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• 2.1 What seniors report about falls and related injuries
• 2.2 What hospitalization data tell us about seniors' falls
• 2.3 What hospitalization data tell us about falls in residential care
• 2.4 What mortality data tell us about deaths due to falls

A comprehensive overview of the nature and scope of seniors' injuries in Canada was derived from the study and analysis of:

• epidemiological evidence on falls highlighting seniors' self-reported data from the Canadian Community Health Survey (CCHS);
• hospitalization data from the Canadian Institute for Health Information Discharge Abstract Database (DAD) for all seniors, then more specifically for seniors in residential care; and
• mortality data from Statistics Canada's Canadian Vital Statistics.

It is important to note that every data source has its own definition of a fall based on the nature of the data, for example, self-reports vs. hospital records. Consequently, care should be taken in comparing falls data from different sources. It is also critical to recognize the distinct limitations of any data source, including the inherent potential for data errors and the impact on hospitalization and mortality data of changes in the International Classification of Diseases (more details are provided on pages 15-16, and in the Technical Reports.

2.1 What Seniors Report About Falls and Related Injuries

This section provides national estimates based on the Canadian Community Health Survey (CCHS) data from seniors age 65 and over who indicated that they had suffered a fall-related injury in the previous year, serious enough to limit their normal activities. Included are estimates of cases and rates of injurious falls, types of injury, types of activity, and where treatment was obtained.

Definition and data

In the CCHS data, a fall is 'defined' by the respondents when they indicate first, that they suffered an injury in the previous year serious enough to limit their normal activities, and second, that the injury was the result of a fall.

This section:

• provides estimates for the Canadian population based on self-reports from a sample of individuals;
• includes data for those age 65 and over for 2002/03 (cycle 2.1 of the CCHS);
• presents data for the age groups 65-69, 70-74, 75-79, and 80 and over; and
• analyzes data collected over a 12-month period beginning in September 2002.

The estimates provided come from a sample of respondents randomly selected from households in selected sample areas. It should be noted that such estimates are prone to error. The Technical report - Injury provides details about the sampling method, sampling and non-response error, the specific survey questions used for the falls analysis, and an interpretation of the findings. Also, there is a well documented tendency for persons self-reporting falls to understate actual incidence. Further, the CCHS provides information about only the most serious injury resulting from a fall in the prior year, thus losing information, important in this context, from those who experienced more than one fall or from those who fell but were not injured.

Findings

Table 1 data have been extrapolated from the sample (CCHS, cycle 2.1) to the total population age 65 and over. It shows that the sample of approximately 29,000 respondents for 2002/03, represents a population of approximately 3.8 million Canadians age 65 and over. In the sample age 65 and over, 56% were female. The median age for the sample age 65 and over was 72 years. Sixty percent of the sample age 65 and over was married, while 34% was widowed, separated or divorced.

The CCHS data indicates that, compared to the population of seniors as a whole, those who reported experiencing an injurious fall were more likely to be female (68% vs. 56%), more likely to be in the 80+ age group (28% vs. 21%), more likely to be widowed, separated or divorced (46% vs. 34%), more likely to have post-secondary graduation (34% vs. 32%), and more likely to have a household income of less than $15,000 (14% vs. 10%).

The finding that those experiencing an injurious fall were more likely to be women and more likely to be age 80 and over is well supported by the literature on falls among seniors.¹⁰ What is not well known is the significant association between marital status and fall injury risk. The CCHS data suggests that those without a spouse, who may be living alone, may be at greater risk for a fall with injury. It was surprising, and contrary to the literature,¹¹ to find that more years of education were associated with a higher risk of sustaining a fall-related injury.

Figure 1 presents estimated cases of injurious falls based on self-reports from the CCHS sample, broken down by gender and age group. Adding the total cases for each age group, there are almost 180,000 injurious falls annually in the Canadian population age 65 and over.

Figure 2 shows rates of injurious falls for men and women by age group. The rate of injurious falls increased with age from a low of 35 per 1000 population age 65-69 to a high of 76 per 1000 population age 80 and over. Female rates exceed male rates in all age groups. These differences are statistically significant except for age 75-79. Overall, survey respondents reported a fall-related injury in the past year, serious enough to limit normal activities, at a national average rate of 47.7 per 1000 population age 65 and over.

