.S. territories, with a median response
rate of 49.9% in 2018. The survey collects information on health-related behavioral
risk factors and chronic conditions among noninstitutionalized U.S. adults aged ≥18
years.
†
Information on falls and fall-related injuries is recorded every 2 years from adults
aged ≥45 years by asking “In the past 12 months, how many times have you fallen?”
If the response was one or more times, the respondent was asked “How many of these
falls caused an injury? By an injury, we mean the fall caused you to limit your regular
activities for at least a day or to go see a doctor.” Responses to each of these questions
ranged from 0 to 76 falls or fall-related injuries. Rates were calculated as the average
number of falls and fall-related injuries per 1,000 older adults. Both questions were
dichotomized to calculate the percentage of older adults who reported having at least
one fall or fall-related injury.
Using 2018 BRFSS data, percentages and rates were calculated by age group for demographic
(sex and race/ethnicity) and geographic (urban/rural status) characteristics. Functional
characteristics (blind/difficulty seeing, difficulty dressing/bathing, difficulty
walking/climbing stairs, difficulty doing errands alone, and difficulty concentrating/making
decisions) also were compared, as were self-reported health status and data on taking
part in any physical activity/exercise in the past month. Analysis was restricted
to respondents aged ≥65 years residing in the 50 states and DC. Any respondents with
missing values or responses of “Don’t know/Not sure” or “Refused” for falls or fall-related
injuries were excluded. Overall, 4.8% of respondents were excluded from the analysis
of falls, leaving 142,834; and 4.9% were excluded from the analysis of fall-related
injuries, leaving 142,591. Two-sample t-tests were used to compare percentages across
characteristics. Linear trend tests were conducted for age group and self-reported
health status. BRFSS data from 2012, 2014, 2016, and 2018 were used to examine trends
in the percentages of adults aged ≥65 years who had fallen or had a fall-related injury
and rates of falls overall and by age group. Polynomial linear regression was used
to assess linearity of trends (
2
). Where nonlinear trends were detected, two-sample t-tests with Bonferroni adjustments
for multiple comparisons were performed to determine differences between years (
2
). Because the BRFSS questions about falls differed in three states (Michigan, Oregon,
and Wisconsin) for 2012, compared with other years, the trend analysis was limited
to 47 states and DC. All results presented are weighted to represent the U.S. population.
Analysis was conducted using SAS-callable SUDAAN (version 11; RTI International) to
account for the complex survey design.
In 2018, 27.5% of adults aged ≥65 years reported at least one fall in the past year
(Table 1), and 10.2 % of adults aged ≥65 years reported at least one fall-related
injury (Table 2). In the preceding year, an average of 714 falls (Table 1) and an
average of 170 fall-related injuries were reported per 1,000 older adults (Table 2),
or approximately 35.6 million falls and 8.4 million fall-related injuries. The percentage
of adults aged ≥65 years reporting a fall or a fall-related injury increased with
age (p<0.001). Among adults aged ≥85 years, 33.8% reported a fall (Table 1) and 13.9%
reported a fall-related injury (Table 2). Overall, a higher percentage of women reported
at least one fall (29.1%; p<0.001) or fall-related injury (11.9%; p<0.001) than did
men in the past year (25.5% reported a fall and 7.9% reported a fall-related injury).
However, when stratified by age group, the percentages of adults aged ≥85 years reporting
a fall (32.8% of women and 35.7% of men; p = 0.184) or fall-related injury (14.3%
of women and 13.4% of men; p = 0.553) did not differ significantly by sex. A lower
percentage of blacks (22.5%; p<0.001) and Asian/Pacific Islanders (15.6%; p<0.001)
reported a fall than did whites (28.3%) (Table 1), and a higher percentage of American
Indian/Alaska Natives (15.2%) reported a fall-related injury than did whites (10.2%;
p = 0.008) (Table 2). The percentages of older adults reporting a fall decreased as
health status improved (p<0.001) (Table 1). Overall, a higher percentage of older
adults living in rural areas (29.5%) reported a fall compared with those living in
urban areas (27.0%; p<0.001); however, when stratified by age group, this was only
true for persons aged 65–74 years (Table 1). Regardless of age group, older adults
reporting difficulties with functional abilities reported a higher percentage of falls
and fall-related injuries than did those without these difficulties (p<0.001). A lower
percentage of older adults who reported any physical activity in the past month reported
a fall (24.9%) compared with those who did not report physical activity (33.1%; p<0.001),
regardless of age group.
