Alexis R. Santos-Lozada, PhD

Credit: media.psu.edu

Older adults in the 65-and-older age bracket have increased rates of deaths caused by falling between 1999 and 2020, according to recent findings, although rates for every subgroup did not dramatically shift over the same period.¹

In 2020, there were a reported 42,114 deaths in the US connected to falls and 86% of them among those aged 65 years or older.² A greater analysis of the issue has been acknowledged as a potential way to address fall death rates since the 1990s.³

Consequently, these new findings on rates since 1999 partially resulted from the widely agreed upon need to study demographic differences in falls among different subgroups of elderly adults in the US. This new study on fall trends was authored by Alexis R. Santos-Lozada, PhD, from the Department of Human Development and Family Studies at Pennsylvania State University.

“More recent calls have also emphasized the need to study racial and ethnic differences in falls among older adults in the US,” Santos-Lozada wrote. “This study examined trends in deaths from falls among US adults aged 65 years or older by sex and by race and ethnicity between 1999 and 2020.”

Background and Findings

Santos-Lozada conducted an analysis of data collected from the Centers for Disease Control and Prevention's WONDER platform on deaths due to falls between 1999 and 2020. He specifically examined deaths where falls were recorded as the underlying cause, as classified by International Statistical Classification of Diseases and Related Health Problems.

Age-adjusted mortality rates (AAMRs) were calculated by Santos-Lozada per 100,000 people for adults aged 65 years or over, by race, ethnicity, and sex The AAMRs were used by Santos-Lozada to account for differences in age structures and allow for direct comparisons across groups.

Mortality rate ratios (MRRs) were also calculated to compare rates in 2020 with rates in 1999. Annual percentage changes (APCs) in AAMRs were calculated and significance was defined by Santos-Lozada as P < .05 (2-sided), and as the study used only de-identified aggregate data, it was considered to be nonhuman research.

Overall, Santos-Lozada reported that the number of deaths from falls among adults in the age bracket of 65 years or older indicated a rise in number from 10,097 in 1999 to 36,508 in 2020. These results indicate a rise in the overall age-adjusted mortality rate from 29.4 to 69.4 deaths per 100,000.

There were several key statistics that his research into fall deaths resulted in, including the following:

• Mortality rate was higher for men than women
• Mortality was higher for White and American Indian or Alaska Native elderly adults compared to Hispanic, Asian or Pacific Islander, and African American elderly adults
• The rise in mortality rates was found to be significant for all subgroups and was also reported to be greatest among women and White adults

The study also found that the mortality rate ratio increased for adults aged 65 years or older and every subgroup, and the trend was also found to be significant at P < .001 for all subgroups.

Specifically, Santos-Lozada reported that overall AAMRs rose from 29.4 (95% CI, 28.8 - 30.0) to 69.4 (95% CI, 68.7 - 70.1) deaths per 100 000, adding that the AAMRs per 100 ,000 according to statistics relating to sex were as follows: 38.3 for men in 1999 and 81.8 in 2020; 24.3 for women in 1999 and 60.4 in 2020.

This study was noted as having some limitations, including that the underlying cause of death was based on the death certificate, and this may lead to misclassification. Additionally, while no substantial changes in the coding of deaths from 1999 to 2020, the increased reporting quality may partly explain the significant rise in falls mortality.

“Given the increase in mortality due to falls among adults aged 65 years or older, continued work to prevent falls and reduce fall-related mortality is warranted,” Santos-Lozada wrote.

References

1. ^{Santos-Lozada AR. Trends in Deaths From Falls Among Adults Aged 65 Years or Older in the US, 1999-2020. JAMA. 2023;329(18):1605–1607. doi:10.1001/jama.2023.3054.}
2. ^{Centers for Disease Control and Prevention. CDC WONDER: about underlying cause of death, 1999-2020. Accessed November 28, 2022. https://wonder.cdc.gov/ucd-icd10.html.00.}
3. ^{Sattin RW. Falls among older persons: a public health perspective. Annu Rev Public Health. 1992;13(79):489-508. doi:10.1146/annurev.pu.13.050192.002421.}