TABLE 1 |  Distribution Of CCHS (Cycle 2.1) Sample For Age 65 and Over, 2002/03

Total CCHS sample With a fall causing injury   Population Percent 95% confidence intervals Population Percent 95% confidence intervals Gender Male Female N   1,658,918 2,124,857 3,783,775   43.8 56.2     42.8 55.3     44.9 57.1     56,912 123,441 180,353   31.6 68.4     30.8 67.3     32.3* 69.5*   Age 65-69 70-74 75-79 80+   1,154,063 1,027,278 804,061 798,373   30.5 27.1 21.3 21.1   29.5 26.3 20.4 20.3   31.5 28.0 22.1 21.9   40,274 44,568 44,977 50,534   22.3 24.7 24.9 28.0   21.6 23.9 23.9 26.9   23.1* 25.5* 25.9  29.1* Marital status Married Common-law Widowed/ Separated/ Divorced Single   2,268,605 62,219 1,283,672 160,348   60.0 1.6 33.9 4.2   59.0 1.4 32.8 3.9   60.9 1.9 35.0 4.6   86,352 1,269 82,803 9,413   47.9 0.7 45.9 5.2   47.1 0.6 44.4 4.8   48.6* 0.8  47.4* 5.7* Education Less than secondary school graduation Secondary school graduation Some post- secondary Post-secondary graduation   1,711,479 589,166 166,470 1,190,164   45.2 15.6 4.4 31.5   44.5 14.8 4.0 30.4   46.0 16.4 4.8 32.5   72,419 31,539 10,846 61,620   40.2 17.5 6.0 34.2   39.5 16.6 5.5 33.0   40.8* 18.4* 6.5* 35.3* Household income Less than $15,000 $15,000 to $29,999 $30,000 to $49,999 $50,000 to $79,999 $80,000 or more Not stated N 394,564 1,012,461 793,169 478,270 244,189 861,122 3,783,775 10.4 26.8 21.0 12.6 6.5 22.8   9.9 25.8 20.1 11.9 6.0 21.6   11.0 27.7 21.8 13.3 6.9 23.9   26,037 45,483 37,258 22,560 14,165 34,851 180,353 14.4 25.2 20.7 12.5 7.9 19.3   13.7 24.4 19.8 11.8 7.3 18.3   15.2* 26.1  21.5  13.2  8.5* 20.3*

*significant at p<0.05 level

 

It is not surprising that the number of falls increased with age with the greatest increases among women. However, the increases found in the rate of falls by age and gender is of concern. The finding that the rates for women are statistically significantly higher than those for men among all but one age group may be related to lower income, greater social isolation and higher rates of chronic disease among women.

Figure 1 | Estimated Rates Of Injuries Resulting From A Fall, By Age Group And Gender , Age 65+, Canada, 2002/03

Source: Canadian Community Health Survey, Cycle 2.1.

Figure 2 | Estimated Rates Of Injuries Resulting From A Fall, By Age Group And Gender, Age 65+, Canada, 2002/03

Source: Canadian Community Health Survey, Cycle 2.1.

Figure 3 presents the distribution of the types of injuries reported by seniors who experienced an injury as a result of a fall. Over one third (37%) of the injuries sustained were to the hip, thigh, knee, lower leg, ankle, or foot, followed by the wrist or hand (17%) and the back (14%).

Figure 3 | Self-Reported Falls Resulting In Injury, By Type Of Injury, Age 65+, Canada, 2002/03

Source: Canadian Community Health Survey, Cycle 2.1.

Figure 4 shows that the majority of respondents (44%) reported slipping, tripping, or stumbling. Over one quarter (26%) reported falling while going up or down stairs. Response categories were combined in the data set due to small numbers and consequently, no further detail is available. It is most likely that the 20% who reported "skating/skiing/ snowboarding/slipping/tripping stumbling" on ice/snow had predominantly slipped, tripped, or stumbled on ice/snow.

The findings depicted in Figure 4 are similarly reflected in the National Trauma Registry,¹² where 23% of severe injuries due to a fall among those age 65 and over were due to a fall on or from stairs or steps.

Figure 4 | Self-Reported Falls Resulting In Injury, By Type Of Activity, Age 65+, Canada, 2002/03

Source: Canadian Community Health Survey, Cycle 2.1.

