尽管采取了预防措施，但美国每年都有更多的成年人跌倒

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Falls are a leading cause of hospitalization and institutionalization for older adults in the U.S. and fall prevention efforts are an important part of geriatric education and health.

Yet, a new University of Michigan study found that despite prevention efforts, falls increase by about 1.5% annually, with wide variations in incidence based on geography.

“It could be that efforts aren’t working–or that they are, by mitigating even worse potential injury risk in the population,” said Geoffrey Hoffman, assistant professor at the U-M School of Nursing and co-author of the research letter, which appears in JAMA Network Open. “Either way, more investment in prevention, such as education and funding for fall education and prevention programs, would help.”

It’s not clear why falls are increasing. Researchers adjusted for age, but the study could have captured population changes in health and function, or in prescribing patterns for medications associated with increased falls. Or, Hoffman said, the results could reflect other factors–for instance, a more active older adult population could result in more falls. Finally, the findings could reflect other changes in treatment and care, or how fall injuries are administratively coded.

Hoffman was surprised by the wide variation in fall injury rates between low and high injury areas. Counties with the highest (in the 90th percentile) fall rates had rates that were roughly 75% higher than counties with the lowest (10th percentile) fall rates.

“This suggests that environmental factors may play a larger role in falls than has been previously discussed and that population-targeted risk management to target-specific areas may be cost-effective and beneficial,” Hoffman said.

Higher-risk areas were in the Central Plains and South. However, these areas are less populated so data is sparser and potentially less reliable, Hoffman said.

Lillian Min, associate professor of geriatric and palliative medicine at Michigan Medicine, said the research shows the potential for using national Medicare data to track falls for older adults on a large-scale.

“Such monitoring may capture benefits of future more effective prevention efforts or identify harms, such as increasing use of fall-risk inducing medications,” said Min, senior author on the study.

While the geographic variability among low and high areas was surprising, the overall findings were not, Hoffman said.

“Severity of illness is increasing among Medicare beneficiaries, with older individuals living longer. So there is a shift in demographics, plus changes in enrollment trends,” he said. “We also have insurance-related limitations. Medicare covers treatment for injury, but not for long-term care that may help maintain function in older individuals, so it’s difficult to mitigate these risks.”

Hoffman said that, until recently, healthier patients enrolled in Medicare Advantage. Because the study looked at fee-for-service beneficiaries (and not those in Medicare Advantage), it may have also captured changes in underlying health risk.

Falls affect 4.5 million older adults in the U.S. and cost Medicare $15 billion to $30 billion annually. Previous reports of increased fall injury trends are limited because data were self-reported and potentially undercounted by excluding moderate injuries. This study examined national trends and geographic variability in fall injuries.

Researchers analyzed claims from 2016-2019 for adults 65 and older. The 1.5% average annual increase translates to an additional 106,000 new fall injuries, or an estimated $1 billion in new fall injury spending over the study period.

全文翻译（仅供参考）

跌倒是美国老年人住院和住院的主要原因，跌倒预防工作是老年人教育和健康的重要组成部分。

然而，密歇根大学的一项新研究发现，尽管采取了预防措施，跌倒仍以每年约 1.5% 的速度增长，且发生率因地理位置而异。

密歇根大学护理学院助理教授、研究信函的合著者杰弗里霍夫曼说：“这可能是努力没有奏效——或者他们通过减轻人群中更严重的潜在伤害风险而奏效了。”出现在 JAMA Network Open 中。“无论哪种方式，更多的预防投资，例如教育和秋季教育和预防计划的资金，都会有所帮助。”

目前尚不清楚为什么跌幅会增加。研究人员根据年龄进行了调整，但该研究可能已经捕捉到人口健康和功能的变化，或者与跌倒增加相关的药物处方模式。或者，霍夫曼说，结果可能反映了其他因素——例如，更活跃的老年人口可能导致更多的跌倒。最后，研究结果可能反映了治疗和护理方面的其他变化，或者跌倒损伤的行政编码方式。

霍夫曼对低伤区和高伤区之间跌倒受伤率的巨大差异感到惊讶。跌幅率最高（第 90 个百分位）的县的比率比跌幅率最低（第 10 个百分位）的县高出大约 75%。

“这表明环境因素在跌倒中的作用可能比之前讨论的要大，针对特定区域的人群风险管理可能具有成本效益且有益，”霍夫曼说。

高风险地区在中原和南部。然而，霍夫曼说，这些地区人口较少，因此数据更稀疏，可能不太可靠。

密歇根医学院老年医学和姑息医学副教授Lillian Min表示，这项研究表明，利用国家医疗保险数据大规模追踪老年人跌倒的潜力。

“这种监测可能会从未来更有效的预防工作中获益或识别危害，例如增加使用诱发跌倒风险的药物，”该研究的资深作者 Min 说。

霍夫曼说，虽然低地和高地之间的地理差异令人惊讶，但总体结果却并非如此。

“医疗保险受益人的疾病严重程度正在增加，老年人的寿命更长。因此，人口结构发生了变化，入学趋势也发生了变化，”他说。“我们也有与保险相关的限制。医疗保险涵盖受伤治疗，但不涵盖可能有助于维持老年人功能的长期护理，因此很难减轻这些风险。”

霍夫曼说，直到最近，更健康的患者加入了 Medicare Advantage。由于该研究着眼于按服务收费的受益人（而不是 Medicare Advantage 中的受益人），它可能还捕捉到了潜在健康风险的变化。

跌倒影响美国 450 万老年人，医疗保险每年损失 150 亿至 300 亿美元。先前有关跌倒伤害趋势增加的报告是有限的，因为数据是自我报告的，并且可能因排除中度伤害而被低估。本研究调查了跌倒伤害的国家趋势和地域差异。

研究人员分析了 2016-2019 年 65 岁及以上成年人的索赔。1.5% 的年均增长意味着在研究期间新增 106,000 起新的跌倒伤害，或估计为 10 亿美元的新跌倒伤害支出。

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