TABLE 1
Number of falls, percentages of adults reporting a fall, and rates* of self-reported
falls in the past year among adults aged ≥65 years, by age group and selected characteristics
(unweighted n = 142,834) — Behavioral Risk Factor Surveillance System, United States,
2018
Age group/Characteristic
No.† reporting a fall
% (95% CI)§
Rate* of falls (95% CI)
Total (all aged ≥65 years)
Overall
13,685,662
27.5 (26.9–28.0)
714 (689–739)
Sex
Male
5,629,838
25.5 (24.6–26.3)
735 (694–775)
Female
8,026,432
29.1 (28.3–29.8)
695 (664–727)
Race/Ethnicity
¶
White
10,898,569
28.3 (27.8–28.9)
738 (710–765)
Black
4,260,153
22.5 (20.4–24.7)
526 (455–597)
American Indian/Alaska Native
325,910
32.2 (27.3–37.5)
1,169 (845–1494)
Asian/Pacific Islander
237,985
15.6 (10.9–21.8)
250 (167–334)
Hispanic
1,039,618
28.1 (24.7–31.7)
677 (555–799)
Multiple/Other
193,208
29.6 (26.3–33.2)
1,333 (859–1,807)
Geography
Urban
11,024,283
27.0 (26.4–27.7)
682 (653–710)
Rural
2,661,031
29.5 (28.5–30.4)
858 (805–910)
Self-reported health
Excellent
974,558
16.4 (15.0–18.0)
288 (254–323)
Very good
3,201,506
21.9 (21.1–22.8)
420 (393–446)
Good
4,423,458
26.6 (25.6–27.7)
615 (573–657)
Fair
3,246,406
36.8 (35.2–38.3)
1,102 (1,030–1,173)
Poor
1,789,371
48.1 (45.8–50.5)
2,057 (1,872–2,242)
Functional characteristics
Blind/Difficulty seeing
Yes
1,611,580
42.1 (39.5–44.9)
1,500 (1,343–1,658)
No
12,013,980
26.2 (25.6–26.8)
646 (622–670)
Difficulty concentrating
Yes
2,398,304
48.5 (46.1–50.9)
1,798 (1,660–1,936)
No
11,133,899
25.0 (24.5–25.6)
584 (562–607)
Difficulty walking/climbing stairs
Yes
6,218,999
46.3 (45.0–47.6)
1,562 (1,488–1,637)
No
7,386,736
20.4 (19.9–21.0)
397 (377–418)
Difficulty performing errands alone
Yes
2,578,010
53.0 (50.6–55.3)
1,994 (1,845–2,142)
No
11,017,965
24.6 (24.1–25.2)
573 (550–595)
Difficulty dressing/bathing
Yes
1,584,599
58.7 (55.6–61.7)
2,496 (2,258–2,735)
No
12,068,592
25.6 (25.1–26.2)
610 (588–633)
Any physical activity in past month
Yes
8,431,996
24.9 (24.2–25.5)
583 (555–612)
No
5,227,220
33.1 (32.0–34.2)
989 (938–1,040)
65–74 years
Overall
7,619,118
25.9 (25.2–26.6)
700 (668–733)
Sex
Male
3,224,096
23.3 (22.2–24.4)
702 (654–750)
Female
4,378,780
28.2 (27.2–29.2)
698 (654–741)
Race/Ethnicity
¶
White
5,832,525
26.3 (25.6–27.0)
721 (685–758)
Black
588,611
21.7 (19.4–24.1)
537 (437–638)
American Indian/Alaska Native
72,207
33.9 (27.7–40.7)
1,323 (856–1,790)
Asian/Pacific Islander