Figure 5 indicates that, for the 72% who sought medical treatment within 48 hours, the majority (65%) were treated in a hospital emergency department. Many were treated in a doctor's office (20%) or a hospital day clinic (9%). Of those treated in the emergency department, 38% reported that they were admitted to hospital for at least one night as a result of the injury.

Figure 5 | Self-Reported Falls Resulting In Injury, By Type Of Treatment Reserved Within 48 Hours, Age 65+, Canada, 2002/03

Source: Canadian Community Health Survey, Cycle 2.1.

Summary

The 2002/03 CCHS sample for those age 65 and over was approximately 29,000 respondents, representing a population of about 3.8 million Canadians age 65 and over. Compared to the population of seniors as a whole, those who reported experiencing an injurious fall were more likely to be female; in the 80+ age group; widowed, separated or divorced; have post-secondary graduation; and a household income of less than $15,000. Based on the self-reports, the rate of injurious falls increased with age and the rates for women exceeded the rates for men in all age groups. Over one third of the injuries sustained were to the hip, thigh, knee, lower leg or ankle. Most respondents reported slipping, tripping, or stumbling and over a quarter reported falling while going up or down stairs. Almost three quarters (72%) received medical treatment from a health professional within 48 hours of the injury.

2.2 What Hospitalization Data Tell Us About Seniors' Falls

The analyses provided in this section are based on the Discharge Abstract Database (DAD) at the Canadian Institute for Health Information (CIHI). They include fall-related hospitalization cases and rates, length of hospital stay, injury type, place of occurrence of fall, and differences by age group and gender for seniors age 65 and over, for the years 1998/99 through 2002/03.

Definitions and data

Revisions to codes in the International Classification of Diseases (changes from ICD 9 to ICD 10) greatly affected the coding of data in hospitals around the world and especially affected data on fall injuries. Therefore, care must be taken in comparisons of data based on the two different classifications. The ICD 10 classification for hospitalization data is being gradually implemented during the 2001-2006 period.

This section uses the DAD data pertaining to acute care hospitalizations for falls among persons 65 years and over in Canada. Fall-related hospitalizations for a specific population are a good estimate of all falls resulting in serious injury for that population. However, this data source does not capture information on injurious falls of lesser severity, which may be treated at hospital emergency departments or physicians' offices, or falls for which medical treatment was not sought (see discussion on Figure 5).

The Injury pyramid below provides a graphic illustration of the possible sources of falls data, and shows that data currently available provides an incomplete picture.

Source: Prevention of falls and injuries among the elderly: A special report from the Office of the Provincial Health Officer, B.C. Ministry of Health Planning, 2004.

Data for this section:

• include fall-related hospital discharges from acute care facilities for those age 65 and over during fiscal years 1998/99 through 2002/03 (hospital discharges include cases who have left hospital alive or have died in hospital after admission);
• reflect the number of hospital discharges rather than the number of injured seniors;
• present information by age groups of 65-74, 75-84 and 85 and over;
• identify causes of injury by the documented "External Cause of Injury" code unless otherwise specified;
• exclude cases with unknown age; and
• show 95% confidence intervals where appropriate.

The online Technical report - Hospitalizations provides detailed information on the data source, the analyses conducted and interpretations of the findings.

Findings

Figure 6 shows that, on an age-specific basis, the fall-related hospitalization rates for the 65-74 and 75-84 age groups were stable at about 6 and 16 per 1000 population respectively during 1998/99 to 2002/03. The 85 and over age group was also stable during this period at 43 per 1000 population. The anticipated growth among the 85 and over age group in Canada from 430,000 in 2001 to 1.6 million by 2041,¹³ together with the fact that people are living longer with chronic conditions, may suggest that the rate of fall-related hospitalizations for this age group could increase.

Figure 6 | Fall-Related Hospital Cases And Rates, Age 65+, Canada, 1998/99 To 2002/03

Confidence intervals are 95% confidence intervals.
Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Figure 7 shows fall-related hospitalization rates by gender and age groups for Canadians age 65 and over for the year 2002/03. Men and women both had increasing rates of hospitalization with age. Women age 65-74 had rates of about 6 per 1000 population increasing to 46 per 1000 in the 85 and over age group. Men had a similar rate to women in the 65-74 age group (4 per 1000) but increased to only 32 per 1000 in the 85 and over age group. For all those age 65 and over, women had a rate of hospitalization of about 16 per 1000 and men of 9 per 1000.

