Fall Injury Episodes Among Noninstitutionalized Older Adults: United States, 2001–2003

16 Pages·2007·0.26 MB·English

Number 392 + September 21, 2007
Fall Injury Episodes Among Noninstitutionalized Older
Adults: United States, 2001–2003
by Jeannine S. Schiller, M.P.H.; Ellen A. Kramarow, Ph.D.; and Achintya N. Dey, M.A.
Division of Health Interview Statistics and Office of Analysis and Epidemiology
Abstract Introduction
Objective—This report presents national estimates of fall injury episodes for Falls are the leading cause of
noninstitutionalized U.S. adults aged 65 years and over, by selected characteristics. nonfatal medically attended injuries in
Circumstances surrounding the fall injury and activity limitations and utilization of the United States (1). Injuries caused by
health care resulting from the fall injury are also presented. falls are more prevalent among adults
Methods—Combined data from the 2001–2003 National Health Interview aged 65 years and over compared with
Surveys (NHIS), conducted by the Centers for Disease Control and Prevention’s younger persons, occurring in 2005 at a
National Center for Health Statistics (NCHS), were analyzed to produce estimates rate of 76 episodes per 1,000 population
for the U.S. civilian noninstitutionalized population. Data on nonfatal medically among persons aged 65 years and over
attended fall injuries occurring within the 3 months preceding the interview were and 36 episodes per 1,000 population
obtained from an adult family member. among persons under age 65 (CDC
Results—The annualized rate of fall injury episodes for noninstitutionalized unpublished data, 2005). Annually, one
adults aged 65 years and over in 2001–2003 was 51 episodes per 1,000 population. in three Americans over age 65 years
Rates of fall injuries increased with age, and were higher for women compared with experiences a fall, and many of these
men. Non-Hispanic white older adults had higher rates of fall injuries compared falls are recurrent (2,3). Falls are
with non-Hispanic black older adults. Older adults with certain chronic conditions associated with numerous morbidities,
and activity limitations had higher rates of fall injuries compared with older adults decreased quality of life, and high health
without these conditions. The most common cause of fall injuries among older care costs (4–6). Physical injuries
adults was slipping, tripping, or stumbling, and most fall injuries occurred inside or associated with falling include fractures,
around the outside of the home. Nearly 60 percent of older adults who experienced contusions, and lacerations. Hip and
a fall injury visited an emergency room for treatment or advice. Nearly one-third of other lower extremity fractures can be
older adults experiencing a fall injury needed help with activities of daily living as especially debilitating for older adults
a result, and over one-half of these persons expected to need this help for at least 6 (7–9). Studies have shown that injuries
months. A similar percentage experienced limitation in instrumental activities of experienced as a result of falling may
daily living as a result of fall injuries. lead to a decrease in the ability to
Conclusion—Fall injuries remain very prevalent among older adults and result perform activities of daily living (10,11).
in high health care utilization and activity limitations. Rates of fall injuries vary by Especially among older adults, falls
demographic and health characteristics of older noninstitutionalized adults. increase disability, and those injured
during a fall often do not return to their
Keywords: National Health Interview Survey c injury episodes c injury prevention c
pre-fall level of physical functioning
older adults
(12).
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
2 Advance Data No. 392 + September 21, 2007
Aside from the physical injuries and This report presents national information is collected from one
limitations that often result from a fall, estimates of nonfatal medically attended randomly selected adult and child (the
there are psychological consequences of fall injury episodes for noninstitution­ ‘‘sample adult’’ and ‘‘sample child’’) per
experiencing a fall injury. Studies have alized adults aged 65 years and over family. The sample adult responds for
shown that a fall injury may trigger the based on data from the National Health himself or herself, and a knowledgeable
fear of additional falls (13,14). Such Interview Survey (NHIS) for 2001– adult in the family provides proxy
fears or the inability to recover pre-fall 2003. The NHIS is one of the major responses for the sample child. In rare
physical functions may lead to increased data collection systems of the National instances, when the sample adult is
depressive symptoms, including fear of Center for Health Statistics (NCHS) and mentally or physically incapable of
institutionalization (15). A study of is a continuous survey of a nationally responding, proxy responses are
adults aged 75 years and over found that representative sample of the U.S. accepted for this person.
those adults who fell at least once civilian noninstitutionalized household Data on nonfatal medically attended
during the past 3 months had an population. NHIS microdata are released injuries and poisonings (collectively
increased risk of being admitted to a annually. In this report, estimates are referred to as ‘‘injuries’’) occurring in
long-term care facility over a 1 year presented by demographic character­ the previous 3-month period to any
period (16). Ultimately, the fear of istics, such as sex, age, race/ethnicity, member of the family residing in the
another fall may lead to decreases in poverty status, place of residence and home at the time of the interview are
quality of life, due to restricting usual region, as well as selected health obtained using the family component.
activities in hopes of avoiding a fall. characteristics including chronic Respondents are asked if during the past
There is considerable health care conditions, activity limitations, and 3 months (or 91 days before the