182,037
17.8 (11.6–26.4)
269 (160–378)
Hispanic
685,669
28.5 (24.2–33.3)
660 (544–776)
Multiple/Other
112,714
28.2 (24.2–32.4)
1,273 (766–1,781)
Geography
Urban
6,107,062
25.4 (24.5–26.2)
663 (627–698)
Rural
1,511,825
28.2 (27.0–29.5)
871 (798–944)
Self-reported health
Excellent
572,626
15.2 (13.3–17.2)
260 (228–292)
Very good
1,831,360
20.3 (19.3–21.4)
391 (361–421)
Good
2,357,029
24.7 (23.4–26.0)
589 (532–647)
Fair
1,893,376
37.3 (35.2–39.4)
1,180 (1,080–1,280)
Poor
941,100
47.9 (45.1–50.8)
2,255 (2,012–2,499)
Functional characteristics
Blind/Difficulty seeing
Yes
828,168
42.7 (38.7–46.8)
1,548 (1,341–1,754)
No
6,758,376
24.6 (23.9–25.4)
638 (607–670)
Difficulty concentrating
Yes
1,362,936
50.9 (47.6–54.1)
1,944 (1,773–2,115)
No
6,175,049
23.2 (22.6–23.9)
566 (536–597)
Difficulty walking/climbing stairs
Yes
3,189,778
47.3 (45.4–49.1)
1,735 (1,626–1,844)
No
4,388,844
19.4 (18.8–20.1)
389 (364–415)
Difficulty performing errands alone
Yes
1,258,886
56.5 (52.9–60.0)
2,366 (2,127–2,604)
No
6,313,271
23.3 (22.6–24.0)
561 (532–590)
Difficulty dressing/bathing
Yes
855,277
59.6 (55.3–63.8)
2,689 (2,365–3,014)
No
6,749,735
24.1 (23.4–24.8)
598 (568–627)
Any physical activity in past month
Yes
4,900,264
23.3 (22.5–24.0)
574 (538–610)
No
2,707,832
32.5 (30.8–34.1)
1,013 (946–1,079)
75–84 years
Overall
4,424,372
28.5 (27.5–29.5)
707 (664–750)
Sex
Male
1,744,922
27.3 (25.6–28.9)
748 (670–826)
Female
2,671,039
29.4 (28.1–30.8)
679 (631–728)
Race/Ethnicity
¶
White
3,660,879
29.8 (28.7–30.8)
742 (694–790)
Black
289,006
23.4 (18.7–28.8)
488 (397–579)
American Indian/Alaska Native
24,161
29.2 (22.0–37.7)
1,022 (657–1,386)
Asian/Pacific Islander
45,914
—**
—
Hispanic
267,023
24.8 (19.7–30.6)
498 (377–619)
Multiple/Other
62,832
31.1 (24.8–38.2)
—
Geography
Urban
3,573,520
28.2 (27.0–29.4)
683 (634–732)
Rural
850,758
29.9 (28.3–31.6)
816 (731–901)
Self-reported health
Excellent
305,524
17.9 (15.5–20.7)
328 (234–422)
Very good
1,031,504
23.5 (21.9–25.2)
443 (385–502)
Good
1,528,297
28.8 (26.9–30.8)
625 (569–682)
Fair
959,740
34.5 (32.0–37.0)
1,017 (892–1,143)
Poor
579,025
44.9 (40.5–49.3)
1,756 (1,454–2,058)
Functional characteristics
Blind/Difficulty seeing
Yes
482,311
39.8 (35.9–43.8)
1,461 (1,189–1,732)
No
3,929,486
27.6 (26.5–28.6)
643 (602–683)
Difficulty concentrating
Yes
681,990
44.3 (40.8–47.8)
1,672 (1,417–1,927)
No
3,705,749
26.7 (25.6–27.8)
599 (560–638)
Difficulty walking/climbing stairs