The findings that rates of fall-related hospitalizations were higher for women than for men and that these differences increased with advancing age are consistent with other studies that show a strong correlation between female gender, older age and the risk of injurious falls.¹⁴ Conditions known to be associated with aging, such as the effects of a stroke, dementia and diabetes, are all known to increase the risk of falling and being injured.¹⁵ Women are known to be at higher risk for fall injuries due to their higher rates of osteoporosis, which makes them more likely to sustain a serious fracture from a fall.¹⁶

Figure 7 | Fall-Related Hospitalalization Rates, By Gender And Age Group, Age 65+, Canada, 2002/03

Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Figure 8 | Fall-Related Hospitalizations, Average Length Of Stay Per Case, By Age Group, Canada, 1998/99 To 2002/03

Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Figure 8 illustrates that, generally, the older the person, the longer their length of hospital stay for a fall-related injury. It also shows that the average length of stay for all age groups was relatively stable from 1998/99 to 2002/03. Over the five years, on average, those age 65-74 had hospital stays of 11 days after a fall, those age 75-84 had stays of 13 days, and those age 85 and over had stays of nearly 14 days. Nationally, the average number of total hospitalization days for fall-related injuries among seniors was 273 per 1000 population age 65 and over.

Confidence intervals are 95% confidence intervals.

Figure 9 | Average Length Of Stay Per Case, All Causes And Fall-Related Hospitalizations, Age 65+, Canada, 1998/99 To 2002/2003

Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Figure 10 | Number And Percent Of Fall-Related Hospital Cases, By Injury Type, Age 65+, Canada, 1998/99 To 2002/03

Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Figure 11 | Fall-Related Hospital Cases, By Place Of Occurrence Of Fall, Age 65+, Canada, 1998/99 To 2002/03

Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Figure 9 shows that the average length of hospital stay for a fall injury was consistently longer (by about 40%) than the average length of stay for all causes of hospitalization for seniors age 65 and over. The average length of stay for both falls and all causes showed little change from 1998/99 through 2002/03.

Figure 10 shows that, over the five years, nearly 85,000 Canadians age 65 and over had injuries to their femur, pelvis, hip or thigh, accounting for 56% of all fall-related injuries among seniors treated in hospital. Injuries to an upper limb, a lower limb, or the spine accounted for 24% of fall-related hospitalizations.

The majority of injuries to major joints, the femur or pelvis are likely associated with hip fractures, which other studies have shown contribute to up to 40% of all fall-related hospitalizations for this age group.¹⁷

Injury type as classified in Major Clinical Category 25: Significant Trauma. Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Figure 11 shows the place of occurrence of falls that led to a hospitalization, nationally, among those age 65 and over for the period 1998/99 through 2002/03. Nearly half (47%) of these falls occurred in or around the home. Falls in residential institutions accounted for 21% of hospitalizations due to falls among those age 65 and over.

Although the home is the more frequently reported place of occurrence of falls, it is important to note that approximately only 7.4% of those age 65 and over live in residential care settings¹⁸ and are therefore contributing a far larger proportion of hospital admissions compared to seniors from other settings.

However, this is to be expected given that seniors living in residential care settings are older and have more chronic health conditions that put them at much greater risk for falls than those living in the community.

Summary

Fall-related hospitalization data for all seniors were analyzed for the years 1998/99 through 2002/03. Seniors' fall-related hospitalizations for all age groups remained stable over the five years. The rates for women were consistently higher than for men and these differences increased with advancing age. The average length of hospital stay for all age groups was relatively stable and generally, the older the person, the longer the length of stay. Nearly 85,000 Canadians age 65 and over had injuries to their femur, pelvis, hip or thigh, accounting for the majority of all fall-related injuries among seniors treated in hospital. Almost half of the falls occurred in or around the home.

2.3 What Hospitalization Data Tell Us About Falls in Residential Care

The information in this section is based on data from the CIHI Discharge Abstract Database (DAD) pertaining to acute care hospitalizations for falls among adults age 65 and older, living in residential care facilities in Canada. (For more details about the DAD, see Section 2.2).