utilization resulting from fall injuries. In health behaviors. This report also interview date) they or anyone in the
2003, over 1.8 million older adults were presents descriptive statistics about the family was injured or poisoned seriously
treated in emergency departments for type of fall injury, activity during fall enough that they got medical advice or
fall injuries, and over 421,000 were injury, location of the fall injury, and treatment. The focus of the injury and
hospitalized (17). Among older adults, health care contacts and limitations poisoning section is on episodes. An
fall injuries were five times as likely to experienced as a result of the fall injury. episode is defined as a traumatic event
be the cause of hospitalization compared in which the person was injured one or
with injuries due to other causes (18). Methods more times from an external cause. The
Due to this high usage of health care International Classification of Diseases,
services, costs associated with fall Data source Ninth Revision, Clinical Modification
injuries are very high for this age group. (ICD–9–CM) is used to define injuries
The statistics shown in this report
For example, among older adults, the and classify external causes of injury
are based on data from the family and
total cost of fall injuries was $27.3 conditions (24). A person may record up
sample adult components of the
billion in 1994, and this cost is expected to a total of 10 episodes and will be
2001–2003 NHIS annual core
to increase to $43.8 billion by 2020 represented in the data file as many
questionnaires (21–23). As previously
(5,19). times as he or she had unique episodes.
noted, the NHIS is a survey of a
Increases in life expectancy during Each episode must have at least one
nationally representative sample of the
the past century have contributed to condition classified according to the
civilian noninstitutionalized household
increases in the size of the older nature-of-injury codes 800–999 in the
population of the United States.
population, and this trend is expected to ICD–9–CM. Medically attended injuries
Individuals residing in long-term care
continue. According to the U.S. Census are defined as those for which a health
institutions or correctional facilities are
Bureau, by 2020, the population aged 65 care professional was contacted either in
excluded from the sample, as well as
years and over will reach 54.6 million, person or by telephone for advice or
those on active duty in the Armed
up from 35.0 million in 2000 (20). treatment. Additional information
Services (although their civilian family
Because the prevalence of fall injuries is available for each episode includes the
members are included) and U.S.
high among older adults, it is desirable cause of the injury, what the person was
nationals living in foreign countries.
to examine the demographic and health doing at the time of the injury, the place
Basic health and demographic
characteristics of those who have of occurrence, whether the person was
information is collected in the family
experienced a recent fall injury. It is hospitalized, where the injured person
component for all members of the
also of interest to assess causes and received medical advice or treatment,
family. Adults present at the time of the
consequences of the fall injury. This and whether the injury caused any
interview are asked to respond for
information will help target prevention limitation of activity. Information about
themselves. Proxy responses are
strategies and identify health care how the injury happened, the body part
accepted for the family component for
utilization needs for older adults who injured, the type of injury, along with
adults not present at the time of the
may be at higher risks for fall injuries responses to questions about specific
interview and for those who are
as well as identify possible adverse types of injuries, place of occurrence,
physically or mentally incapable of
outcomes resulting from fall injuries. and activity were used to assign
responding for themselves. Additional
ICD–9–CM diagnostic and external
Advance Data No. 392 + September 21, 2007 3
cause codes for all injuries. More details 3-month recall period used in the NHIS significant difference. Terms such as
on injury data in the NHIS since the (26). Beginning with the 2004 NHIS, ’’similar’’ or ’’no difference’’ indicate
latest survey redesign in 1997 can be imputation is performed at NCHS for that the statistics being compared were
found in Injury and Poisoning Episodes injury episode dates for which the not significantly different. Lack of
and Conditions: National Health respondent had not provided sufficient comment regarding the difference
Interview Survey, 1997 (25). information to determine a month, day, between any two statistics does not
and year of occurrence. Imputation was mean that the difference was tested and
Statistical analysis done so that for all episodes it would be found to be not significant.
possible to calculate a specific elapsed Most statistics presented in this
Three years of data were combined
time in days between the date of the report can be replicated using NHIS
to obtain sufficient sample sizes for
injury episode and the date the injury public-use data files and accompanying
subgroup analyses. Differences in injury
questions were asked. The availability of documentation available for down­
questions on the NHIS prior to 2001
this information will allow for use of a loading from the NCHS website at
prevented analysis of earlier data for
five-week reference period (or any http://www.cdc.gov/nchs/nhis.htm. Many
this study. The interviewed sample for
desired reference period less than or of the references cited in this report are
2001–2003 consisted of 111,014
equal to the three-month recall period). also available via the NCHS website at
households, which yielded 113,037
Point estimates and estimates of http://www.cdc.gov/nchs.
families and 286,294 persons (of which
their variances were calculated using
31,875 were aged 65 years and over).
