Full text of DOI:10.1093/gerona/56.11.M686

Journal of Gerontology: MEDICAL SCIENCES
Copyright 2001 by The Gerontological Society of America
2001, Vol. 56A, No. 11, M686–M692
Do the Risks and Consequences of Hospitalized Fall
Injuries Among Older Adults in California Vary by
Type of Fall?
Arthur A. Ellis and Roger B. Trent
Injury Surveillance and Epidemiology Section, Epidemiology and Prevention for Injury Control Branch, California Department
of Health Services, Sacramento.
Background. Research on fall injuries in older persons generally does not examine different types of falls separately.
(The main types are same level, from one level to another, and on or from stairs and steps.) There is no a priori reason to
believe that various types of falls have similar demographic risk factors and consequences. Therefore, we examined pat-
terns in types of falls, place of falls, and consequences of fall injuries as Californians move through their later decades.
Methods. We analyzed all computerized patient discharge records for all adults 20 years and over hospitalized with a
fall as the principal external cause of injury in California nonfederal acute care hospitals, from 1995 through 1997 (N ꢀ
242,166). Older-adult age groups were compared with all younger adults. Place of fall, hospital charges, and disposition
at discharge were analyzed by type of fall.
Results. The three main types of fall injury increase with age, but each type shows variation by age and sex. Women
have the highest rates for the main types but not for the less common types. Hospitalized falls vary by place of fall.
Mean hospital charges ($17,086) vary by type of fall, with falls from one level to another having the largest mean hospi-
tal charge ($19,632). Disposition at discharge does not vary by type of fall.
Conclusions. We found significant variation in demographic factors, place of fall, and mean hospital charges for
falling by type of fall, suggesting that future research should focus on individual types of falls rather than on aggregated
falls.
ALLS, common at any age, are endemic among older
adults (1–5). Each year, one in three Americans over 65
fornia show that fall injuries start rising at about age 55.
Women have a higher hospitalization rate from falls
(3,4,15,17).
The literature on falls among the elderly population is
large, but no study has analyzed serious older-adult fall in-
juries by type (e.g., from slipping or tripping). Most studies
aggregate types of fall, and some focus on one type. There
is no empirical or a priori reason to believe that various
types of falls have similar demographic risk factors and
consequences.
Research has shown that the largest proportion of falls
among older adults occurs at home and indoors (25–30).
However, no one has documented whether the various types
of falls take place mainly at home. Inasmuch as a common
fall prevention approach is to reduce fall hazards, such as
obstacles and slippery surfaces, it is important to know
where various types of falls occur.
This study describes older-adult fall injuries in California
by type of fall. We use a large hospitalized injury data set to
examine patterns in types of falls, place of falls, and conse-
quences of fall injuries as people move through their later
decades. Specifically, our study addresses the following
questions: (i) Do particular types of falls account for the
large increase in fall injuries that come with age? (ii) Does
the typical place of fall vary with type of fall and change as
people age? and (iii) Do medical outcomes vary with type
of fall and become more adverse with age?
F
years of age falls (6,7). In California in 1995, 688 people 65
years and older died because of falls, and another 53,312
were hospitalized, a ratio of 1:77. Among injuries, falls
were the leading cause of hospitalization in this age group,
dwarfing the second leading cause (car crash injuries) by
60-fold (unpublished data).
Although most falls among older adults (90%) do not
cause injury or death (8), research shows that many are
medically and personally serious (4,6,7,9–16). Older adults
who suffer a fall injury become heavy users of medical re-
sources (15,17). Fractures are a common consequence of
falls among older adults, and hip fractures produce the
greatest morbidity and mortality (18–20).
Falls are the most costly injury among older persons in
the United States (21–23). The total annual cost of falls was
estimated to be $75 to $100 billion, according to an earlier
report (24). However, the projected costs for slip and trip in-
juries and deaths for persons aged 75 years and older are ex-
pected to increase at a substantially higher rate (59%) than
for the population in general (27%) (25). Hospitalization
costs are higher for women than men, rise dramatically with
age (15), and increase with fall frequency and severity (21).
Falls among elderly persons have distinct age and sex
patterns. The risk of suffering a fall injury rises sharply with
age (4,17,19,25,26). Our earlier (unpublished) data for Cali-
M686

RISKS AND CONSEQUENCES OF FALL INJURIES
M687
METHODS
charges (billed charges only, not revenue, excluding profes-
sional fees), and length of stay (days between admission and
discharge).
