Falls.

Falls in elderly persons create a tremendous individual and social burden. Of the more than 147 million injury-related emergency department visits logged each year, falls account for approximately 24%, representing the leading cause of external injury.1 Children and elderly persons comprise the largest group responsible for this percentage. Compared with children, however, older adults are 10 times more likely to be hospitalized and 8 times more likely to die as the result of their fall.2 Notably, the number of falls increases with age in both men and women, across all ethnic groups.3–5 The injury rate for falls is also highest among elderly persons, particularly among those older than 85 years,6 although falls do not only involve the very old. Some 20% to 30% of persons older than 65 years will sustain a serious fall in the coming year, which translates to an estimated 7 million falls annually.7,8 The estimated cost of caring for elderly persons who fall is exceedingly high—as much as $12.4 billion per year.9 Among elderly persons, falls typically occur in various places, including hospitals, nursing homes, and private homes. For hospitals, falls generally represent the single largest category of reported incidents10; indeed, hospital-based falls are rapidly becoming a major worldwide epidemiologic problem.11 Homebased and nursing home falls also cause great concern. Between 15% and 44.9% of falls in elderly persons take place in the home, and as many as 60% of nursing home residents experience a fall at some point during their institutionalization.12 Consequently, implementing preventive measures to prevent falls in elderly persons should be a major goal of primary care practitioners interested in enabling their elderly patients to continue to live and function independently. Prevention of falls in elderly persons takes on added significance in light of the potential sequelae of these falls. Of greatest concern is the significant mortality associated with falls in an aged population. Falls cause 70% of accidental deaths in persons age 75 years and older.13 Roughly 9500 deaths of elderly persons in the United States each year are directly associated with falls.14 Although elderly persons represent only 12% of the US population, they account for 75% all deaths from falls.15 Approximately 25% of elderly persons who sustain a hip fracture as a result of a fall die within 6 months of their injury; more than 50% of those who survive are discharged to nursing homes, and nearly 50% of these patients will still be in the nursing home a year later.16 There are other significant morbidities associated with falls in an aged population. The length of hospitalization for elderly persons who fall and survive the event is roughly twice as long as that of elderly patients who are admitted to hospitals for other reasons.17 In addition, those who fall are at greater risk for experiencing functional declines in activities of daily living and participation in physical and social activities that can often lead to institutionalization.18,19 Of nursing home residents who fall each year, half will have multiple episodes, often resulting in significant injuries; head trauma, soft-tissue injuries, fractures (including hip fractures), and dislocations are most common.20 It is estimated that for each of the next few years, at least 340,000 hip fractures will occur in elderly persons as a result of falls, increasing to double this amount by the middle of the 21st century.21 The physical impairment associated with falls may also be accompanied by emotional difficulties. Fear of future falls may limit the activities of elderly persons who