Cost of falls in old age: a systematic review



The purpose of this study was to review the evidence of the economic burden of falls in old age. This review showed that falls are a relevant economic burden. Efforts should be directed to fall-prevention programmes.


Falls are a common mechanism of injury and a leading cause of costs of injury in the elderly. The purpose of this study was to review for the first time the evidence of the economic burden caused by falls in old age.


A systematic review was conducted in the databases of PubMed, of the Centre for Reviews and Dissemination and in the Cochrane Database of Systematic Reviews until June 2009. Studies were assessed for inclusion, classified and synthesised. Costs per inhabitant, the share of fall-related costs in total health care expenditures and in gross domestic products (GDP) were calculated. If appropriate, cost data were inflated to the year 2006 and converted to US Dollar (USD PPP).


A total of 32 studies were included. National fall-related costs of prevalence-based studies were between 0.85% and 1.5% of the total health care expenditures, 0.07% to 0.20% of the GDP and ranged from 113 to 547 USD PPP per inhabitant. Direct costs occurred especially in higher age groups, in females, in hospitals and long-term care facilities and for fractures. Mean costs per fall victim, per fall and per fall-related hospitalisation ranged from 2,044 to 25,955; 1,059 to 10,913 and 5,654 to 42,840 USD PPP and depended on fall severity. A more detailed comparison is restricted by the limited number of studies.


Falls are a relevant economic burden to society. Efforts should be directed to economic evaluations of fall-prevention programmes aiming at reducing fall-related fractures, which contribute substantially to fall-related costs.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. 1.

    WHO (2008) The Global Burden of Diseas 2004 Update

  2. 2.

    Peden M, McGee K, Krug EE (2002) Injury: A leading cause of the global burden of disease, 2000. WHO

  3. 3.

    Peden M, McGee K, Sharma G (2002) The injury chart book: a graphical overview of the global burden of injuries. WHO

  4. 4.

    Hyder AA, Aggarwal A (2009) The increasing burden of injuries in Eastern Europe and Eurasia: making the case for safety investments. Health Policy 89:1–13

    Article  PubMed  Google Scholar 

  5. 5.

    Rice DP, MacKenzie EJ, Associates (1989) Cost of Injury in the United States: A Report to Congress

  6. 6.

    Watson WL, Ozanne-Smith J (1997) The Cost of Injury to Victoria. Monash University, Accident Research Center, Report No. 124

  7. 7.

    Corso P, Finkelstein E, Miller T, Fiebelkorn I, Zaloshnja E (2006) Incidence and lifetime costs of injuries in the United States. Inj Prev 12:212–218

    Article  CAS  PubMed  Google Scholar 

  8. 8.

    Konnopka A, Jerusel N, König HH (2009) The health and economic consequences of osteopenia- and osteoporosis-attributable hip fractures in Germany: estimation for 2002 and projection until 2050. Osteoporos Int 20:1117–1129

    Article  CAS  PubMed  Google Scholar 

  9. 9.

    Holt G, Smith R, Duncan K, Hutchison JD, Reid D (2009) Changes in population demographics and the future incidence of hip fracture. Injury 40:722–726

    Article  CAS  PubMed  Google Scholar 

  10. 10.

    Moller J (2003) Projected costs of fall related injury to older persons due to demographic change in Australia. Report to the Commonwealth Department of Health and Ageing under the National Falls Prevention for Older People Initiative, No. 3314

  11. 11.

    Rice DP (1994) Cost-of-illness studies: fact or fiction? Lancet 344:1519–1520

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Rice DP (2000) Cost of illness studies: what is good about them? Inj Prev 6:177–179

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Borgstrom F, Kanis JA (2008) Health economics of osteoporosis. Best Pract Res Clin Endocrinol Metab 22:885–900

    Article  PubMed  Google Scholar 

  14. 14.

    Haentjens P, Lamraski G, Boonen S (2005) Costs and consequences of hip fracture occurrence in old age: an economic perspective. Disabil Rehabil 27:1129–1141

    Article  CAS  PubMed  Google Scholar 

  15. 15.

    Gillespie LD, Robertson MC, Gillespie WJ, Lamb SE, Gates S, Cumming RG, Rowe BH (2009) Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev: CD007146

  16. 16.