SUDAAN, a software package that is Results
For the combined years 2001–2003, the
designed to account for a complex
household response rate was 89.2%. The Figure 1 shows rates of fall injury
sample design such as that used by the
final response rate for the Sample Adult episodes for persons of all ages and
NHIS. The Taylor series linearization
component was 74.1%. Procedures used shows that for adults, these rates
method was selected for variance
in calculating response rates for increase considerably with age. Table 1
estimation (27). All estimates were
combined NHIS data years are described presents frequencies and rates of fall
calculated using NHIS weights that are
in detail in Appendix I of the Survey injury episodes by various character­
based on census totals for sex, age, and
Description of the NHIS data files istics. The annual crude rate of fall
race/ethnicity of the civilian noninsti­
(21–23). This report is based on 524 fall injury episodes for adults aged 65 years
tutionalized population of the United
injury episodes among 31,875 adults and over based on the 2001–2003 NHIS
States. Estimates based on variables
aged 65 years and over (unweighted was 51 episodes per 1,000 population
from the family component (Tables 1
counts). Of those who fell, 93% of these per year. Adults aged 85 years and over
and 3–6) were weighted using the
older adults had only one fall injury had the highest rates of fall injury
Person Record Weights, while estimates
episode reported during the 3-month episodes, and rates were similar among
based on variables in the sample adult
recall period. men and women. However, among
component (Table 2) were weighted
Data from the NHIS can be used to adults aged 65–74 years and 75–84
using the Sample Adult Record Weights.
estimate the number and rate of fall years, the rate of fall injury episodes
Due to sampling variability, overall rates
injuries in the noninstitutionalized was higher in females than in males
of fall injuries calculated using the two
population. Because the recall period for (65–74 years: 39 and 25 per 1,000
different sets of weights are slightly
injury episodes is 3 months, each population, respectively; 75–84 years:
different. All estimates shown meet the
3-month estimate was multiplied by 4 to 80 and 43 per 1,000 population,
NCHS standard of having less than or
calculate estimates of the number of respectively). Among older adults,
equal to 30% relative standard error.
injury episodes occurring annually. non-Hispanic whites had higher
Some estimates presented in this
Rates are calculated as the annual age-adjusted rates of fall injury episodes
report were age adjusted using the 2000
number of fall injury episodes per 1,000 than non-Hispanic blacks (53 and 34 per
projected U.S. population as the
population. However, it is not possible 1,000 population, respectively). Fall
standard population (28,29). The
to estimate the number of people injured injury episode rates for Hispanics (51
SUDAAN procedures DESCRIPT and
annually using the NHIS. Although the per 1,000 population), were similar to
RATIO were used to produce age-
number of persons who were injured rates for non-Hispanic whites. Fall
adjusted estimates. Age adjustment was
during the 3-month recall period is injury episode rates (age-adjusted) were
used to allow comparison of various
known, the same individuals may or lower for older adults who were married
sociodemographic subgroups that have
may not have had comparable numbers or living with a partner compared with
different age structures. The estimates in
of additional episodes over the rest of their widowed, never married, divorced,
this report that were age adjusted used
the year (25). Recent research suggests or separated counterparts (40 and 66 per
the age groups 65–74 years, 75–84
that when studying all injuries (or minor 1,000 population, respectively). Older
years, and 85 years and over.
injuries), it may be preferable to base adults who had fair or poor health status
Estimates were compared using
estimates on injuries occurring within 5 had higher rates (age-adjusted) of fall
two-tailed significance tests at the 0.05
weeks before the interview rather than injury episodes compared with older
level. Terms such as ‘‘greater than’’ and
on all injuries occurring within the adults with excellent or very good (78
’’less than’’ indicate a statistically
4 Advance Data No. 392 + September 21, 2007
and 36 per 1,000 population,
100
respectively) or good health status (46
per 1,000 population). There were no
90
significant differences in fall injury
episode rates by metropolitan statistical
80
area status or region of residence.
70 Frequencies and age-adjusted rates
n
o of fall injury episodes are presented for
ulati 60 selected health characteristics in Table 2.
p
o The rate of fall injury episodes was
p
0 50 higher among adults aged 65 years and
0
0
1, over with heart disease, stroke, cancer,
er 40 diabetes, or vision problems compared
p
e with adults without these conditions.
at 30
R Fall injury episode rates for older adults
did not vary significantly by obesity,
20
alcohol consumption, hypertension, or
10 asthma. Older adults who had great
difficulty (responding ‘‘very difficult to
0 do’’ or ‘‘can’t do at all’’) walking
0-11 12-17 18-44 45-64 65-74 75-84 85 years one-quarter of a mile, standing for two
and over
Age group hours, stooping, or climbing 10 steps
without resting had significantly higher
DATA SOURCE: National Health Interview Surveys, 2001- 2003. Estimates are based on household interviews of a sample of
the civilian noninstitutionalized population. rates of fall injury episodes compared
with adults who found those activities
Figure 1. Annualized rates of fall injury episodes among persons of all ages, by age
either not at all difficult, only a little
group: United States, 2001–2003
difficult, or somewhat difficult. Fall
injury episode rates for older adults
whose health was better or the same
compared to last year were lower
compared with older adults whose
health was worse compared to last year.
40