Data Source
We obtained computerized hospital discharge summaries
for 1991 through 1997 from the California Office of State-
wide Health Planning and Development (OSHPD). As re-
quired by law, all nonfederal acute care hospitals report dis-
charges to the OSHPD. All injury records contain an
external cause of injury (E-) code (31). Only the first hospi-
talization for a fall injury is E-coded, permitting us to look
at incident cases and avoid duplication of counts for patients
re-admitted in the same year for the same fall. California
hospital discharge data appear reliable, as demonstrated by
the OSHPD’s reabstraction studies of hospital records.
Computerized edits and analyst review are performed on
every record. The OSHPD allows an error tolerance level of
0.1% for E-codes (32).
For denominator populations, we used California Depart-
ment of Finance population estimates by age, sex, and the
following race/ethnicity categories: white, black, Hispanic,
Asian, and Native American. No “other” category is given
for persons not included in the previous categories or for
persons of mixed race.
Place of fall was determined for cases admitted because
of one E-coded fall injury (n ꢀ 219,402 or 91% of all falls).
Multiple fall cases (n ꢀ 7292) were disregarded because
place of occurrence cannot be determined uniquely.
Analysis
To determine risk, we calculated average age-specific
crude incidence rates per 100,000 California population per
year (rate ꢀ mean fall injuries for 1995–1997/California
population, July 1, 1996 ꢁ 100,000). Rates based on nu-
merators less than 20 are unstable and are not shown. Statis-
tically significant differences between rates were deter-
mined by nonoverlapping confidence intervals at the 95%
level. All rate comparisons cited in the text are statistically
significant at p ꢂ .05. Rate increases by age and sex were
described by fitting the rates to an exponential curve using
Prism Release 3.0 software (Prism Software Corp., Lake
Forest, CA). Statistical Analysis System for Windows, Re-
lease 6.12 (SAS Institute, Inc., Cary, NC) was used for all
other analyses.
Case Definition
RESULTS
This study includes all adults, aged 20 years and older, hos-
pitalized with a fall injury as the principal external cause of
injury in California nonfederal acute care hospitals. Older
adults were stratified by age group for analyses (55–64
years, 65–74 years, 75–84 years, and 85 years and older)
and were compared with all younger adults (20–54 years).
We selected three recent years of patient discharge data—
1995 through 1997—to increase the size of the population
analyzed. Hospitalized falls and fall injury rates (per
100,000) rose significantly each year (Table 1).
We identified older-adult fall injuries by using the Inter-
national Classification of Diseases, Ninth Revision E-code
series “Accidental Falls,” E880 through E888, with the ex-
ception of E887 (fracture, cause unspecified). Because this
code probably contains some (unidentifiable) nonfalls, we
excluded 4704 (1.9% of E880–E888 cases) to avoid includ-
ing as cases patients who did not fall (5).
Trends, Incidence, and Population Characteristics
Falls are a major public health problem in California,
with 268,181 fall injuries requiring hospitalization during
the 1995 through 1997 study period. Table 2 illustrates how
the risk of falling rises dramatically with age, with women
falling more frequently than men starting at age 50. The av-
erage annual rate of falls was 276/100,000 (all ages). For
1995 through 1997, there were 242,166 hospitalized falls
among all adult residents of California (aged 20 years and
older), an average annual rate of 358.
Table 3 shows demographic risk factors and types of falls
for California adults from 1995 through 1997. Women have
Table 2. Hospitalized Fall Injury Rates (per 100,000) by Gender
and Age Among California Residents, 1995–1997
Both Genders
Men
Number
Women
Number
Variables
We used the following patient discharge data set vari-
ables: age, type and place of fall injury (both derived
from E-codes), sex, race, disposition at discharge, hospital
Number*
Rate
Rate
Rate
All ages
ꢂ10 y
268,181
16,102
9,913
276
98
103,766
9,781
7,328
6,521
9,163
9,815
8,142
10,100
18,226
19,306
5,384
213
116
108
88
104
139
190
341
868
164,412
6,321
2,584
2,887
4,990
339
79
40
44
60
10–19 y
20–29 y
30–39 y
40–49 y
50–59 y
60–69 y
70–79 y
80–89 y
90ꢃ
75
68
83
9,408
14,153
16,763
17,044
25,973
57,672
74,884
26,269
Table 1. Hospitalized Falls and Fall Injury Rates (per 100,000)
Among California Residents, 1995–1997
118
196
414
1,176
3,507
7,058
6,948
98
8,901
202
479
1,407
4,050
7,638
15,873
39,446
55,577
20,885
Year
Number
Rate
95% CI
2,529
5,454
1995
1996
1997
77,466
80,124
84,576
346
356
370
344–349
353–358
368–372
*Includes three cases with gender unknown.