    Cameron ID, Murray GR, Gillespie LD, Cumming RG, Robertson MC, Hill KD, Kerse N (2005) Interventions for preventing falls in older people in residential care facilities and hospitals (Protocol). Cochrane Database Syst Rev: CD005465

  17. 17.

    OECD (2008) OECD Health Data 2008

  18. 18.

    Runge JW (1993) The cost of injury. Emerg Med Clin North Am 11:241–253

    CAS  PubMed  Google Scholar 

  19. 19.

    Newton JL, Kyle P, Liversidge P, Robinson G, Wilton K, Reeve P (2006) The costs of falls in the community to the North East Ambulance Service. Emerg Med J 23:479–481

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Takanishi DM Jr, Yu M, Morita SY (2008) Increased fatalities and cost of traumatic injuries in elderly pedestrians in hawaii: a challenge for prevention and outreach. Asia Pac J Public Health 20:327–339

    PubMed  Google Scholar 

  21. 21.

    Finkelstein E, Prabhu M, Chen H (2007) Increased prevalence of falls among elderly individuals with mental health and substance abuse conditions. Am J Geriatr Psychiatry 15:611–619

    Article  PubMed  Google Scholar 

  22. 22.

    Stevens JA, Corso PS, Finkelstein EA, Miller TR (2006) The costs of fatal and non-fatal falls among older adults. Inj Prev 12:290–295

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Roudsari BS, Ebel BE, Corso PS, Molinari NA, Koepsell TD (2005) The acute medical care costs of fall-related injuries among the U.S. older adults. Injury 36:1316–1322

    Article  PubMed  Google Scholar 

  24. 24.

    Finkelstein EA, Chen H, Miller TR, Corso PS, Stevens JA (2005) A comparison of the case-control and case-crossover designs for estimating medical costs of nonfatal fall-related injuries among older Americans. Med Care 43:1087–1091

    Article  PubMed  Google Scholar 

  25. 25.

    Mahoney JE, Glysch RL, Guilfoyle SM, Hale LJ, Katcher ML (2005) Trends, risk factors, and prevention of falls in older adults in Wisconsin. WMJ 104:22–28

    PubMed  Google Scholar 

  26. 26.

    Kochera A (2002) Falls among older persons and the role of the home: an analysis of cost, incidence, and potential savings from home modification. Issue Brief (Public Policy Inst (Am Assoc Retired Pers)): 1–14

  27. 27.

    Ellis AA, Trent RB (2001) Do the risks and consequences of hospitalized fall injuries among older adults in California vary by type of fall? J Gerontol A Biol Sci Med Sci 56:M686–M692

    CAS  PubMed  Google Scholar 

  28. 28.

    Mathers LJ, Weiss HB (1998) Incidence and characteristics of fall-related emergency department visits. Acad Emerg Med 5:1064–1070

    Article  CAS  PubMed  Google Scholar 

  29. 29.

    Englander F, Hodson TJ, Terregrossa RA (1996) Economic dimensions of slip and fall injuries. J Forensic Sci 41:733–746

    CAS  PubMed  Google Scholar 

  30. 30.

    Covington DL, Maxwell JG, Clancy TV (1993) Hospital resources used to treat the injured elderly at North Carolina trauma centers. J Am Geriatr Soc 41:847–852

    CAS  PubMed  Google Scholar 

  31. 31.

    Alexander BH, Rivara FP, Wolf ME (1992) The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health 82:1020–1023

    Article  CAS  PubMed  Google Scholar 

  32. 32.

    Carroll NV, Delafuente JC, Cox FM, Narayanan S (2008) Fall-related hospitalization and facility costs among residents of institutions providing long-term care. Gerontologist 48:213–222

    PubMed  Google Scholar 

  33. 33.

    Carroll NV, Slattum PW, Cox FM (2005) The cost of falls among the community-dwelling elderly. J Manag Care Pharm 11:307–316

    PubMed  Google Scholar 

  34. 34.

    Sorensen SV, De LG, Kunaprayoon D, Resnick B, Rupnow MF, Studenski S (2006) A taxonomy and economic consequences of nursing home falls. Drugs Aging 23:251–262

    Article  PubMed  Google Scholar 

  35. 35.