Circumstances surrounding fall
injuries of older adults are shown in
35

Tables 3–5 and Figure 2. The causes of
fall injuries are presented in Table 3.
30

Fifty-seven percent of the fall injury
episodes occurred due to slipping,
25

tripping, or stumbling. The next highest
nt
e cause of fall injuries was loss of
c 20
er balance, dizziness, fainting, or a seizure
P
(27%). The majority of fall injuries
15
occurred at home (Table 4). Nearly
three-quarters of the fall injury episodes
10
occurred at home, either inside the
house (50%) or around the outside of
5
the house (24%). The remaining
one-quarter of the fall injury episodes
0
Working Unpaid Leisure Sleeping, Other1 occurred in locations including streets,
around work activity resting, eating,
parking lots, residential institutions,
the house or cooking
or yard public buildings, recreation areas,
schools, industrial areas, etc. Over
1“Other" includes the following categories: unspecified, driving or riding in a motor vehicle, working at a paid job, attending
school, and being care for.
one-half of the fall injury episodes
NOTE: Respondents could indicate participation in up to two activities per fall injury episode.
among older adults happened on the
DATA SOURCE: National Health Interview Surveys, 2001- 2003. Estimates are based on household interviews of a sample of floor or level ground (Table 5). Sixteen
the civilian noninstitutionalized population.
percent of the fall injury episodes
Figure 2. Percentages of fall injury episodes among adults aged 65 years and over, by occurred on either stairs or an escalator,
activity when fall injury occurred: United States, 2001–2003 followed by curbs and furniture (8% for
Advance Data No. 392 + September 21, 2007 5
both types). Twenty-nine percent of fall problems, leading to a possible increase the likelihood of experiencing a
injury episodes occurred while the older underestimation of events (31). The fall (19). Our study found that non-
adult was working around the house or populations for these surveys are also Hispanic white older adults were more
yard, and over 20% of the episodes different. The NHIS fall injury data are likely to experience a fall injury
occurred while engaged in leisure not limited to ED visits, while the compared with non-Hispanic black
activities (Figure 2). Smaller percentages NHAMCS estimates are limited to ED adults. This finding was consistent with
of fall injury episodes occurred while visits only. In addition, the NHIS does a study based on hospitalized Califor­
doing unpaid work (6%) or activities not include institutionalized persons in nians aged 20 years and over that
such as sleeping, eating, resting, or its sample, while the NHAMCS includes indicated that whites were more likely
cooking (9%). both institutionalized and noninstitu­ to have experienced fall injuries
Fall injuries among older adults tionalized persons. A strength of the compared with blacks and Hispanics
resulted in activity limitations and NHIS is that it captures additional fall (36). Based on our study, older adults
varying levels of health care utilization injury episodes that result in medical who were either married or cohabiting
(Table 6). Six percent of fall injury attention other than emergency had lower rates of fall injuries compared
episodes among older adults resulted in department visits. The NHIS, however, with adults who were divorced,
a phone call to a doctor for treatment or is not designed to cover injuries separated, widowed, or who had never
advice. Nearly 40% of the episodes led experienced by institutionalized persons. married. This finding is consistent with
to a doctor’s office visit, while 8% led In 2002, 5% of the total U.S. population a similar finding from a Finnish study
to an outpatient clinic visit, and 57% aged 65 years and over was that found that unmarried marital status
resulted in a visit to an emergency institutionalized, but this number was a significant predictor of major
room. Thirty-two percent of fall injury increases to 17% for adults aged 85 injurious falls (37). The higher rate of
episodes caused a need for help with years and over (32). Consequently, fall fall injuries among older adults who are
activities of daily living, and for over injuries among the very old are less not married or not living with a partner
