Costs of fatal falls among US older adults trump those attributed to firearm deaths: Study

The cost of fatal falls among older people (45–85+) trump those of firearm deaths in the US, finds research published in the open access journal Trauma Surgery & Acute Care Open.

The stark economics and shifting age demographics in the US underscore the urgency of preventive measures, conclude the researchers.

Falls account for around one in five of all injury-related hospital admissions, and the World Health Organization reports that falls are the second leading cause of unintentional injury deaths worldwide, with the over 65s especially vulnerable, highlight the researchers.

Like falls, firearms related injuries and deaths take a significant economic toll, but firearm injuries disproportionately affect younger age groups, exacting a greater financial impact on years of potential life lost and productivity, note the researchers.

However, with the population growth of older people, thanks, in part, to improvements in medical care, these costs could change, they suggest.

To explore this further, they calculated and compared the associated average medical costs and the combined cost of medical expenses plus a monetary estimate of lost years of life/productivity of fatal firearm and fall-related injuries in different age groups between 2015 and 2020.

They drew on data from the Web-based Injury Statistics Query and Reporting System database (WISQARS), which provides information on fatal and non-fatal injuries, violent deaths, and medical and productivity costs of injuries in the US.

The researchers looked at entries for everyone between the ages of 15 and 85+, collating the number of fatal cases, including unintentional injuries, plus data on the total population of the US and the years of potential lives lost for both fatal firearm injuries and falls.

Between 2015 and 2020, 1,454,007 people died of their injuries in the US. Of these, 230,663 cases (16%) were due to falls, of which 193,643 were among the over 65s; and 239,352 deaths (15.5%) were due to firearm injury, of which 39,980 were among the over 65s.

The years of potential life lost amounted to 1,500,900 for fatal falls and 8,909,758 for firearm injuries.

The percentage of fatal falls increased significantly in all age ranges between 2015 and 2019, rising sharply in 2019 for patients over the age of 65.

The total medical costs of fatal falls across all age groups were significantly higher than those for firearms injuries. In 2015–20, the average medical costs were $1,427,773,589 for fatal falls compared with $246,456,666 for firearm injuries.

The average medical cost was also significantly higher for fatal falls than it was for firearms injuries: $76,982 vs. $44,522 per patient.

This might be because of the surgery, prolonged hospital stays, and rehabilitation needed, all of which are expensive, whereas firearms victims often don’t survive their injuries, explain the researchers.

Falls can also lead to long-term health conditions that require ongoing medical management, incurring substantial costs for both the individuals concerned and health care systems.

While the total and average combined costs of firearm injuries exceeded those of falls, overall, after 2019, the combined costs of fatal falls were higher because of the rise of these incidents among 45 to 85+ year olds.

The percentage of fatal falls increased significantly in all age ranges over the five years, but rose sharply in 2019 for patients over the age of 65, rising to just under 7% after 2019 compared with nearly 3% before 2019.

Changing demographics affect the economic burden of health care in society, say the researchers, who point out that between 2010 and 2020, the proportion of the over 65s in the US population shot up by nearly 39%, rising from just over 40 million to nearly 56 million, or 17% of the total.

The researchers acknowledge various limitations to their findings. For example, firearm injuries are far more common among younger people while falls are more common among the elderly, introducing an element of survivability bias. And they weren’t able to evaluate data on non-fatal firearm injuries, as WISQARS doesn’t report the number or costs of these.

Nevertheless, they point out, “While public discourse often places an emphasis on issues such as gun violence because of its acuteness, our study underscores the hidden economic burden of geriatric falls.”

And they conclude, “The increase in fatalities, shifting demographics, and stark economic comparisons between fatal falls and other causes of death underscore the urgency of the issue. Policy makers must recognize geriatric falls as a critical public health challenge and implement proactive measures to prevent falls, provide specialized health care, and allocate resources strategically.”