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Falls in the Medicare Population: Incidence, Associated Factors, and Impact on Health Care

A Shumway-Cook, PT, PhD, FAPTA, is Professor Emeritus, Department of Rehabilitation Medicine, Box 356490, University of Washington, Seattle, WA 98195-6490 (USA).
MA Ciol, PhD, is Research Associate Professor, Department of Rehabilitation Medicine, University of Washington.
J Hoffman, PhD, is Assistant Professor, Department of Rehabilitation Medicine, University of Washington.
BJ Dudgeon, OT, PhD, is Associate Professor, Department of Rehabilitation Medicine, University of Washington.
K Yorkston, PhD, is Professor, Department of Rehabilitation Medicine, University of Washington.
L Chan, MD, MPH, is Chief, Rehabilitation Medicine Department, Clinical Center, National Institutes of Health, Bethesda, MD 20892-1604.

ashumway{at}u.washington.edu

Background and Purpose: Falls are a major health problem in the elderly community; however, questions regarding incidence, risk factors, and provider response to falls exist. The purpose of this study was to examine the incidence of falls, associated factors, health care costs, and provider response to falls among Medicare beneficiaries.

Participants: The participants were 12,669 respondents to the Medicare Current Beneficiaries Survey (MCBS).

Methods: Categories of number of falls (none, one, recurrent) and injury type (medically injurious versus not medically injurious) were created from the falls supplement to the MCBS. Means and proportions for the entire Medicare population were estimated using sampling weights. The association between sociodemographic variables and fall status was modeled using ordinal or binary logistic regression. Aggregate health costs by fall category were estimated from claims data.

Results: Population estimates of falls reported in 2002 ranged from 3.7 million (single fall) to 3.1 million (recurrent falls), with an estimated 2.2 million people having a medically injurious fall. Recurrent falls were more likely with increased age, being female, being nonwhite, reporting fair or poor health, and increased number of limitations in personal activities of daily living and instrumental activities of daily living and comorbidities. Although estimates of the actual costs of falls could not be determined, "fallers" consistently had larger utilization costs than "nonfallers" for the year 2002. Fewer than half (48%) of the beneficiaries reported talking to a health care provider following a fall, and 60% of those beneficiaries reported receiving fall prevention information.

Discussion and Conclusions: Falls are common and may be associated with significant health care costs. Most importantly, health care providers may be missing many opportunities to provide fall prevention information to older people.

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