The analyses provided in this section include fall-related hospitalization cases and rates, length of hospital stay, place of occurrence of fall, and differences by age group and gender for the years 1998/99 through 2002/03.

Definitions and Data

The definitions and data cautions stated in the previous section also apply to this section, which uses the same data source, further narrowed by selecting for residential care.

This section:

• includes hospitalization data for persons for whom "place of occurrence" of the fall was designated as "Residential Institution," and the place they were "transferred from" to hospital was "Chronic Care Facility," "Nursing Home" or "Home for the Aged";
• does not include residents of care facilities under age 65;
• does not include falls while outside the residential care facility (this could be a source of underreporting for this population); and
• does not include a calculation of any rates, due to a scarcity of information on total populations living in residential care facilities for the years 1998/99 through 2002/03.

Fall-related injuries among those age 65 and older in residential care appear to be far more frequent than among those who are not in residential care.¹⁹ Seniors in residential care account for approximately 7% of the 65+ population, but account for 15% of all fall-related hospitalizations for that age group.

Approximately 50% of all long-term care residents fall each year, and of these, 40% fall twice or more each year.²⁰ Approximately 10% of these falls result in serious injury, including up to 5% in bone fractures.²¹ For women living in a residential care facility, the risk of sustaining a hip fracture is 10.5 times higher than for women of the same age living in the community; less than 15% of facility residents who sustain a hip fracture regain pre-injury ambulation status.²²

In 2001, the Canadian population age 65 and over was approximately 3.9 million people and of these, it is estimated that 7.4% or approximately 287,500 were living in residential institutions. They represented 9.2% of senior women and 4.9% of senior men. This is a decline since 1981, when 10.5% of senior women and 6.7% of senior men lived in these facilities. Living in residential institutions is most common for the oldest seniors, those age 85 and over. However, for this age group, the proportion of men in these facilities dropped from 29% in 1981 to 23% in 2001, and the proportion of women dropped from 41% in 1981 to 35% in 2001. Although the rates for seniors living in residential institutions are declining, this trend is offset by the aging of our population, which results in steadily increasing numbers of seniors.²³

Adults living in residential institutions now tend to have more complex health challenges, such as advanced dementia, multiple chronic health conditions and limited mobility. These characteristics put this population at greater risk of falling and sustaining a fall-related injury. The online Technical Report - Hospitalizations…in Residential Care Facilities provides detailed information on the analysis conducted and an interpretation of the findings.

Findings

Figure 12 shows that fall-related hospitalization cases for seniors not in residential care ranged between 40,000 and 43,000 per year through the period. Fall-related hospitalizations for seniors in residential care ranged from about 6,000 to 9,000 per year. Seniors age 65 and over who live in residential care facilities and who fall represent about 12% to 15% of all fall-related hospitalizations among those age 65 and over across the country from 1998/99 through 2002/03.

Over the 1998/99 to 2002/03 period, the number of fall-related hospital cases for those age 65 and over living in residential care increased from about 6,000 to 7,000 with the greatest number seen in 2000/01 at about 9,000 cases.

Figure 12 | Fall-Related Hospital Cases For Residential Care* vs. Non-Residential Care, Age 65+, Canada, 1998/99 to 2002/03

*Residential care homes include chronic care facilities, nursing homes, homes for the aged.
Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Figure 13 | Fall-Related Hospital Cases For Residential Care,* By Age Group, Canada, 1998/99 To 2002/03

*Residential care homes include chronic care facilities, nursing homes, homes for the aged.
Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Figure 14 | Fall-Related Hospitizations, Average Length Of Stay Per Case For Residential Care* vs. Non-Residential Care, 1998/99 To 2002/03

*Residential care homes include chronic care facilities, nursing homes, homes for the aged.
Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Figure 13 shows that, from 1998/99 through 2002/03, there were over 40,000 fall-related hospitalizations among Canadians age 65 and over living in residential care. This is the equivalent of approximately 8,000 hospitalizations due to falls per year.

