Trends in Fatal and Nonfatal Injuries Among Older Americans, 2004–2017


      This study (1) provides annual population estimates of fatal and nonfatal injury incidence rates for older adults for 2004–2017; (2) determines if trends differ by whether the injury was fatal or nonfatal, a fall or nonfall injury, and for nonfatal injuries, minor or serious; and (3) investigates whether trends vary by age, sex, and race.


      This study used National Vital Statistics System and National Health Interview Survey data covering the population of adults aged ≥65 years for 2004–2017. Fatal injury incidence rates were estimated using negative binomial models; nonfatal injury incidence rates were estimated using Poisson models. All models compared overall risk and trend differences by year, age, sex, and race, and interactions between year and age, sex, and race. All analyses were conducted in 2019.


      Fatal injury incidence was stable over time, but this apparent stability masked a 35% increase in fatal falls and a 17% decrease in fatal nonfall injuries. Increases in fall-related deaths were concentrated among those aged ≥85 years, men, and white older adults. The trend in fatal falls accelerated over time for those aged ≥85 years and white older adults. By contrast, there was a large increase in nonfatal injury incidence, occurring across all injury types. Nonfatal injury risk grew with age and was higher for women and white older adults, but trends did not vary by age, sex, or race.


      Large increases in fatal and nonfatal injuries underscore the urgency of national implementation of fall prevention programs and expanding fall prevention efforts to more general injury prevention.
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      1. National Center for Injury Prevention and Control, CDC. Ten leading causes of death by age group, United States-2016. Updated April 10, 2019. Accessed September 17, 2019.

        • Heinrich S
        • Rapp K
        • Rissmann U
        • Becker C
        • König HH
        Cost of falls in old age: a systematic review.
        Osteoporos Int. 2010; 21: 891-902
        • Xu D
        • Drew JAR
        What doesn't kill you doesn't make you stronger: the long-term consequences of nonfatal injury for older adults.
        Gerontologist. 2018; 58: 759-767
        • Inaba K
        • Goecke M
        • Sharkey P
        • Brenneman F
        Long-term outcomes after injury in the elderly.
        J Trauma. 2003; 54: 486-491
        • Williams JS
        • Kowal P
        • Hestekin H
        • et al.
        Prevalence, risk factors and disability associated with fall-related injury in older adults in low- and middle-income countries: results from the WHO Study on global AGEing and adult health (SAGE).
        BMC Med. 2015; 13: 147
        • Carter MW
        • Porell FW
        The effect of sentinel injury on Medicare expenditures over time.
        J Am Geriatr Soc. 2011; 59: 406-416
        • Porell FW
        • Carter MW
        Risk of mortality and nursing home institutionalization after injury.
        J Am Geriatr Soc. 2012; 60: 1498-1503
        • Moyer VA
        • U.S. Preventive Services Task Force
        Prevention of falls in community-dwelling older adults: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2012; 157: 197-204
      2. Holder Y, Peden M, Krug E, et al., eds. Injury surveillance guidelines. Geneva, Switzerland: WHO. Published 2001. Accessed September 17, 2019.

        • National Prevention Council
        National prevention strategy.
        HHS, Office of the Surgeon General, Washington, DCPublished 2011
        • Guirguis-Blake JM
        • Michael YL
        • Perdue LA
        • Coppola EL
        • Beil TL
        Interventions to prevent falls in older adults: updated evidence report and systematic review for the U.S. Preventive Services Task Force.
        JAMA. 2018; 319: 1705-1716
        • Zermansky AG
        • Alldred DP
        • Petty DR
        • et al.
        Clinical medication review by a pharmacist of elderly people living in care homes–randomised controlled trial.
        Age Ageing. 2006; 35: 586-591
        • Inouye SK
        • Studenski S
        • Tinetti ME
        • Kuchel GA
        Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept.
        J Am Geriatr Soc. 2007; 55: 780-791
        • Tinetti ME
        • Baker DI
        • King M
        • et al.
        Effect of dissemination of evidence in reducing injuries from falls.
        N Engl J Med. 2008; 359: 252-261
        • Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society
        Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons.
        J Am Geriatr Soc. 2011; 59: 148-157
        • Desapriya E
        • Harjee R
        • Brubacher J
        • et al.
        Vision screening of older drivers for preventing road traffic injuries and fatalities.
        Cochrane Database Syst Rev. 2014; 2CD006252
        • Ball K
        • Edwards JD
        • Ross LA
        • McGwin G
        Cognitive training decreases motor vehicle collision involvement of older drivers.
        J Am Geriatr Soc. 2010; 58: 2107-2113
        • Xu D
        • Drew JAR
        Cause, nature and care-seeking behaviour for injuries among community-dwelling older adults, USA, 2004-2013.
        Inj Prev. 2016; 22: 46-51
        • Pressley JC
        • Barlow B
        • Quitel L
        • Jafri A
        Improving access to comprehensive injury risk assessment and risk factor reduction in older adult populations.
        Am J Public Health. 2007; 97: 676-678
        • Rockett IR
        • Regier MD
        • Kapusta ND
        • et al.
        Leading causes of unintentional and intentional injury mortality: United States, 2000–2009.
        Am J Public Health. 2012; 102: e84-e92
        • Orces CH
        • Alamgir H
        Trends in fall-related injuries among older adults treated in emergency departments in the USA.
        Inj Prev. 2014; 20: 421-423
        • Lyman S
        • Ferguson SA
        • Braver ER
        • Williams AF
        Older driver involvements in police reported crashes and fatal crashes: trends and projections.
        Inj Prev. 2002; 8: 116-120
        • Kharrazi RJ
        • Nash D
        • Mielenz TJ
        Increasing trend of fatal falls in older adults in the United States, 1992 to 2005: coding practice or reporting quality?.
        J Am Geriatr Soc. 2015; 63: 1913-1917
        • Schiller JS
        • Kramarow EA
        • Dey AN
        Fall injury episodes among noninstitutionalized older adults, United States, 2001‒2003.
        Adv Data. 2007; : 1-16
        • Hu G
        • Baker SP
        An explanation for the recent increase in the fall death rate among older Americans: a subgroup analysis.
        Public Health Rep. 2012; 127: 275-281
        • Stevens JA
        • Ryan G
        • Kresnow M
        Fatalities and injuries from falls among older adults United states, 1993-2003 and 2001-2005.
        JAMA. 2007; 297: 32-33
        • Ning P
        • Schwebel DC
        • Chu H
        • Zhu M
        • Hu G
        Changes in reporting for unintentional injury deaths, United States of America.
        Bull World Health Organ. 2019; 97: 190-199
        • Hu G
        • Baker SP
        Recent increases in fatal and non-fatal injury among people aged 65 years and over in the USA.
        Inj Prev. 2010; 16: 26-30
      3. CDC, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS). Accessed September 17, 2019.

