Active Surveillance and Analysis of Fatal Falls among Older Adults in New York City

Background/Purpose: Falls are the leading cause of injury-related death among older adults, but Vital Records data are limited in their ability to describe their circumstances. The purpose of this study was to implement an active surveillance system to better characterize the context of fatal falls among older adults in NYC.

Methods: Data from 2006 were collected at the NYC Office of the Chief Medical Examiner for all deaths resulting from a fall among persons 65+ years old. Case files were reviewed to obtain information on pre-event (e.g., decedent's demographics, comorbidities, medications) and peri-event circumstances (e.g., injury sustained, location of incident, presence of others).

Results/Outcome: There were 291 fall-related deaths among older adults (31 per 100,000) in 2006. Most deaths (244) occurred inside a building, including 180 (73.8%) in the decedent's home. In 48 cases (19.7%), decedents fell down stairs; 35 (14.3%) fell in their bedroom and 28.5% lived alone at the time of incident. Traumatic brain injuries were documented in 134 cases (46.1%). Hip fractures were reported in 83 cases (28.5%). Of the 74 cases with documented medications, 42 (56.8%) were on anticoagulation therapy. Diabetes was noted in 21.7% of case files. The mean number of days between a person's fall and death was 15 days (SD=27), while the median was 8 days (IQ range=15).

Conclusions: Active surveillance provides unique insight on fatal fall circumstances among older adults. Case review identified individual, social, and environmental factors that should be considered when designing senior risk assessments and fall prevention activities.