The number of hospitalizations increased with age in all years shown. The number of cases among those age 65-74 increased to over 1000 per year in 2000/01 with a decrease in the final two years. The number of cases among those age 75-84 increased to about 3,500 per year in 2000/01 with a decrease in the final two years. For those age 85 and older, there was an increase in hospitalizations due to falls to 4,500 in 2000/01 followed by a decrease over the next two years.

Figure 14 shows that in 1998/99, the average length of stay for fall-related hospitalizations for those age 65 and over living in a residential care facility was about 19% longer than the average length of stay for those not living in residential care. This gap narrowed over the five years and, by 2002/03, those not living in residential care had longer stays on average compared to those living in residential care. The average length of stay for falls for non-residential care patients has shown little change from 1998/99 through 2002/03.

Figure 15 illustrates that the older the person is, the shorter the stay in hospital. On average, those 65-74 years of age stay in hospital 15-20 days after a fall, while those 75-84 stay 13-15 days and those age 85 and over stay 12-14 days. The average length of stay in all age groups declined over the five-year period. This contrasts with the non-residential population that shows an unchanging average length of stay over the period.

Figure 16 shows that, over the five-year period, nearly 17,000 Canadians age 65 and over living in a residential care facility were hospitalized for fall-related injuries to a major joint, femur, pelvis, hip or thigh, these accounting for more than 75% of all fall-related injuries among those of this group who were treated in hospital. Injuries to the upper limbs, lower limbs or spine accounted for 11% of fall-related hospitalizations for this age group. As mentioned previously, the majority of the injuries to a major joint, femur or pelvis are likely associated with hip fractures, which are shown in other studies to contribute up to 40% of all fall-related hospitalizations for this age group.²⁴ Most injuries are to the lower limbs.

Figure 15 | Fall-Related Hospitalizations, Average Length Of Stay Per Case For Seniors In Residential Care,* By Age Group, Age 65+, Canada, 1998/99 To 2002/03

*Residential care homes include chronic care facilities, nursing homes, homes for the aged.
Source: Acute separations from 1998/99 to 2002/03, Canadian Institute for Health Information Discharge Abstract Database.

Summary

From 1998/99 through 2002/03, about 40,000 Canadians age 65 and over living in residential care were hospitalized for a fall-related injury. Although over the five years, the average length of hospital stay for those living in residential care was longer than the length of stay for those not living in residential care, the gap narrowed over the five years and, by 2002/03, those not living in residential care had longer stays on average compared to those living in residential care. Contrary to the data for fall-related hospitalizations for all seniors age 65 and over, if a senior lived in residential care, the older the person was, the shorter the hospital stay and the average length of stay declined over the five-year period. The population not living in residential care showed an unchanging average length of stay over the period.

Figure 16 | Number And Percent Of Hospital Cases Associated With Falls In Residential Care By Injury Type, Canada, 1998/99 To 2002/03

2.4 What Mortality Data Tell Us About Deaths Due to Falls

The analyses provided in this section present data from Canadian Vital Statistics on all direct deaths due to falls among those age 65 and over and include differences by place of injury, gender, and age groups, as well as trends over time.

Definitions and Data

Data were requested for Canadians age 65 and over for deaths due to unintentional falls. Sample data runs resulted in Statistics Canada limiting the data to six years in two periods, 1997-1999 and 2000-2002.

This section:

• includes data on direct deaths, equivalent to the 'underlying cause of death' as indicated on the medical certificate of death;
• excludes indirect deaths, where a fall may have eventually led to death but was not the underlying cause of death;
• presents data for age groups of 65-69, 70-74, 75-79, 80-84 and 85 years and over;
• excludes deaths of non-residents of Canada, deaths of residents of Canada with unknown province or territory of residence, and deaths for which age of deceased was unknown; and
• shows 95% confidence intervals where appropriate.

The online Technical report - Deaths provides detailed information on the specific data request made to Statistics Canada, data limitations, the specific codes used to identify falls, the analyses conducted and an interpretation of the findings.

Findings

Figure 17 shows that, for the six years examined, more than 7,000 Canadians age 65 and over died as a direct result of a fall. This number increased from 3,209 in the 1997-1999 period to 4,110 in the 2000-2002 period. It also shows rates of deaths. On an age-standardized basis, there was a statistically significant increase in the rate of deaths due to falls from 8.1 per 10,000 population in the 1997-1999 period to 9.4 per 10,000 population in the 2000-2002 period.