    Rizzo JA, Friedkin R, Williams CS, Nabors J, Acampora D, Tinetti ME (1998) Health care utilization and costs in a Medicare population by fall status. Med Care 36:1174–1188

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Shumway-Cook A, Ciol MA, Hoffman J, Dudgeon BJ, Yorkston K, Chan L (2009) Falls in the Medicare population: incidence, associated factors, and impact on health care. Phys Ther 89:324–332

    PubMed  Google Scholar 

  37. 37.

    Gannon B, O'Shea E, Hudson E (2008) Economic consequences of falls and fractures among older people. Ir Med J 101:170–173

    CAS  PubMed  Google Scholar 

  38. 38.

    Cotter PE, Timmons S, O'Connor M, Twomey C, O'Mahony D (2006) The financial implications of falls in older people for an acute hospital. Ir J Med Sci 175:11–13

    Article  CAS  PubMed  Google Scholar 

  39. 39.

    Carey D, Laffoy M (2005) Hospitalisations due to falls in older persons. Ir Med J 98:179–181

    CAS  PubMed  Google Scholar 

  40. 40.

    Scuffham P, Chaplin S, Legood R (2003) Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 57:740–744

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Panneman MJ, Goettsch WG, Kramarz P, Herings RM (2003) The costs of benzodiazepine-associated hospital-treated fall Injuries in the EU: a Pharmo study. Drugs Aging 20:833–839

    Article  PubMed  Google Scholar 

  42. 42.

    Sjogren H, Bjornstig U (1991) Injuries to the elderly in the traffic environment. Accid Anal Prev 23:77–86

    Article  CAS  PubMed  Google Scholar 

  43. 43.

    Sjogren H, Bjornstig U (1989) Unintentional injuries among elderly people: incidence, causes, severity, and costs. Accid Anal Prev 21:233–242

    Article  CAS  PubMed  Google Scholar 

  44. 44.

    Nurmi I, Luthje P (2002) Incidence and costs of falls and fall injuries among elderly in institutional care. Scand J Prim Health Care 20:118–122

    PubMed  Google Scholar 

  45. 45.

    Seematter-Bagnoud L, Wietlisbach V, Yersin B, Bula CJ (2006) Healthcare utilization of elderly persons hospitalized after a noninjurious fall in a Swiss academic medical center. J Am Geriatr Soc 54:891–897

    Article  PubMed  Google Scholar 

  46. 46.

    Hendrie D, Hall SE, Arena G, Legge M (2004) Health system costs of falls of older adults in Western Australia. Aust Health Rev 28:363–373

    Article  PubMed  Google Scholar 

  47. 47.

    Mathers C, Penm R (1999) Health system costs of injury, poisoning and musculoskeletal disorders in Australia 1993–1994

  48. 48.

    Hall SE, Hendrie DV (2003) A prospective study of the costs of falls in older adults living in the community. Aust N Z J Public Health 27:343–351

    Article  PubMed  Google Scholar 

  49. 49.

    James K, Eldemire-Shearer D, Gouldbourne J, Morris C (2007) Falls and fall prevention in the elderly: the Jamaican perspective. West Indian Med J 56:534–539

    CAS  PubMed  Google Scholar 

  50. 50.

    Schuster M, Cohen BB, Rodgers CG, Walker DK, Friedman DJ, Ozonoff VV (1995) Overview of causes and costs of injuries in Massachusetts: a methodology for analysis of state data. Public Health Rep 110:246–250

    CAS  PubMed  Google Scholar 

  51. 51.

    Kotsopoulos IA, Evers SM, Ament AJ, de Krom MC (2001) Estimating the costs of epilepsy: an international comparison of epilepsy cost studies. Epilepsia 42:634–640

    Article  CAS  PubMed  Google Scholar 

  52. 52.

    Hu TW (2006) Perspectives: an international review of the national cost estimates of mental illness, 1990–2003. J Ment Health Policy Econ 9:3–13

    PubMed  Google Scholar 

  53. 53.

