Two million residents live in nearly 20,000 nursing homes at a cost of $53 billion dollars annually.
By 2030, five million residents will reside in nursing homes at a cost of $700 billion dollars
annually.1 One in four residents will stay for less than one year. One in eleven individuals will
reside in nursing homes at least five years. Half of all nursing home residents will stay for more
than six months.
Mental disorders, i.e. dementia, delirium and psychiatric illness, afflict 90% of the residents. The
population is becoming older, sicker and more dependent.
Each year about 12,000 older Americans die as a result of a fall. Falls are the second leading
cause of unintentional injury death in the U.S., second to auto accidents, and the leading cause of
nonfatal injuries.2 The death rate due to falls in the general population is 5.7/100,000 persons,
increasing to 10.2/100,000 for those aged 65-74 and to 147.0/100,000 for persons older.3
Population based studies of community-dwelling elderly persons 4 have estimated an annual total
injurious fall rate of 229/1,000 persons,' serious fall injury rate of 84-96/1,000, 5 and fall injury
hospitalization rate of 13.5/1,000.6 Half of serious fall injury events in elderly persons result in
discharge to a nursing home.7 Hip fractures in older adults resulted in more admissions than any
other injury, and accounted for 254,000 admissions in 1988. There is a 10-20% reduction in
expected survival in the first year, and roughly half never recover normal function. 7
A study was conducted by the Iowa Hospital Association during the period January through
March, 1982. 8 A total of 2,459 falls were reported during the period. The following characteristics
were tabulated:
 patient falls by shift were evenly distributed;
 74.4% of all falls occurred in the medical/surgical unit, 14.9% occurred in the special care unit,
6.7% occurred in the psychiatric unit, the remaining occurred in the obstetrics and pediatric units;
and,
 the predominant locations of falls occurred 68.5% of the time in the patient's room, 14.6 %
in the bathroom, and 5.0% in the corridor.
St. Paul Fire and Marine Insurance, which insures 1,500+ hospitals nationwide, reviewed all
institutional claims (13,674 in total) between may, 1982 and December, 1985 and found:
 1,718 patient falls (12-5%) of all claims
 $7,785 was the average cost for bed-related falls
 $8,663 was the average cost for ambulation related falls 9
The claim's cost of falls has steadily risen. The trend is didactic.
Type / Period
'91 - '92
'94 - '95
'95 - '96
Fall - bed related
$24,807
$28,978
(1)
Fall - ambulation
$23,346
$26,651
$40,800
Fall - bathroom related
*
$36,935
$87,600
Fall - resident transfer
*
$23,874
$35,200
Fall - miscellaneous other
*
$49,300
*
Falls as a percent of top 10 most
frequent claims
14.1%
11.5%
75.0 % 10
(*) not measured
(1) original printed information was incorrect and subject to change.
1. "Topics in Geriatrics", Mayo Foundation for Medical Education and Research, 11-29-96.
2. Baker, SP, O'Neill B, Ginsburg MJ, et. id., eds, "The Injury Fact Book", 2nd ed., New York:
Oxford Press, 1992.
3. Centers for Disease Control, Public health surveillance of 1990 injury control objectives for the
nation. CDC surveillance summary. MMWR 1988,37(SS-1): 1-68.
4. O'Loughlin JL, Robitalille Y, Boivin J-F, et. Al., "Incidence of and risk factors for falls and
injurious falls among the community-dwelling elderly. Am J Epedemiol 1993;137:342-354.
5. Satin RW, Lambert Huber DA, Devito CA, et. Al., "The incidence of fall injury events among the
elderly in a defined population. Am J Epidemiol 1990:131:1028-1037.
6. Alexander BH, Rivara FP, Wolf ME., "The cost and frequency of hospitalization for fall-related
injuries in older adults. Am J Public Health 1992;82:1020-1023.
7. Cummings SR, Kelsey J, Nevin M, et. A, "Epidemiology of osteoporotic fractures", Epidemiol
Rev 1985;7:178-208
8. "The Quality Assurance / Risk Management Newsletter", The Iowa Hospital Assoc., July, 1982.
9. Balck, B., Risk Management St. Paul Fire and Marine, 1994.
10. St. Paul's Fire and Marine, "Hospital Update, Annual Reports to Policy Holders".