Yes
2,134,694
45.1 (42.9–47.4)
1,435 (1,314–1,556)
No
2,264,615
21.1 (20.1–22.2)
385 (353–416)
Difficulty performing errands alone
Yes
814,654
50.3 (46.4–54.2)
1,906 (1,642–2,169)
No
3,590,020
25.9 (24.9–26.9)
566 (529–603)
Difficulty dressing/bathing
Yes
486,255
58.0 (52.6–63.3)
2,423 (2,018–2,828)
No
3,927,919
26.8 (25.8–27.8)
608 (569–647)
Any physical activity in past month
Yes
2,667,197
26.3 (25.0–27.6)
571 (525–617)
No
1,746,501
32.7 (31.0–34.5)
963 (874–1,052)
≥85 years
Overall
1,642,172
33.8 (31.8–35.9)
816 (719–913)
Sex
Male
660,820
35.7 (32.3–39.2)
931 (755–1,107)
Female
976,613
32.8 (30.3–35.4)
733 (621–846)
Race/Ethnicity
¶
White
1,405,165
35.3 (33.2–37.5)
817 (737–897)
Black
79,686
26.0 (20.3–32.6)
580 (393–766)
American Indian/Alaska Native
8,547
—
—
Asian/Pacific Islander
10,034
—
—
Hispanic
86,926
39.8 (26.6–54.7)
—
Multiple/Other
17,663
35.0 (22.3–50.2)
789 (439–1,139)
Geography
Urban
1,343,701
33.4 (31.1–35.8)
795 (682–908)
Rural
298,448
35.7 (31.8–39.9)
916 (773–1,059)
Self-reported health
Excellent
96,407
21.6 (17.1–26.9)
373 (288–459)
Very good
338,642
28.0 (24.6–31.6)
544 (462–625)
Good
538,133
30.9 (27.7–34.3)
726 (549–902)
Fair
393,290
40.5 (35.5–45.7)
934 (791–1,078)
Poor
269,246
58.1 (51.6–64.4)
2,051 (1,418–2,685)
Functional characteristics
Blind/Difficulty seeing
Yes
301,101
44.7 (37.8–51.8)
1,435 (974–1,897)
No
1,326,118
31.9 (29.8–34.1)
714 (628–800)
Difficulty concentrating
Yes
353,378
48.9 (41.0–56.8)
1,527 (1,091–1,962)
No
1,253,102
30.9 (29.0–32.8)
654 (601–707)
Difficulty walking/climbing stairs
Yes
894,527
45.8 (42.4–49.2)
1,275 (1,094–1,457)
No
733,277
25.8 (23.2–28.5)
506 (395–617)
Difficulty performing errands alone
Yes
504,470
49.5 (44.9–54.2)
1,319 (1,073–1,565)
No
1,114,674
29.4 (27.3–31.7)
679 (575–783)
Difficulty dressing/bathing
Yes
243,067
56.9 (49.4–64.1)
1,991 (1,314–2,668)
No
1,390,938
31.5 (29.4–33.7)
701 (617–784)
Any physical activity in past month
Yes
864,536
31.9 (29.2–34.7)
704 (584–824)
No
772,887
36.4 (33.4–39.5)
960 (800–1,119)
Abbreviation: CI = confidence interval.
* Weighted number of falls per 1,000 adults aged ≥65 years.
† Weighted number of adults aged ≥65 years reporting at least one fall in the past
year. Because of varying question-specific nonresponse, sample sizes might vary among
questions.
§ Weighted percentage of adults aged ≥65 years reporting at least one fall in the
past year.