Source: California Office of Statewide Health Planning and Development,
hospital records and California Department of Finance, 1970–1996 Population
Estimates, January 1998.
Note: CI ꢀ confidence interval.
Source: California Office of Statewide Health Planning and Development,
hospital records.

M688
ELLIS AND TRENT
Table 3. Hospitalized Fall Injuries, Percentages, and Rates (per 100,000) by Gender, Age, Race/Ethnicity and Type of Fall Among
California Residents Aged 20 and Older, 1995–1997
Average Rate per
Parameter
Number
242,166
Percentage
100
100,000 per Year
95% CI
All falls
Gender*
Men
Women
Age group
20–54 y
55–64 y
65–74 y
75–84 y
85 y ꢃ
358
356.0–360.9
86,657
155,507
36
64
258
457
255.5–261.4
453.0–460.8
48,658
19,072
40,030
72,818
61,588
20
8
17
30
25
97
269
683
2089
5532
95.8–98.8
262.8–276.0
671.3–694.4
2063.4–2115.4
5458.2–5605.3
Race/ethnicity†
White
190,121
10,510
27,770
395
9,051
2,519
79
4
11
‡
488
233
168
96
127
NA
483.8–491.4
224.9–240.2
164.6–171.4
79.3–112.0
122.9–132.0
NA
Black
Hispanic
Native American
Asian/Pacific Islander
Other
4
1
Type of fall
On or from stairs and steps (E880)§
On or from ladder or scaffolding (E881)
From or out of building or other structure (E882)
Into pool or hole opening in surface (E883)
From one level to another (E884):
Other falls (E844.9)
10,638
7,367
3,857
678
27,838
10,340
7,129
6,293
2,023
1,064
444
432
113
99,630
2,315
89,841
4
3
2
‡
16
11
6
15.2–16.3
10.5–11.3
5.4–6.0
1
0.9–1.1
11
4
3
3
1
‡
41
15
11
9
NA
2
1
1
0
147
3
40.4–42.0
14.8–15.8
10.1–11.0
8.9–9.7
NA
1.4–1.7
0.6–0.8
0.5–0.7
0.1–0.2
145.9–149.1
3.2–3.7
Chair (E884.2)
Bed (E844.4)
Wheelchair (E884.3)ꢀ
Commode (E844.6)
Other furniture (E844.5)
Cliff (E884.1)
‡
‡
‡
Playground equipment (E884.0)
Same level from slipping/tripping/stumbling (E885)
Same level contact with another person (E886)
Other and unspecified fall (E888)
41
1
37
133
131.5–134.5
Notes: CI ꢀ confidence interval; NA ꢀ not applicable. For race/ethnicity, see Methods; for Wheelchair, see reference 11.
*Two cases with gender unknown shown in the total only.
†1800 cases (0.7%) with race/ethnicity unknown shown in the total only.
‡Less than 0.05%.
§External cause of injury (E) codes are from the International Classification of Diseases, Ninth Revision, E-code series “Accidental Falls,” E880–E888, with the
exception of E887 (fracture, cause unspecified).
ꢀThe E-code for wheelchair falls became effective October 1995, so these data are for October 1995 through December 1997.
Source: California Office of Statewide Health Planning and Development, patient discharge records and California Department of Finance, 1970–1996 Population
Estimates, January 1998.
an elevated rate, nearly double that of men (457 vs 258).
Fall risk shows a 2.5- to 3-fold increase between each suc-
cessive age group. The rate difference between adults aged
20 to 54 years and 85 years and older is 57-fold. The in-
crease in rates across age for both men and women is expo-
nential (data not shown). Whites are at the most risk, with a
rate double that of Blacks, followed by Hispanics, Asian/
Pacific Islanders, and Native Americans. Fall injuries from
slipping, tripping, and stumbling on the same level are
clearly most common among adults, followed by injuries
from falling from one level to another and from falling on or
from stairs and steps. These three types of falls represent
91% of all fall injuries with type known (excluding other
and unspecified). Among fall injuries from one level to an-
other, falls from a bed or chair are particularly common.
