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While definitions vary, researchers typically define a fall as the occasion in which an individual loses their balance causing them to hit the ground or other object at a lower level.1 Falls occur at home, the workplace, school, or in recreational settings. They can occur while walking on a flat surface, ascending or descending from a staircase, or when standing on an object such as a ladder or step stool. Falls can also occur from substantial height, such as falling from a window or roof top. The location and the circumstances of falls vary by age group.

Unintentional falls are the leading cause of nonfatal injuries seen in emergency departments in the United States among all age groups except 10- to 24-year olds where they are the second leading cause.2 In the past 15 years, the rate of fatal falls remained relatively constant among individuals less than 65 years old (Fig. 171-1). In contrast, the fatal fall rate among older adults, persons 65 and older, has increased considerably (Fig. 171-1).2

FIGURE 171-1

Fall deaths and death rates by age group and year, United States, 2001–2017. (Source: Data from Centers for Disease Control and Prevention: Web-based Injury Statistics Query and Reporting System (WISQARS).

Given the high and increasing burden among older adults, more research has been conducted and reported on the circumstances and prevention of falls among persons 65 and older. Therefore, this chapter focuses primarily on older adults, yet also touches upon what is known about falls among infants, children, and adults younger than 65. This includes an overview of the predominant risk factors and circumstances associated with falls, the health and economic burden, and effective strategies for preventing falls for all age groups. We also spotlight global trends in falls.


Incidence and Mortality

In 2017, falls accounted for 24% (5,620,191 fall injuries) of all unintentional injuries among infants, children, and adults less than 65 years of age.2 The occurrence of nonfatal fall injuries resulting in emergency department (ED) visits or hospitalizations has a “U”-shaped curve representing a large number of injuries among infants and toddlers 1–2 years of age followed by a decrease until age 65 when nonfatal fall injury rates rise again (Fig. 171-2). Deaths from falls among individuals under 65 are relatively infrequent, occurring at a rate of 1.9 per 100,000 individuals.2

FIGURE 171-2

Rate of emergency department visits and hospitalizations for fall injuries by age and sex, United States, 2017. (Source: Data from Centers for Disease Control and Prevention: Web-based Injury Statistics Query and Reporting System (WISQARS).

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