Original Article

Epidemiology of Falls in Older Adults in Texas

Authors: Hasanat Alamgir, PhD, Nicole J. Wong, MPH, Yueha Hu, PhD, Mo Yu, MSc, Amanda Marshall, MS, Shicheng Yu, PhD


Objectives: The expected increase in the US older adult population implies an increased risk of fall-related injury among these individuals. We describe the epidemiology of fall morbidity among older adults in Texas, a large US state with a diverse population base.

Methods: Texas Behavioral Risk Factor Surveillance System 2010 data were analyzed. The falls outcome was defined as falling: any fall in the past 3 months and a serious fall: a fall resulting in limited activities for at least 1 day or requiring medical attention.

Results: A total of 5996 subjects were included in this analysis; 17.6% (n = 1055) reported falling 1 to 5 times in the previous 3 months, and 361 (6%) experienced serious falls. Risk of falling had a significant positive association among respondents who rated their general health as fair to poor (relative risk [RR] 2.39, 95% confidence interval [CI] 1.55–3.68) and a negative association for those who reported regular physical activity (RR 0.59, 95% CI 0.42–0.82). A similar model examined the risk of serious falls and found statistically positive associations in respondents who reported fair or poor general health (RR 3.29, 95% CI 2.00–5.43). Negative associations were found for those who reported regular physical activity (RR 0.56, 95% CI 0.38–0.83) and for men (RR 0.62, 95% CI 0.39–0.98). No statistically significant correlations for either of the fall outcomes were found with residence, obesity, education, income, age, ethnicity, employment, marital status, diabetes mellitus, or cardiovascular disease.

Conclusions: Interventions aimed at the prevention of falls should focus on maintaining and improving general health and promoting physical activity among older adults.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.


1. Vincent G, Velkoff V. The Next Four Decades: The Older Population in the United States: 2010 to 2050. Washington, DC: US Census Bureau; 2010.
2. Wiener JM, Tilly J. Population ageing in the United States of America: implications for public programmes. Int J Epidemiol 2002;31:776-781.
3. Texas Department of Aging and Disability Services. Trends/critical issues/ future implications/challenges. Texas State Plan on Aging Fiscal Years 2011-2013. https://www.dads.state.tx.us/news_info/publications/planning/stateplanonaging/2011-2013/trends.html. Accessed January 11, 2015.
4. Hornbrook MC, Stevens VJ, Wingfield DJ, et al. Preventing falls among community-dwelling older persons: results from a randomized trial. Gerontologist 1994;34:16-23.
5. Vellas BJ, Wayne SJ, Romero LJ, et al. Fear of falling and restriction of mobility in elderly fallers. Age Ageing 1997;26:189-193.
6. Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Inj Prev 2005;11:115-119.
7. Bloch F, Thibaud M, Duque´ B, et al. Episodes of falling among elderly people: a systematic review and meta-analysis of social and demographic pre-disposing characteristics. Clinics (Sao Paulo) 2010;65:895-903.
8. Almeida ST, Soldera CL, Carli GA, et al. Analysis of extrinsic and intrinsic factors that predispose elderly individuals to fall. Rev Assoc Med Bras 2012;58:427-433.
9. Shumway-Cook A, Ciol MA, Hoffman J, et al. Falls in the Medicare population: incidence, associated factors, and impact on health care. Phys Ther 2009;89:324-332.
10. Orces CH. Trends in hospitalization for fall-related injury among older adults in the United States, 1988-2005. Ageing Res 2010;1:e1.
11. Ory MG, Smith ML, Wade A, et al. Implementing and disseminating an evidence-based program to prevent falls in older adults, Texas, 2007-2009. Prev Chronic Dis 2010;7:A130.
12. Centers for Disease Control and Prevention. Behavioral risk factor surveillance system. http://www.cdc.gov/brfss. Accessed January 11, 2015.
13. Purcell P. Income and poverty among older Americans in 2008. Report No. 7-5700. http://assets.opencrs.com/rpts/RL32697_20091002.pdf. Published October 2, 2009. Accessed January 11, 2015.
14. Centers for Disease Control and Prevention. Overweight and obesity. Adult obesity facts. http://www.cdc.gov/obesity/data/adult.html. Published September 9, 2014. Accessed January 11, 2015.
15. Stevens JA, Hasbrouck LM, Durant TM, et al. Surveillance for injuries and violence among older adults. MMWR Surveill Summ 1999;48:27-50.
16. Centers for Disease Control and Prevention. Injury Prevention and Control: Data and Statistics (WISQARSTM). Nonfatal injury data. http://www.cdc.gov/injury/wisqars/nonfatal.html. Accessed January 11, 2015.
17. Stevens JA, Mack KA, Paulozzi LJ, et al. Self-reported falls and fall-related injuries among persons aged Q65 years--United States, 2006. J Saf Res 2008;39:345-349.
18. Bloch F, Thibaud M, Tournoux-Facon C, et al. Estimation of the risk factors for falls in the elderly: can meta-analysis provide a valid answer? Geriatr Gerontol Int 2013;13:250-263.
19. Masud T, Morris RO. Epidemiology of falls. Age Aging 2001;30(Suppl 4):3-7.
20. Chen H-Y, Baumgardner DJ, Rice JP. Health-related quality of life among adults with multiple chronic conditions in the United States, Behavioral Risk Factor Surveillance System, 2007. Prev Chronic Dis 2011;8:A09.
21. Liu-Ambrose T, Khan KM, Eng JJ, et al. Resistance and agility training reduce fall risk in women aged 75 to 85 with low bone mass: a 6-month randomized, controlled trial. J Am Geriatr Soc 2004;52:657-665.
22. Shaw JM, Snow CM. Weighted vest exercise improves indices of fall risk in older women. J Gerontol A Biol Sci Med Sci 1998;53:M53-M58.
23. Geusens P, Dinant G. Integrating a gender dimension into osteoporosis and fracture risk research. Gend Med 2007;4(Suppl B):S147-S161.
24. Pierannunzi C, Hu SS, Balluz L. A systematic review of publications assessing reliability and validity of the Behavioral Risk Factor Surveillance System (BRFSS), 2004-2011. BMC Med Res Methodol 2013;13:49.