The NCSL Blog

25

By Rachel Goodman

Just late last year, U.S. Supreme Court Justice Ruth Bader Ginsburg made national news after falling in her office.

Justice Ruth Bader GinsburgGinsburg, 85 years old at the time, fractured three ribs as a result of the fall and was briefly hospitalized, but returned to work just six days later.

Ginsburg’s experience reflects a growing health issue in the U.S.: falls among older adults. In 2014 alone, an estimated 28% of individuals aged 65 and older fell, though less than half reported their fall to a doctor. Ginsburg did report her fall to a physician and was able to recover relatively quickly, but this is not the case for many other older adults.

In recent years, the frequency of fall-related injuries and fatalities has increased, and falls are now the leading cause of fatal injury among older adults. Older adult falls are mostly preventable.

CDC falls chartTo raise awareness about older adult falls, the National Council on Aging (NCOA) has established an annual Falls Prevention Awareness Day (FPAD). This year, FPAD was held Sep. 23, and the NCAO hosted various webinars, chats and live video broadcasts about fall prevention.

Preventing elderly falls has become increasingly important as the prevalence of fall-related injuries and fatalities grows. Between 2000 and 2016, the total number of deaths from falls among adults aged 75 and older nearly tripled from 8,613 to 25,189.

Falling ranks among the leading causes of traumatic brain injuries (TBI) and hip fractures. The Centers for Disease Control and Prevention (CDC) estimates that 1 in 5 older adult falls cause a serious injury such as a TBI or broken bones.

In addition to their negative impacts on health, older adult falls lead to high costs both for individuals and health systems. With more than 800,000 older adults hospitalized for fall-related injuries each year, it is no surprise that annual medical costs for falls total $50 billion. Of this amount, Medicare pays $29 billion, Medicaid pays $9 billion, and private insurance and out-of-pocket payments account for the remaining $12 billion.

While these figures account for direct medical costs such as rehabilitation and hospital care, they do not account for indirect costs related to the long-term effects of falls. In particular, they do not account for the cost of long-term services and supports (LTSS) which an individual may require after sustaining a fall. LTSS are designed for individuals with functional limitations who need assistance with daily activities such as dressing, bathing and preparing meals. These services can be very expensive and are often covered by Medicaid, adding to the total economic burden of older adult falls.

State Action

As the negative health effects and economic toll of older adult falls grow more severe, various states have enacted legislation to address the issue. Connecticut, New Mexico, New York and Washington established statewide fall prevention programs dedicated to raising awareness and providing resources to older adults. Similarly, some states, such as Utah, established fall prevention commissions or workgroups to develop recommendations for preventing falls.

Some states have attempted to reduce the prevalence of elderly falls in other ways. For example, Minnesota requires unlicensed personnel in assisted living facilities to complete fall prevention training, and Washington requires long-term care workers to complete core competency training, which includes fall prevention training.

Additional state strategies for fall prevention involve engaging health care providers and pharmacists, who play a vital role in preventing falls among older adults. Specific strategies include facilitating better medication management to prevent falls and providing incentives to primary care providers to integrate falls risk assessments and fall prevention activities into their practice.

Federal Initiatives

Various federal agencies and professional organizations also recognize the significant role the provider-patient relationship can play in preventing older adult falls. For example, the CDC’s Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative offers resources about falls for health care providers as well as patients. STEADI provides information and training to providers about screening and managing fall risk.

The CDC recently developed resources for pharmacists, who can assist in the prevention of elderly falls through proper medication management. As part of this initiative, the CDC created the Community Pharmacy Algorithm for Fall Risk Screening, Assessment, and Care Coordination. The American Society of Consultant Pharmacists and the NCOA also collaborated to develop the Falls Risk Reduction Toolkit, which was designed as a pharmacist’s companion to STEADI.

Additional Resources

Rachel Goodman is an intern in the NCSL Health Program.

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About the NCSL Blog

This blog offers updates on the National Conference of State Legislatures' research and training, the latest on federalism and the state legislative institution, and posts about state legislators and legislative staff. The blog is edited by NCSL staff and written primarily by NCSL's experts on public policy and the state legislative institution.