one-half of these episodes, this help was likely to be covered by the NHIS. may be related to the older adult
expected to be needed for at least 6 In making comparisons to other engaging in physically demanding
months. The same percentage of fall surveys, it is important to consider that activities that exceed their abilities in
injury episodes (32%) resulted in a need use of a 5-week reference period may order to maintain independence, but that
for help with instrumental activities of lead to more accurate reports of some increase their likelihood of falling (37).
daily living, and almost three-quarters of types of injuries, including fall injuries. Numerous studies have investigated
these episodes were expected to require Research based on the 1997–1999 NHIS the association between health char­
this help for at least 6 months. shows that injuries occurring during the acteristics and falls or fall injuries. A
5 weeks preceding the interview were Proceedings based on two symposia on
Discussion more likely to be reported than those the prevention of falls summarizes the
occurring 6–13 weeks before the results of 52 studies that examined risk
Based on this study, adults aged 65
interview. These differences are seen factors for falls and/or fall injuries from
years and over in the noninstitu­
more for less severe injuries such as 1976–1994 (38), and more recent studies
tionalized U.S. population experienced
contusions and superficial injuries have examined health char- acteristics as
51 fall injury episodes per 1,000
compared with severe injuries such as well (37,39–50). Consistent with other
population per year or approximately 1.7
fractures (26). Because fall injuries can studies that have found that declining
million fall injury episodes annually.
be either minor or severe, it would be self-reported health status is associated
Fall injury episode frequencies and rates
desirable to use the 5-week reference with falls (45,49,51), our study found
based on the NHIS were somewhat
period when possible. Preliminary that rates of fall injury episodes for
lower than those obtained using another
analyses of 2004–2005 NHIS data show older adults were higher among persons
NCHS survey, the National Hospital
that regardless of whether the 3-month with fair or poor health status compared
Ambulatory Medical Care Survey
recall period or 5-week reference period with good, very good, or excellent
(NHAMCS) (30). The NHAMCS
was used, overall fall injury episode health status. Older adults with heart
includes only data on fall injuries that
rates for older adults increased disease, stroke, cancer, diabetes, or
resulted in a visit to a hospital
compared with 2001–2003 rates. vision problems were also more likely
emergency department (ED). Differences
Findings that older women are more to experience a fall injury. Previous
in these estimates between the surveys
likely to experience a fall injury than studies have found that heart disease
could be explained by several factors.
older men and that fall injuries increase (47), stroke (47), and vision problems
The NHIS is a household interview
with age among older adults were (41,45) may be risk factors for falls or
survey and the NHAMCS is based on
consistent with the NHAMCS and other fall injuries. These chronic conditions
provider medical records. The NHIS
studies (30,33–35). One explanation of may increase susceptibility to falls by
does not capture all fall injury episodes
the higher rates of fall injury episodes way of altering sensory or motor
if the respondent does not recall them, a
among older women is they experience systems. Medications taken to control
problem that may be more prevalent
a substantial loss of bone density these types of chronic conditions may
among older adults with memory
following menopause, a factor that may also increase the likelihood of falls (42).
6 Advance Data No. 392 + September 21, 2007
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Advance Data No. 392 + September 21, 2007 9
Table 1. Annualized frequencies and age-adjusted annualized rates of fall injury episodes among adults aged 65 years and over, by
selected characteristics: United States, 2001–2003
Number in Rate per 1,000 population
Characteristic thousands (95% confidence interval)
Sex and age1