¶ Whites, blacks, American Indians/Alaska Natives, Asians/Pacific Islanders, and others/unknown
were non-Hispanic; Hispanics could be of any race.
** Dashes indicate sample size <50 or relative standard error >30%.
TABLE 2
Number of fall-related injuries, percentage of adults reporting a fall-related injury,
and rates* of self-reported fall-related injuries in the past year among adults ≥65
years by age group and select characteristics (unweighted n = 142,591) — Behavioral
Risk Factor Surveillance System, United States, 2018
Age group/Characteristic
No.† reporting a fall-related injury
% of fall-related injuries§ (95% CI)
Rate* of fall-related injuries (95% CI)
Total (all aged ≥65 years)
Overall
5,051,046
10.2 (9.8–10.6)
170 (160–179)
Sex
Male
1,753,182
7.9 (7.4–8.6)
140 (125–155)
Female
3,285,921
11.9 (11.4–12.5)
193 (181–204)
Race/Ethnicity
¶
White
3,927,593
10.2 (9.9–10.6)
170 (161–178)
Black
373,817
8.8 (7.1–10.8)
122 (99–144)
American Indian/Alaska Native
49,235
15.2 (11.4–19.9)
360 (183–536)
Asian/Pacific Islander
107,711
—**
90 (39–142)
Hispanic
422,695
11.5 (9.2–14.1)
192 (132–251)
Multiple/Other
73,334
11.3 (9.2–13.7)
—
Geography
Urban
4,112,951
10.1 (9.6–10.6)
167 (157–178)
Rural
937,957
10.4 (9.8–11.1)
180 (161–199)
Self-reported health
Excellent
322,006
5.4 (4.3–6.9)
65 (51–79)
Very good
972,529
6.7 (6.1–7.3)
81 (74–89)
Good
1,518,761
9.2 (8.5–9.8)
133 (122–145)
Fair
1,294,112
14.7 (13.6–15.9)
263 (238–289)
Poor
917,291
24.9 (23.0–26.9)
624 (535–713)
Functional characteristics
Blind/Difficulty seeing
Yes
742,101
19.6 (17.4–21.9)
436 (354–519)
No
4,281,945
9.4 (9.0–9.8)
147 (140–155)
Difficulty concentrating
Yes
1,104,754
22.5 (20.6–24.6)
489 (425–552)
No
3,888,940
8.7 (8.4–9.1)
133 (125–141)
Difficulty walking/climbing stairs
Yes
2,704,665
20.3 (19.2–21.3)
407 (376–438)
No
2,315,536
6.4 (6.0–6.8)
82 (76–88)
Difficulty performing errands alone
Yes
1,318,985
27.3 (25.1–29.7)
587 (524–651)
No
3,693,519
8.3 (7.9–8.6)
124 (116–132)
Difficulty dressing/bathing
Yes
833,239
31.2 (28.3–34.4)
724 (619–829)
No
4,198,368
8.9 (8.6–9.3)
138 (130–145)
Any physical activity in past month
Yes
2,918,250
8.6 (8.1–9.1)
131 (121–140)
No
2,120,902
13.5 (12.7–14.3)
253 (232–274)
65–74 years
Overall
2,743,633
9.3 (8.8–9.9)
160 (148–171)
Sex
Male
958,537
6.9 (6.3–7.6)
123 (108–138)
Female
1,775,596
11.4 (10.7–12.2)
191 (175–208)
Race/Ethnicity
White
1,999,023
9.0 (8.6–9.5)
155 (144–166)
Black
226,321
8.4 (6.9–10.2)
126 (100–153)
American Indian/Alaska Native
35,860
16.9 (11.9–23.9)
452 (191–714)
Asian/Pacific Islander
95,225
—
—
Hispanic
299,340
12.5 (9.5–16.3)
180 (136–224)
Multiple/Other
42,830
10.7 (8.6–13.3)
—
Geography
Urban
511,500
9.3 (8.7–9.9)
160 (146–173)
Rural
