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Public Health and Aging Nonfatal Fall-Related Traumatic Brain Injury Among Older Adults  California, 1996--1999

In the United States, falls are the second leading cause of traumatic brain injury (TBI) hospitalizations overall and the leading cause of TBI hospitalizations among persons aged >65 years (1). In 1995, TBIs resulted in an estimated $56 billion in direct and indirect costs in the United States (2). In California, during 1999, a total of 61,475 hospitalizations from falls were reported among persons aged >65 years (3). Risk factors for falling among older persons included arthritis; impairments in balance, gait, vision, and muscle strength; and the use of four or more prescription medications (2,4). As part of CDC's program of state-based TBI surveillance, California hospital discharge data were collected and analyzed to describe fall-related TBIs. This report summarizes the results of that analysis, which support previous findings that persons aged >65 years are at risk for hospitalization for a fall and that same-level falls are far more common among persons aged >65 years than falls from a higher level (e.g, a ladder, chair, or stair) (1,2,5). Defining the circumstances of fall injuries and recognizing the type of fall leading to TBI hospitalizations among older persons can help health-care providers conduct risk assessment and management of falls in this population.

All nonfederal, acute care hospitals in California are required to report hospital discharges to the Office of Statewide Health Planning and Development. All first admissions with an injury diagnosis must be coded for external cause of injury (E-code); E-codes are listed in >99% of these records (5). For this report, cases were limited to first admissions. Hospitalization records of transfers, fatal cases, and out-of-state residents were excluded by matching sex, date of birth, and a record linkage number (i.e, an encrypted social security number). Hospital discharge records were coded according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) (6). TBI cases were defined by the most recent CDC surveillance definition, in which any of the 25 diagnoses include one of the following nature-of-injury diagnosis codes: 800.0--801.9 (fracture of the vault of the skull), 803.0--804.9 (other and unqualified skull fracture), 850.0--854.1 (intracranial injury including concussion, laceration, and hemorrhage), or 959.01 (head injury, unspecified). The primary cause of injury for falls (E880--E886, E888) was analyzed by mechanism.* Age was categorized into one younger comparison group (aged 0--64 years) and three older groups (aged 65--74 years, 75--84 years, and >85 years). Incidence rates were calculated per 100,000 population by using mid-year population estimates of California residents for each year (Epidemiology and Prevention for Injury Control, California Department of Health Services, unpublished data, 1996--1999).

During 1996--1999, a total of 29,761 fall-related TBI hospitalizations were reported; of these, 28,009 (94%) patients were discharged, and 1,752 were deceased. A total of 1,252 (71%) of fatal fall-related TBI hospitalizations were among those aged >65 years. Overall, the nonfatal fall-related TBI hospitalization rate was 21.1 per 100,000 population (95% confidence interval = 20.8--21.3) (Table 1). Hospitalization rates increased with age; the highest rate (223.0) was among persons aged >85 years. Compared with persons aged 0--64 years, the rate ratio of hospitalizations was 3.1 for persons aged 65--74 years, 7.6 for those aged 75--84 years, and 16.4 for those aged >85 years. Overall, males were hospitalized more frequently (59%) than females. Although 70% of hospitalizations among those aged <65 years were among males, females accounted for 56% of hospitalizations among those aged >65 years. For those aged >65 years, whites represented 78% of hospitalizations and had the highest rate (25.4) among all racial/ethnic populations.

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	Did You Know?
	There are treatments available for brain damage. The effects of impairment or disability resulting from brain damage may be treated by a number of methods, including medication, psychotherapy, neuropsychological rehabilitation, surgery or physical implants such as deep brain stimulation.