Both sexes:

65yearsandover(ageadjusted). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,689 51.55 (45.82 57.27)

65yearsandover(crude). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,689 50.56 (44.89 56.24)

65–74years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 585 32.70 (26.26 39.13)

75–84years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 790 65.37 (55.68 75.07)

85yearsandover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313 91.85 (68.32 115.39)

Male:

65yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524 39.65 (31.21 48.10)

65–74years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 24.83 (16.84 32.81)

75–84years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 43.35 (30.18 56.51)

85yearsandover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 92.13 (45.66 138.60)

Female:

65yearsandover . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,165 60.26 (51.75 68.77)

65–74years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 383 39.28 (29.42 49.14)

75–84years. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 579 80.28 (65.86 94.69)

85yearsandover. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 91.70 (64.92 118.48)

Hispanic or Latino origin and race2

HispanicorLatino. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 51.05 (28.68 73.42)

NotHispanicorLatinowhite,singlerace . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,458 53.48 (46.98 59.98)

Not Hispanic or Latino black or African American, single race . . . . . . . . . . . . . . . 92 34.06 (18.04 50.09)

Non-Hispanic,other . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 *29.92 ( 8.56 51.29)

Marital status
Never married, divorced, separated, or widowed . . . . . . . . . . . . . . . . . . . . . . . 990 66.12 (56.29 75.96)
Marriedorcohabiting. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 686 39.56 (32.33 46.79)
Poverty status3
Poor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242 65.55 (43.26 87.83)
NearPoor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493 53.57 (39.87 67.26)
Notpoor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 954 48.53 (40.75 56.30)
Place of residence4
LargeMSA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 708 51.00 (42.47 59.53)
SmallMSA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 603 52.41 (42.33 62.50)
NotinMSA. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377 50.96 (39.01 62.90)
Region

Northeast. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342 48.41 (35.41 61.40)

Midwest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 426 54.64 (43.28 65.99)

South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 549 47.41 (38.52 56.30)

West. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371 59.63 (45.08 74.18)

Respondent-assessed health status5
Excellentorverygood. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 448 36.40 (28.17 44.63)
Good . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 532 45.57 (36.35 54.80)
Fairorpoor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 708 78.08 (65.39 90.78)
* Figure does not meet standard of reliability or precision.

1Estimates for age groups are not age adjusted.

2Persons of Hispanic or Latino origin may be of any race or combination of races. Similary, the category ‘‘not Hispanic or Latino’’ refers to all persons who are not of Hispanic or Latino origin,

regardless of race.