Figure 17 | Deaths And Morality Rate* Due To Falls, Age 65+, Canada, 1997-2002

*Age standardized to the 1991 Canadian population.
Source: Statistics Canada, Deaths Database.

The increasing number of fall-related deaths among those age 65 and over reflects the growing proportion of this age group in Canada. There was also a statistically significant increase in the rate of fall-related deaths. While the interpretation of the data is complicated by the possible impact of the conversion from ICD 9 to ICD 10 coding, nonetheless, the increase in the number and rate of deaths due to falls among seniors may be due in part to an increase in health conditions associated with increasing age. These conditions can contribute to an increased risk of sustaining a severe injury and a decrease in the ability to recover from an injury.

Figure 18 shows the number of deaths by age group for the two three-year periods. For both periods, the number of deaths increased with age, rising from fewer than 300 in the 65-69 age group, to more than 2,000 in the 85 and over age group for the second period.

Figure 19 indicates that the rate of deaths due to falls increased with age from fewer than 10 deaths per 10,000 population in the youngest age group, to over 50 deaths per 10,000 in the oldest age group. A significant difference in the rates from the first period to the second was seen for all of the age groups.

Figure 20 shows deaths due to falls by gender for Canadians age 65 and over. Deaths due to falls among women rose from approximately 1,797 in the 1997-1999 period to 2,224 in the subsequent period. This translates into an age-standardized rate of 9.9 deaths per 10,000 in the first period and 12.4 deaths per 10,000 in 2000-2002. This increase was statistically significant (p<0.05).

Figure 18 | Deaths Due To Falls, By Age Group, Age 65+, Canada, 1997-2002

Source: Statistics Canada, Deaths Database.

Deaths due to falls among men increased from 1,412 in the 1997-1999 period to 1,886 in the subsequent period. The age-standardized rate for men increased from 6.9 to 7.9 deaths per 10,000 population over the six-year period. However, this increase was not statistically significant (p>0.05).

Figure 19 | Mortality Rate Due To Falls By Age Group, Age 65+, Canada, 1997-2002

Source: Statistics Canada, Deaths Database.

Figure 20 | Deaths And Morality Rate* Due To Falls, By Gender, Age 65+, Canada, 1997-2002

*Age standardized to the 1991 Canadian population.
Source: Statistics Canada, Deaths Database.

Location and Type of Fall

Additional analyses were carried out on data concerning location and type of fall. Where the location of the falls resulting in death was known, over 53% occurred in a private home environment, 18% in residential care facilities, and 29% in other locations such as public buildings, on the street, in a commercial or service area, in a recreation or sport area and on a farm.

Although the majority of fall-related deaths of seniors occurred in the home environment, it is important to consider the amount of time that persons at greatest risk of falling spend inside compared to outside their homes. Twenty-nine percent of falls causing death occurred outside the home, even though much less time may be spent outside the home by those age 65 and over.

For fall-related injuries resulting in death for seniors, falls within the home occurred most often from one level to another (78%), rather than on the same level (22%). This is consistent with findings in the CIHI study of severe injuries, showing that the majority of these occurred on stairs and steps.²⁵

By comparison, where a fall occurred outside the home (but not including residential care facilities), 66% were the result of a fall from one level to another and 34% were due to falls on the same level. Significantly more falls from one level to another occurred in the home environment than outside the home.

Summary

Mortality data from Statistics Canada were analyzed for all direct deaths due to falls among those age 65 and over, for the years 1997 to 2002. The analyses include differences by place of injury, gender, and age group. In the period, more than 7,000 Canadians age 65 and over died as a direct result of a fall. On an age-standardized basis, there was a statistically significant increase in the rate of deaths due to falls from 1997-1999 to 2000-2002 and the rate of deaths due to falls increased with age in both time periods. The rate of deaths due to falls was higher for women than for men. Where the location of the fall was known, the majority of falls resulting in deaths among Canadians age 65 and over occurred in the person's home.

---

10. Fletcher, P. C. and J. P. Hirdes. "Risk factors for falling among community-based seniors using home care services." Journal of gerontology, Vol. 57A, No. 8, 2002, pp. M504-M510.
Scott V.; S. Peck and P. Kendall. Prevention of falls and injuries among the elderly: A special report from the Office of the Provincial Health Officer. Victoria, B.C.: Ministry of Health Planning, 2004.