Incidence Rates by Type of Fall Injuries and Age
The risk of injury from falling varies by type of fall, age,
and sex (Table 4). For the three main types of falls, rates
jump dramatically with age. The increase between younger
adults aged 20 to 54 and older adults aged 85 and older was
76-fold for fall injuries from slipping, tripping, and stum-
bling on the same level (31 vs 2383), 33-fold for fall injuries
from one level to another (17 vs 556), and 19-fold for fall
injuries on or from stairs and steps (7 vs 132).
Women have higher rates for the three leading types,
whereas men have higher rates for all less common types.
The risk for women increases with age for fall injuries from
slipping, tripping, and stumbling (from 33 for ages 20–54 to
2690 for ages 85 and older) and those from stairs and steps
(from 8 to 144). For fall injuries from one level to another,

RISKS AND CONSEQUENCES OF FALL INJURIES
M689
Table 4. Hospitalized Falls, Rates (per 100,000)* by Gender and Age, and Type of Fall Among California Residents Aged 20 and
Older, 1995–1997
All Ages
20–54 y
55–64 y
65–74 y
75–84 y
85ꢃ y
Characteristic
Both Genders
Number Rate Number Rate Number Rate Number Rate Number Rate Number Rate
Same level from slipping/tripping/stumbling (E885)†
99,630 147 15,671
31
17
7
8
6
7,798 110 17,294 295 32,335
928 26,533 2,383
From one level to another (E884)
On or from stairs and steps (E880)
On or from ladder or scaffolding (E881)
From or out of building or other structure (E882)
Same level contact with another person (E886)
Into pool or hole in surface (E883)
Other and unspecified (E888)
27,838
10,638
7,367
3,857
2,315
678
41
16
11
6
3
1
8,506
3,409
3,898
3,135
1,652
528
2,319
1,175
1,189
313
33
17
17
4
4,082
1,978
1,278
233
70
34
22
4
6,743
2,604
809
193
75
23
4
6,188
1,472
193
34
556
132
17
142
3
3
1
111
2
148
3
235
7
1
169
11
15
‡
62
1
39
1
38
89,841 133 11,859
242,166 358 48,658
24
6,105
86 14,978 255 29,912
858 26,988 2,424
Total
97 19,072 269 40,030 683 72,818 2,089 61,588 5,532
Men
Same level from slipping, tripping, or stumbling (E885) 29,194
87
38
11
18
10
4
7,643
6,072
1,487
3,388
2,708
1,323
413
30
24
6
13
11
5
2,654
1,232
406
968
280
52
39
2,633
77
36
12
28
8
2
1
77
4,975 188
8,281
2,259
726
599
108
42
19
8,899
593
162
52
43
8
5,641 1,675
From one level to another (E884)
On or from stairs and steps (E880)
On or from ladder or scaffolding (E881)
From or out of building or other structure (E882)
Same level contact with another person (E886)
Into pool or hole in surface (E883)
Other and unspecified (E888)
12,759
3,556
6,060
3,309
1,503
497
1,727
582
973
195
51
65
22
37
7
1,469
355
132
18
436
105
39
‡
2
3
‡
35
5
10
‡
1
89
2
26
21
1
29,779
6,653
5,388 204
637
6,206 1,843
Total
86,657 258 29,687 115
8,264 240 13,912 527 20,933 1,498 13,861 4,116
Women
Same level from slipping, tripping, or stumbling (E885) 70,436 207
8,028
2,434
1,922
510
427
329
33
10
8
2
2
1
0
21
5,144 141 12,319 382 24,053 1,152 20,892 2,690
From one level to another (E884)
On or from stairs and steps (E880)
On or from ladder or scaffolding (E881)
From or out of building or other structure (E882)
Same level contact with another person (E886)
Into pool or hole in surface (E883)
Other and unspecified (E888)
15,079
7,082
1,307
548
812
181
44
21
4
2
2
1,087
769
221
33
30
21
6
2,355
1,396
305
38
73
43
9
4,484
1,878
210
34
215
90
10
2
4,719
1,117
61
608
144
8
‡
1
1
16
59
23
2
1
97
18
3
‡
193
19
9
‡
134
6
17
‡
1
115
5,205
60,062 176
3,472
95
9,590 298 21,013 1,006 20,782 2,676
Total
155,507 457 18,970
78 10,808 297 26,118 810 51,884 2,485 47,727 6,146
*Average annual rates for 1995–1997.
†External cause of injury (E) codes are from the International Classification of Diseases, Ninth Revision, E-code series “Accidental Falls,” E880–E888, with the
exception of E887 (fracture, cause unspecified).
‡Two cases with gender unknown shown in the total only.
§Rates not computed for fewer than 20 cases.