        • Blewett LA
        • Drew JAR
        • King ML
        • et al.
        IPUMS Health Surveys: National Health Interview Survey, Version 6.4 [dataset].
        IPUMS, Minneapolis, MN2019
      4. National Center for Health Statistics. National Health Interview Survey, 2017. Public-use data file and documentation. Hyattsville, MD: National Center for Health Statistics. Accessed December 17, 2019.

        • Deandrea S
        • Lucenteforte E
        • Bravi F
        • Foschi R
        • La Vecchia C
        • Negri E
        Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis.
        Epidemiology. 2010; 21: 658-668
        • Tinetti ME
        • Han L
        • Lee DS
        • et al.
        Antihypertensive medications and serious fall injuries in a nationally representative sample of older adults.
        JAMA Intern Med. 2014; 174: 588-595
        • Gurwitz JH
        • Field TS
        • Harrold LR
        • et al.
        Incidence and preventability of adverse drug events among older persons in the ambulatory setting.
        JAMA. 2003; 289: 1107-1116
        • Field TS
        • Gurwitz JH
        • Harrold LR
        • et al.
        Risk factors for adverse drug events among older adults in the ambulatory setting.
        J Am Geriatr Soc. 2004; 52: 1349-1354
        • Ambrose AF
        • Paul G
        • Hausdorff JM
        Risk factors for falls among older adults: a review of the literature.
        Maturitas. 2013; 75: 51-61
        • Dunlop DD
        • Manheim LM
        • Sohn MW
        • Liu X
        • Chang RW
        Incidence of functional limitation in older adults: the impact of gender, race, and chronic conditions.
        Arch Phys Med Rehabil. 2002; 83: 964-971
        • Peel NM
        • Kassulke DJ
        • McClure RJ
        Population based study of hospitalised fall related injuries in older people.
        Inj Prev. 2002; 8: 280-283
        • Hartholt KA
        • Lee R
        • Burns ER
        • van Beeck EF
        Mortality from falls among U.S. adults aged 75 years or older, 2000-2016 [published correction appears in JAMA. 2019;322(11):1108].
        JAMA. 2019; 321: 2131-2133
        • Albrecht J
        • McCunn M
        • Stein D
        • Simoni-Wastila L
        • Smith G
        Sex differences in mortality following isolated traumatic brain injury among older adults.
        J Trauma Acute Care Surg. 2016; 81: 486-492
        • Hanlon JT
        • Landerman LR
        • Fillenbaum GG
        • Studenski S
        Falls in African American and white community-dwelling elderly residents.
        J Gerontol A Biol Sci Med Sci. 2002; 57: M473-M478
        • Nicklett EJ
        • Taylor RJ
        Racial/ethnic predictors of falls among older adults: the health and retirement study.
        J Aging Health. 2014; 26: 1060-1075
        • Kochanek KD
        • Murphy SL
        • Xu J
        • et al.
        Deaths: final data for 2017.
        Natl Vital Stat Rep. 2019; 68: 1-77
        • Alamgir H
        • Muazzam S
        • Nasrullah M
        Unintentional falls mortality among elderly in the United States: time for action.
        Injury. 2012; 43: 2065-2071
        • Franco MR
        • Pereira LS
        • Ferreira PH
        Exercise interventions for preventing falls in older people living in the community.
        Br J Sports Med. 2014; 48: 867-868
        • Rubenstein LZ
        Falls in older people: epidemiology, risk factors and strategies for prevention.
        Age Ageing. 2006; 35: ii37-ii41
        • Menec VH
        • Means R
        • Keating N
        • Parkhurst G
        • Eales J
        Conceptualizing age-friendly communities.
        Can J Aging. 2011; 30: 479-493