2,232,054
9.6 (8.8–10.4)
161 (146–176)
Self-reported health
Excellent
173,443
4.6 (3.1–6.8)
54 (35–73)
Very good
571,453
6.3 (5.6–7.1)
79 (69–89)
Good
744,975
7.8 (7.2–8.5)
116 (103–128)
Fair
765,642
15.1 (13.5–17.0)
276 (238–314)
Poor
477,503
24.5 (22.3–26.9)
649 (540–758)
Functional characteristics
Blind/Difficulty seeing
Yes
402,881
21.0 (17.5–24.9)
486 (366–605)
No
2,326,598
8.5 (8.0–9.0)
136 (128–145)
Difficulty concentrating
Yes
642,512
24.2 (21.4–27.3)
529 (454–604)
No
2,064,220
7.8 (7.3–8.3)
121 (111–130)
Difficulty walking/climbing stairs
Yes
1,408,428
21.0 (19.6–22.5)
452 (407–496)
No
1,324,451
5.9 (5.4–6.4)
73 (67–80)
Difficulty performing errands alone
Yes
650,112
29.4 (26.0–33.0)
717 (600–834)
No
2,072,807
7.6 (7.2–8.1)
114 (106–121)
Difficulty dressing/bathing
Yes
454,702
32.0 (28.4–35.9)
766 (633–899)
No
2,280,876
8.2 (7.7–8.7)
128 (118–138)
Any physical activity in past month
Yes
1,620,337
7.7 (7.2–8.3)
121 (108–133)
No
1,118,474
13.4 (12.3–14.7)
258 (234–282)
75–84 years
Overall
1,634,953
10.6 (9.8–11.3)
170 (156–185)
Sex
Male
547,968
8.6 (7.4–9.9)
141 (118–164)
Female
1,085,428
12.0 (11.1–12.9)
192 (173–210)
Race/Ethnicity
White
1,355,522
11.0 (10.3–11.8)
179 (164–195)
Black
115,601
9.3 (5.4–15.7)
112 (61–162)
American Indian/Alaska Native
7,702
9.4 (5.6–15.4)
179 (78–280)
Asian/Pacific Islander
9,402
—
—
Hispanic
90,085
8.4 (5.9–11.8)
135 (82–187)
Multiple/Other
21,322
10.6 (7.5–14.8)
173 (99–246)
Geography
Urban
1,338,288
10.6 (9.7–11.5)
167 (151–183)
Rural
296,606
10.4 (9.5–11.5)
185 (149–222)
Self-reported health
Excellent
112,211
6.6 (4.8–8.9)
80 (56–103)
Very good
301,804
6.9 (5.9–8.0)
82 (69–94)
Good
538,594
10.2 (8.7–11.8)
139 (120–157)
Fair
382,369
13.8 (12.3–15.4)
260 (220–300)
Poor
286,516
22.3 (19.2–25.7)
527 (408–647)
Functional characteristics
Blind/Difficulty seeing
Yes
190,201
15.8 (13.4–18.5)
338 (258–419)
No
1,440,008
10.1 (9.4–10.9)
156 (142–170)
Difficulty concentrating
Yes
294,225
19.2 (16.6–22.2)
398 (324–472)
No
1,326,930
9.6 (8.8–10.4)
145 (131–159)
Difficulty walking/Climbing stairs
Yes
889,083
18.9 (17.1–20.8)
360 (320–401)
No
731,862
6.8 (6.2–7.5)
86 (76–96)
Difficulty performing errands alone
Yes
404,429
25.2 (21.3–29.4)
511 (432–591)
No
1,222,743
8.8 (8.2–9.5)
130 (118–143)
Difficulty dressing/Bathing
Yes
248,895
30.1 (24.0–37.0)
636 (524–749)
No
1,379,549
9.4 (8.8–10.1)
144 (130–157)
Any physical activity in past month
Yes
964,611
9.5 (8.6–10.5)
141 (125–157)
No
665,922
12.5 (11.4–13.7)
226 (198–254)
≥85 years
Overall
672,460
13.9 (12.5–15.4)
227 (179–276)
Sex
Male
246,677
13.4 (11.0–16.2)
265 (148–382)
Female
424,896
14.3 (12.7–16.1)
205 (175–236)
Race/Ethnicity
White
573,048
14.5 (13.0–16.1)
222 (186–257)
Black