3Poverty status is based on family income and family size using the U.S. Census Bureau’s poverty thresholds for 2000, 2001, and 2002. ‘‘Poor’’ persons are defined as below the poverty

threshold, ‘‘near poor’’ persons have incomes of 100% to less than 200% of the poverty threshold, and ‘‘not poor’’ persons have incomes that are 200% of the poverty threshold or greater. Missing

family income data were imputed for 36% of older adults. See ‘‘Technical Notes’’ on income.

4MSA is metropolitan statistical area.

5Respondent-assessed health status is based on the question ‘‘Would you say [person’s] health in general is excellent, very good, good, fair, or poor?’’

NOTE: Unless otherwise noted, estimates are age adjusted using the projected 2000 U.S. population as the standard population and using three age groups: 65–74 years, 75–84 years, and 85
years and over.
DATA SOURCE: National Health Interview Surveys, 2001–2003. Estimates are based on household interviews of a sample of the civilian noninstitutionalized population.
10 Advance Data No. 392 + September 21, 2007
Table 2. Annualized frequencies and age-adjusted annualized rates of fall injury episodes among adults aged 65 years and over, by
health characteristics: United States, 2001–2003
Numberin Rateper1,000population
Characteristic thousands (95%confidenceinterval)
Allfallinjuryepisodes1. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,769 53.85 ( 45.41 62.29)

Heartdisease2
Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 733 67.37 ( 49.75 84.99)
No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,027 46.59 ( 37.34 55.84)
Hypertension3
Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 986 53.72 ( 42.92 64.52)
No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 770 53.55 ( 39.92 67.18)
Stroke4
Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289 92.98 ( 54.81 131.14)
No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,472 50.13 ( 41.39 58.87)
Emphysema5
Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183 *115.09 ( 36.87 193.31)
No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,578 50.53 ( 42.56 58.50)
Asthma5
Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 75.26 ( 38.93 111.60)
No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,554 51.59 ( 42.91 60.28)
Anycancer6
Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490 72.06 ( 53.41 90.72)
No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,279 49.15 ( 39.54 58.76)
Diabetes7
Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443 94.58 ( 55.63 133.53)
No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,320 48.39 ( 39.93 56.84)
Visiontrouble8
Yes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 528 84.12 ( 60.40 107.84)
No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,241 46.49 ( 38.07 54.90)
Difficultywalkingaquarterofamile
Notatalldifficult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 647 35.12 ( 25.42 44.82)
Littleorsomewhatdifficult. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 29.89 ( 15.91 43.87)
Verydifficultorcannotdo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 770 108.02 ( 84.05 131.99)
Difficultystandingfortwohours
Notatalldifficult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521 31.75 ( 21.88 41.63)
Littleorsomewhatdifficult. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230 38.22 ( 21.57 54.86)
Verydifficultorcannotdo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 832 104.04 ( 81.75 126.33)
Difficultystooping,bending,orkneeling
Notatalldifficult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491 30.32 ( 21.32 39.32)
Littleorsomewhatdifficult. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340 41.43 ( 26.37 56.50)
Verydifficultorcannotdo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 861 112.66 ( 88.12 137.19)
Difficultyclimbingtenstepswithoutresting
Notatalldifficult . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 650 31.30 ( 23.31 39.29)
Littleorsomewhatdifficult. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255 49.77 ( 30.21 69.33)
Verydifficultorcannotdo. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 721 133.00 (102.04 163.95)
Bodymassindex9
Underweightorhealthyweight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 721 52.23 ( 38.61 65.85)
Overweight. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 588 49.06 ( 36.15 61.97)
Obese. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410 72.39 ( 49.74 95.03)
Leisure-timephysicalactivity10
Anyregular. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308 43.56 ( 25.29 61.83)
Noregular . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,409 55.11 ( 45.42 64.81)
Alcoholconsumption11
Nondrinker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,154 60.16 ( 48.41 71.91)
Currentinfrequentorlightdrinker. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367 42.72 ( 28.48 56.97)
Currentmoderateorheavydrinker . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 46.75 ( 24.38 69.13)
Healthstatuscomparedtolastyear12
Betterorthesame . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,139 40.66 ( 33.11 48.22)
Worse. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 624 122.55 ( 89.06 156.04)
*Figuredoesnotmeetstandardofreliabilityorprecision.