BACKGROUND: Falls are common among adults 65 and older. In Minnesota, the numbers of fall deaths among older adults keeps increasing, for both males and females. Falls not only result in death, but also frequently result in injury, disability, hospitalization and institutionalization. We explore whether the increase in falls is associated with an increase in frailty among older adults. Earlier investigations have not shown an association between falls and comorbidities on our death certificate data, probably due to limited documentation by medical examiners and coroners. Hospital discharge data offers another opportunity to explore the relation between falls and frailty (as measured by comorbidities) because of better documentation for billing purposes.
METHODS: We investigate hospital-treated cases due to falls among 65 years and older in Minnesota during 2010-2014.
RESULTS: We found 32,891 cases for women and 17,620 cases for males in 2014. These numbers have been increasing since 2010, at a rate of an additional 2000 cases per year for females, and 1,300 cases per year for males. Individuals 85 years and older represent 40% of total falls. However, for those 65 and older, the increase has been in the ED-only cases, which have increased from an age-adjusted rate of 2,941.6 per 100,000 to 3,318.1, an average increase of 92 per 100,000 per year. The rate of hospitalization decreased from 1,563.9 per 100,000 in 2010 to 1,427.9 in 2014. The frequent complications associated with falls include head injury (19.8%), intertrochanteric fractures and femoral neck fractures (11.2%), urinary tract infections (1.6%) and pneumonia/sepsis (1.6%). Although the causes of falls are complex, individual characteristics that increase an individual's tendency to fall, such as muscle weakness, osteoarthritis, visual impairment, dementia, age-associated comorbidities, such as hypertension (28%), diabetes (18%), cardiovascular disease (16%) are considered to be important risk factors. The number of patients who had multiple comorbidities has been increasing since 2010; 7% of total cases in 2014 had both hypertension and diabetes, 2% of total cases had all of hypertension, diabetes and cardiovascular disease.
CONCLUSIONS: The rapid increase in hospital-treated falls is very concerning. Frailty can be measured by the number of important comorbidities; such as hypertension, diabetes, visual impairment, cardiovascular disease, and the number of hospital/emergency room visits. The increase in frailty accounts for some of the increase in ED-treated falls.