31,894
10.5 (7.1–15.2)
119 (74–164)
American Indian/Alaska Native
5,673
—
—
Asian/Pacific Islander
3,084
—
—
Hispanic
33,270
—
—
Multiple/Other
9,182
—
—
Geography
Urban
542,610
13.6 (12.1–15.2)
216 (163–268)
Rural
129,850
15.6 (12.1–19.8)
283 (155–410)
Self-reported health
Excellent
36,352
8.2 (5.3–12.3)
96 (59–133)
Very good
99,273
8.2 (6.5–10.4)
100 (77–123)
Good
235,192
13.6 (11.4–16.1)
216 (150–282)
Fair
146,101
15.1 (12.5–18.2)
203 (165–241)
Poor
153,272
33.4 (26.5–41.1)
788 (367–1210)
Functional characteristics
Blind/Difficulty seeing
Yes
149,020
22.4 (17.6–28.0)
—
No
515,339
12.5 (11.1–14.0)
187 (154–221)
Difficulty concentrating
Yes
168,017
23.4 (17.8–30.2)
532 (234–831)
No
497,790
12.3 (11.1–13.7)
174 (150–198)
Difficulty walking/climbing stairs
Yes
407,155
21.0 (18.5–23.7)
366 (261–470)
No
259,223
9.1 (7.6–10.9)
133 (91–174)
Difficulty performing errands alone
Yes
264,445
26.2 (22.1–30.7)
424 (311–536)
No
397,969
10.5 (9.3–11.9)
174 (120–227)
Difficulty dressing/bathing
Yes
129,643
30.9 (24.5–38.2)
—
No
537,943
12.2 (10.9–13.7)
176 (144–207)
Any physical activity in past month
Yes
333,302
12.3 (10.5–14.4)
171 (142–201)
No
336,507
15.9 (13.8–18.3)
298 (194–403)
Abbreviation: CI = confidence interval.
* Weighted number of fall-related injuries per 1,000 older adults.
† Weighted number of adults aged ≥65 years reporting at least one fall-related injury
in the past year. Because of varying question-specific nonresponse, sample sizes might
vary among questions.
§ Weighted percentage of older adults reporting at least one fall-related injury in
the past year.
¶ Whites, blacks, American Indians/Alaska Natives, Asians/Pacific Islanders, and others/unknown
were non-Hispanic; Hispanics could be of any race.
** Dashes indicate sample size <50 or relative standard error >30%.
Among states in which falls and fall injuries were consistently reported across years
(excluding Michigan, Oregon, and Wisconsin where data in 2012 were reported differently
than in other years), the percentage of those older adults reporting a fall increased
from 27.9% in 2012 to 29.6% in 2016 (p<0.001) and decreased to 27.4% in 2018 (p<0.001)
(Figure). The rates of falls and fall-related injuries and the percentages of older
adults reporting a fall-related injury did not significantly change from 2012 to 2018.
FIGURE
Percentages and rates of self-reported falls and fall-related injuries among adults
aged ≥65 years, by age group — Behavioral Risk Factor Surveillance System, United
States,* 2012–2018
* Data from Michigan, Oregon, and Wisconsin were omitted because of the difference
in the way these states collected information about falls during 2012, compared with
the rest of the states.