11. Evans, R. G.; M. Barer and T. R. Marmor. Why are some people healthy and others are not?: The determinants of health of populations. New York: Aldine De Gruyter, 1994.
Hirdes, J. P. and W. F. Forbes. "Factors associated with the maintenance of good self-rated health." Journal of aging and health, Vol. 5, No. 1, 1993, pp. 101-22.

12. Canadian Institute for Health Information. National trauma registry 2003 report: Major injury in Canada (includes 2001-2002 data). Ottawa: 2003.

13. Health Canada. Canada's aging population. Ottawa: Division of aging and seniors, 2002.

14. Fletcher, P. C. and J. P. Hirdes. "Risk factors for falling among community-based seniors using home care services." Journal of gerontology, Vol. 57A, No. 8, 2002, pp. M504-M510.
Peel, N. M.; D. J. Kassulke and R. J. McClure. "Population based study of hospitalised fall related injuries in older people." Injury prevention, Vol. 8, 2002, pp. 280-83.
Scott V.; S. Peck and P. Kendall. Prevention of falls and injuries among the elderly: A special report from the Office of the Provincial Health Officer. Victoria, B.C.: Ministry of Health Planning, 2004.

15. Oleske, D. M. et al. "Epidemiology of injury in people with Alzheimer's disease." Journal of the American geriatrics society, Vol. 43, No. 7, 1995, pp. 741-46.
Lamb, S. E. et al. "Risk factors for falling in home-dwelling older women with stroke: The women's health and aging study." Stroke, Vol. 34, No. 2, 2003, pp. 494-501.

16. Scientific Advisory Board and Osteoporosis Society of Canada. "Clinical practice guidelines for the diagnosis and management of osteoporosis." Canadian medical association journal, Vol. 155, No. 8, 1996, pp. 1113-26.

17. Peel, N. M.; D. J. Kassulke and R. J. McClure. "Population based study of hospitalised fall related injuries in older people." Injury prevention, Vol. 8, 2002, pp. 280-83.
Scott V.; S. Peck and P. Kendall. Prevention of falls and injuries among the elderly: A special report from the Office of the Provincial Health Officer. Victoria, B.C.: Ministry of Health Planning, 2004.

18. Statistics Canada Census. 2001. Online:
www12.statcan.ca/english/census01/Products/Analytic/companion/fam/canada.cfm

19. Scott V.; S. Peck and P. Kendall. Prevention of falls and injuries among the elderly: A special report from the Office of the Provincial Health Officer. Victoria, B.C.: Ministry of Health Planning, 2004.

20. Aronow, W. and C. Ahn. "Association of postprandial hypotension with incidence of falls, syncope, coronary events, stroke, and total mortality at 29-month follow-up in 499 older nursing home residents." Journal of the American geriatrics society, Vol. 45, 1997, pp. 1051-53. Kiely, D. K. et al. "Identifying nursing home residents at risk of falling." Journal of the American geriatrics society, Vol. 46, No. 5, 1998, pp. 551-55.

21. Butler, M. et al. "The risks of hip fracture in older people from private homes and institutions." Age and ageing, Vol. 25, 1996, pp. 381-85.
Thapa, P. B. et al. "Antidepressants and the risk of falls among nursing home residents." New England journal of medicine, Vol. 339, 1998, pp. 875-82.

22. Folman, Y. et al. "Functional recovery after operative treatment of femoral and neck fractures in an institutionalized elderly population." Archives of physical medicine and rehabilitation, Vol. 75, No. 4, 1994, pp. 454-56.

23. Statistics Canada Census. 2001

24. Peel, N. M.; D. J. Kassulke and R. J. McClure. "Population based study of hospitalised fall related injuries in older people." Injury prevention, Vol. 8, 2002, pp. 280-83.
Scott V.; S. Peck and P. Kendall. Prevention of falls and injuries among the elderly: A special report from the Office of the Provincial Health Officer. Victoria, B.C.: Ministry of Health Planning, 2004.

25. Canadian Institute for Health Information. National trauma registry 2003 report: Major injury in Canada (includes 2001-2002 data). Ottawa: 2003.

 

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