Increase in Fall-Related Fatalities in the Home Following the COVID-19 Pandemic Onset, 2025, Hoffen et al.

[SNT Gatchaman]

Increase in Fall-Related Fatalities in the Home Following the COVID-19 Pandemic Onset

Spoiler: Authors

Jessica Hoffen; Madeline Goosman; Andrew H Stephen; Adam R Aluisio; Brent J Emigh; Benjamin M Hall; Daithi S Heffernan

BACKGROUND
Falls are a leading cause of injury and death in older adults (age ≥ 65 years). The onset of the COVID-19 pandemic in the United States (US) marked a transition into a period of greater social isolation to curb the spread of disease. The pandemic additionally greatly strained the US healthcare system. As a result, older adults participated in less physical activity and experienced greater hesitancy to seek medical care in an effort to minimize their risk of infection. They additionally may have experienced delays and incomplete access to such care. It is possible that such changes worsened frailty and increased vulnerability to falls and fall-related sequelae among this population. We hypothesized that the COVID-19 pandemic led to an increase in fall-related fatalities generally and an increase in fall-related fatalities that occurred in the home.

METHODS
We conducted an interrupted time series analysis using a regression model on monthly fall fatalities among older adults from January 2015 through December 2020. Fall fatality data were extracted from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER), along with the estimated annual population of US residents aged ≥ 65. The COVID-19 pandemic, defined as starting in the US in March 2020, was the interruption variable.

RESULTS
There were 192,586 fall fatalities among older adults in the study period, with a mean of 2614 deaths per month ( = 228.4) pre-pandemic, and 3051 deaths per month ( = 215.1) post-pandemic onset. There was no statistically significant change in the incidence of all fall-related fatalities following pandemic onset. However, there was a 25% increase in incidence of fall-related fatalities that occurred within fall victims homes, specifically (IRR = 1.25, 95% CI 1.14, 1.36).

CONCLUSION
There was a significant increase in fall-related fatalities within homes among older adults in the US after the onset of the COVID-19 pandemic. During pandemic type situations and times of social distancing, increased social supports and resources must be maintained for older adults to reduce the incidence of falls within the home and fall-related injuries.

Web | DOI | PDF | Journal of the American Geriatrics Society | Paywall

 

[SNT Gatchaman]

Falling at home and being unmarried are associated with increased risk of fall-related fatality, and falls that go unwitnessed by a family member, member of the public, or group living center staff are more likely to result in death. The COVID-19 pandemic and social distancing initiatives created a situation that increased or exacerbated these factors. Older adults, particularly those living independently, were impacted by the distancing policies applied to the general public, including limitations on gatherings and closure of many locations that promoted social connectivity such as retail and restaurant spaces, houses of worship, and senior centers. Older adults were also more likely than younger individuals to adhere to social distancing guidelines and avoid visiting with individuals outside of the home, even as policies mandating such actions eased. Subsequently, older adults reported increased social isolation and loneliness following pandemic onset—known risk factors for a fall. This population also reported decreased engagement in physical activity and reduction in health care usage, which may have increased their frailty, further elevating their risk for falls and fall related injuries.

Older adults living at home during the pandemic did not have regular access to health aides, nurses, and programs often seen in nursing homes and hospice facilities. These home health care services provide a regular source of social interaction and health status monitoring for a subset of community- dwelling older adults and were understaffed during the height of the pandemic. The dramatic 25% increase in fall-related deaths within homes at the start of the pandemic may be related to this, as well as possibly the lack of timely response to falls within decedents' homes.

Additionally, one can speculate that fear of contracting COVID-19 may have increased the reticence of fall victims to present to a healthcare facility. Considerations should be made to allocate resources to maintain home health aides and visiting nurses to not only protect older adults but also to reduce the burden on the healthcare system as many of these fall victims will require hospital care. Other creative community-based solutions exist, such as utilizing young people displaced from work due to shutdowns to visit isolated older adults. For years, apps have existed for ride shares, for food delivery services, and to rent others' homes. A case could be made for a similar service to safely connect older adults to young adults in their neighborhood for conversation, a walk, or any type of social activity.

 

[SNT Gatchaman]

A nod to deconditioning and fraility, but zero attempt to identify how many had had COVID or any other secondary contributors to death. So orthostatic intolerance certainly doesn't get on the radar.

 

[ScoutB]

There was no statistically significant change in the incidence of all fall-related fatalities following pandemic onset. However, there was a 25% increase in incidence of fall-related fatalities that occurred within fall victims homes.

Isn't the natural explanation here simply that falls that (statistically, on average) would have happened out of the home, happened in the home instead because everyone (especially the elderly) was staying at home social distancing?

 

[SNT Gatchaman]

But the other point is that in the last year of this study (2020) the elderly were dying of Covid. A lot. So mortality from falls should have dropped substantially.