The figure is a series of four panels showing the percentages and rates of self-reported
falls and fall-related injuries among adults aged ≥65 years, by age group, in the
United States, from data reported in the Behavioral Risk Factor Surveillance System
in 2012, 2014, 2016, and 2018.
Discussion
The percentage of older adults reporting a fall increased from 2012 to 2016, followed
by a modest decline from 2016 to 2018. Although statistically significant, these changes
were small. Even with this decrease in 2018, older adults reported 35.6 million falls.
Among those falls, 8.4 million resulted in an injury that limited regular activities
for at least a day or resulted in a medical visit. In the United States, health care
spending on older adult falls has been approximately $50 billion annually (
3
). In 2018, approximately 52 million adults were aged ≥65 years
§
by 2030, this number will increase to approximately 73 million.
¶
Despite no significant changes in the rate of fall-related injuries from 2012 to 2018,
the number of fall-related injuries and health care costs can be expected to increase
as the proportion of older adults in the United States grows.
Adults aged ≥85 years were more likely to report a fall or fall-related injury in
the preceding year than were those aged <85 years. Currently, adults aged ≥85 years
account for <2% of the population; by 2050 this proportion is projected to increase
to 5%. Many fall risk factors increase with age, including chronic health conditions
related to falls, increased use of medications, and functional decline (
4
). More research is needed to determine how fall risk factors differ among persons
aged ≥85 years and to identify targeted interventions that could adequately address
the needs of these adults.
The findings in this report are subject to at least five limitations. First, because
BRFSS data are self-reported, they are subject to recall bias, especially for falls
that did not result in injury or that occurred several months before the survey (
5
). Second, this survey is cross-sectional. Although functional abilities, health status,
and physical activity were all associated with falls and fall-related injuries, it
is not possible to determine whether these factors preceded the fall or resulted from
a fall. Third, BRFSS does not include older adults living in nursing homes, which
might have led to an underestimation of falls and fall-related injuries, especially
among adults aged ≥85 years (
6
). Fourth, the response rate (median response rate of 49.9%) could result in non-response
bias, however BRFSS data are weighted to adjust for some of this bias. Finally, the
results of the trend analyses were derived from only four time points. Future analyses
with more time points might describe these trends with more certainty.
Regardless of age group, higher percentages of older adults who reported no physical
activity in the past month or reported difficulty with one or more functional characteristics
(difficulty walking up or down stairs, dressing and bathing, and performing errands
alone) reported falls and fall-related injuries. These risk factors are frequently
modifiable suggesting that, regardless of age, many falls might be prevented. Older
adults of any age can, together with their health care providers, take steps to reduce
their risk for falls. CDC created the Stopping Elderly Accidents, Deaths & Injuries
(STEADI) initiative, which offers tools and resources for health care providers to
screen their older patients for fall risk, assess modifiable fall risk factors, and
to intervene with evidence-based fall prevention interventions (https://www.cdc.gov/steadi).
These include medication management, vision screening, home modifications, referral
to physical therapists who can address problems with gait, strength, and balance,
and referral to effective community-based fall prevention programs. As the proportion
of older adults living in the United States continues to grow, so too will the number
of falls and fall-related injuries. However, many of these falls are preventable.
To help keep older adults living independently and injury-free, reducing fall risk
and fall-related injuries is essential.
Summary
What is already known about this topic?
Falls are the leading cause of injury among adults aged ≥65 years, who in 2014 experienced
an estimated 29 million falls, resulting in 7 million fall-related injuries.
What is added by this report?
In 2018, 27.5% of adults aged ≥65 years reported at least one fall in the past year
(35.6 million falls) and 10.2% reported a fall-related injury (8.4 million fall-related
injuries). From 2012 to 2016, the percentages of these adults reporting a fall increased,
and from 2016 to 2018, the percentages decreased.
What are the implications for public health practice?
Falls and fall-related injuries are highly prevalent but are preventable. Health care
providers play a crucial role and can help older adults reduce their risk for falls.