Source: California Office of Statewide Health Planning and Development, hospital records and California Department of Finance, 1970–1996 Population Esti-
mates, January 1998.
men have higher rates until age 64, and women have higher
rates thereafter.
are about $2000 higher than charges for the age 20 through
54 comparison group. Hospital charges for all fall injuries
amounted to $4.1 billion for 1.7 million hospital days for
the study period. Mean charges came to $17,086, and the
mean stay was 7 days. Mean charges and length of stay vary
by type of fall injury, with those from one level to another
having the largest means (charges ꢀ $19,632, and length of
stay ꢀ 8 days).
Figure 1 shows that disposition at discharge varies by
age. However, examination revealed that it does not vary by
type of fall injury. Transfer from hospital to long-term nurs-
ing care, the most common discharge destination for older
adults with fall injuries, is typically an adverse outcome.
Nearly 67% of those aged 85 years and older were trans-
ferred to long-term care, compared with only 5% of those in
the 20 to 54 age group. The percentage of fall injury patients
dying in the hospital also rose consistently with age (from
1% for ages 20–54 to 4% for ages 85 and older). In contrast,
the percentage of patients experiencing a routine discharge
and returning home was strongly inversely related to age
Place of Fall Injury by Type of Fall and Age
Nearly two thirds of all hospitalized falls occur at home,
with the proportion increasing with age (from 39% for ages
20–54 to 70% for ages 85ꢃ) (Table 5). A residential institu-
tion is the second leading place for fall injuries (with 14%),
and the proportion increases with age (from 7% for ages
20–54 to 21% for ages 85ꢃ). For all other specified places,
fall injury becomes less frequent with age. The place of fall
injury also varies by type of fall injury. For example, more
than two thirds of fall injuries from slipping, tripping, and
stumbling occur at home, but only one half of those from
one level to another occur at home.
Fall Injury Outcomes and Consequences by Age
Hospital charges, which are partly a function of length of
stay, do not rise with age for older adult fall injuries (Table
6). However, hospital charges for older adult fall injuries

M690
ELLIS AND TRENT
Table 5. Hospitalized Falls and Percentage of Distribution by Age, Type, and Place of Fall Among California Residents Aged 20 and
Older, 1995–1997
All Ages
20–54
55–64
65–74
75–84
85ꢃ
Type of Fall
Place of Fall
Percentage
(Number)
Percentage
(Number)
Percentage
(Number)
Percentage
(Number)
Percentage
(Number)
Percentage
(Number)
Number
All Falls
Home
137,885
31,159
23,528
8,087
6,559
6,023
63
14
11
4
3
3
39
7
21
5
12
5
11
57
10
17
5
3
4
5
0
67
12
11
5
2
3
1
0
71
15
8
3
1
2
0
0
70
21
5
2
0
2
0
0
Residential institution
Place unspecified
Public building
Recreation place
Street or highway
Industrial place*
Farm
5,919
242
3
0
0
Total
219,402
100
100
101
101
100
100
(40,915)
(16,760)
(36,401)
(67,414)
(57,912)
Slipping/Tripping/Stumbling on Same Level
Home
62,078
10,515
5,979
4,035
3,110
3,205
1,449
55
69
12
7
4
3
4
2
0
42
7
15
6
16
7
6
0
60
8
11
7
4
5
5
71
9
7
6
2
4
1
0
76
11
5
4
1
3
0
0
75
17
3
3
0
2
0
0
Residential institution
Place unspecified
Public building
Recreation place
Street or highway
Industrial place*
Farm
0
Total
90,426
101
99
(13,334)
100
(6,802)
100
(15,606)
100
(29,763)
100
(24,921)
Falling From One Level to Another
Home
12,702
6,410
2,152
604
867
489
52
26
9
2
4
2
5
0
35
11
20
3
11
4
16
1
50
20
12
4
3
3
8
60
26
7
3
1
1
1
0
61
32
3
2
1
1
0
56
39
2
1
0
1
0
0
Residential institution
Place unspecified
Public building
Recreation place
Street or highway
Industrial place*
Farm
1,295
71
0
0
Total
24,590
100
101
(6,684)
100
(2,018)
99
(3,749)
100
(6,288)
99
(5,851)
Falling on/From Stairs/Steps
Home
6,321
234
1,342
710
75
536
209
5
66
2
15
7
1
6
57
2
24
5
1
5
5
0
66
2
17
8
0
4
3
69
3
12
9
1
6
1
71
2
9
9
1
7
0
0
75
3
8
7
0
6
0
0
Residential institution
Place unspecified
Public building
Recreation place
Street or highway
Industrial place*
Farm
2
0
0
0
Total
9,523
99
99
(2,966)
100
(1,046)
101
(1,779)
99
(2,375)
99
(1,357)
Note: Cases with place unknown not shown on table: total 15,471; slipping/tripping/stumbling 6,204; falling from one level to another 2,289; falling on/from stairs/
steps 819; and other types 6,159.
*Includes falls in mine and quarry; 24 in total.
Source: California Office of Statewide Health Planning and Development, hospital records.
(decreasing from 83% for ages 20–54 to 14% for ages 85
and older).
Like recent studies in Finland (33) and the United States
(34), we found an upward trend in rates among older adults.
The reasons for the rising trend among older adults are un-
clear, but the implications for health care are serious. In
California, demographers have forecasted that the popula-
tion of those 55 and older will increase from 18% of the to-
tal population in 1999 to 26% in 2040 (35).
All major types of fall injuries climbed significantly with
age in our study, but same-level falls from slipping, trip-
ping, and stumbling accounted for the majority. Most of
DISCUSSION
Unlike falls in general, types of fall injuries have not been
widely studied. Taking advantage of California’s large pop-
ulation, we were able to see how fall injuries—and major
fall types—change as people age. The increase in rate with
age is remarkable. From age 50 on, the increase is exponen-
tial. By age 90, the rate reaches 7058 per 100,000.

RISKS AND CONSEQUENCES OF FALL INJURIES
M691
Table 6. Hospitalized Falls and Mean Hospital Charges by Type of
Fall and Age Among California Residents Aged 20 and
Older 1995–1997
However, hospital records do not identify type of fall for
89,841 (37%) cases. Whether these missing data are distrib-
uted so as to bias our findings cannot be determined, al-
though age–sex patterns of unidentified falls are very simi-
lar to those of identified falls (data not shown). Intrinsic risk
factors are not included in California hospital discharge
records and could not be studied. For example, we do not
know which patients took medications that affect balance.
Given the extremely high rates of older-adult fall injuries,
the aging of our population, and possibly increasing rates,
the prevention of falls among older adults should be a top
public health priority. The potential cost benefit of pro-
grams to prevent morbidity from falls is believed to be very
large (21,37). We encourage prevention workers to take
note of our findings that demographic factors, place of fall,
and mean hospital charges all vary by type of fall. These
findings suggest that future research should focus on indi-
vidual types of falls rather than on aggregated falls.
Slipping, Tripping,
or Stumbling
on Same Level
Falling From
One Level
to Another
Falling on
or From
Stairs and Steps
All
Falls
All ages $17,086
$16,333
$12,920
$16,182
$16,647
$17,352
$16,950
$19,632
$19,377
$22,719
$22,063
$19,158
$17,740
$15,507
$13,363
$15,825
$15,835
$17,401
$16,427
20–54 y
55–64 y
65–74 y
75–84 y
85ꢃ y
$15,976
$17,970
$17,799
$17,511
$16,723
Source: California Office of Statewide Health Planning and Development,
hospital records.
these occur at the patient’s home, as the literature has shown
(26,27,29,30). Exposure is key: Older adults may have less
chance of falling in places they are presumably less likely to
visit as they get older, such as recreation and industrial
places.
Acknowledgments
The consequences of older-adult fall injuries are extreme
and increase with age. Falls are the most costly injury among
older adults (21,22). Hospital charges alone amounted to
$4.1 billion for 1.7 million hospital days during our study
period. We found that hospital charges do vary by type of
fall, with falls from one level to another having the largest
charges.
Disposition at discharge varied radically by age but not
by type of fall. Transfers to long-term care in nursing homes
increased with age, and this was the most typical discharge
destination for older adults with fall injuries, as other stud-
ies report (4,36). Among very old fall patients, long-term
care becomes the norm. This pattern suggests high morbid-
ity and high costs.
The California Department of Health Services supported this research.
Address correspondence to Arthur A. Ellis, MA, Department of Health
Services, Epidemiology and Prevention for Injury Control Branch, Injury
Surveillance and Epidemiology Section, 611 N. 7th Street, MS 39A, PO
Box 942732, Sacramento, CA 94234-7320. E-mail: aellis@dhs.ca.gov
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Received September 5, 2000
Accepted September 14, 2000
28. Nyberg L, Gustafson Y, Berggren D, Brannstrom B, Bucht G. Falls
Decision Editor: John E. Morley, MB, BCh