    Evers SM, Struijs JN, Ament AJ, van Genugten ML, Jager JH, van den Bos GA (2004) International comparison of stroke cost studies. Stroke 35:1209–1215

    Article  PubMed  Google Scholar 

  54. 54.

    Kleweno CP, Bryant WK, Jacir AM, Levine WN, Ahmad CS (2008) Discrepancies and rates of publication in orthopaedic sports medicine abstracts. Am J Sports Med 36:1875–1879

    Article  PubMed  Google Scholar 

  55. 55.

    Bhandari M, Devereaux PJ, Guyatt GH, Cook DJ, Swiontkowski MF, Sprague S, Schemitsch EH (2002) An observational study of orthopaedic abstracts and subsequent full-text publications. J Bone Joint Surg Am 84-A:615–621

    PubMed  Google Scholar 

  56. 56.

    Drummond MF, Jefferson TO (1996) Guidelines for authors and peer reviewers of economic submissions to the BMJ. The BMJ Economic Evaluation Working Party. BMJ 313:275–283

    CAS  PubMed  Google Scholar 

  57. 57.

    Annest JL, Fingerhut LA, Gallagher SS, Grossman DC, Hedegaard H, Johnson RL, Kohn M, Pickett D, Thomas KE, Trent RB (2008) Strategies to improve external cause-of-injury coding in state-based hospital discharge and emergency department data systems: recommendations of the CDC Workgroup for Improvement of External Cause-of-Injury Coding. MMWR Recomm Rep 57:1–15

    PubMed  Google Scholar 

  58. 58.

    McKenzie K, Enraght-Moony EL, Walker SM, McClure RJ, Harrison JE (2009) Accuracy of external cause-of-injury coding in hospital records. Inj Prev 15:60–64

    Article  CAS  PubMed  Google Scholar 

  59. 59.

    Jensen J, Lundin-Olsson L, Nyberg L, Gustafson Y (2002) Fall and injury prevention in older people living in residential care facilities. A cluster randomized trial. Ann Intern Med 136:733–741

    PubMed  Google Scholar 

  60. 60.

    McClure R, Turner C, Peel N, Spinks A, Eakin E, Hughes K (2005) Population-based interventions for the prevention of fall-related injuries in older people. Cochrane Database Syst Rev: CD004441

  61. 61.

    Gillespie LD, Gillespie WJ, Robertson MC, Lamb SE, Cumming RG, Rowe BH (2009) Interventions for preventing falls in elderly people. Cochrane Database Syst Rev: CD000340

  62. 62.

    Tinetti ME, Baker DI, King M, Gottschalk M, Murphy TE, Acampora D, Carlin BP, Leo-Summers L, Allore HG (2008) Effect of dissemination of evidence in reducing injuries from falls. N Engl J Med 359:252–261

    Article  CAS  PubMed  Google Scholar 

  63. 63.

    Becker C, Kron M, Lindemann U, Sturm E, Eichner B, Walter-Jung B, Nikolaus T (2003) Effectiveness of a multifaceted intervention on falls in nursing home residents. J Am Geriatr Soc 51:306–313

    Article  PubMed  Google Scholar 

  64. 64.

    Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C (2006) Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials. Age Ageing 35:5–10

    Article  PubMed  Google Scholar 

  65. 65.

    Lamb SE, Jorstad-Stein EC, Hauer K, Becker C (2005) Development of a common outcome data set for fall injury prevention trials: the Prevention of Falls Network Europe consensus. J Am Geriatr Soc 53:1618–1622

    Article  PubMed  Google Scholar 

Download references


We thank Ina Weigelt and Hannes Naumann for retrieving most of the literature.

Conflicts of interest


Role of funding source

Funding for the study was provided by the German Federal Ministry of Education and Research (grant numbers: 01EL0702, 01EL0717, 01EL0718). The German Federal Ministry of Education and Research had no further role in study design; nor in the collection, analysis or interpretation of data; in writing the report or in the decision to submit the paper for publication.

Author information



Corresponding author

Correspondence to S. Heinrich.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Heinrich, S., Rapp, K., Rissmann, U. et al. Cost of falls in old age: a systematic review. Osteoporos Int 21, 891–902 (2010).

Download citation


  • Costs
  • Elderly
  • Falls
  • Injury
  • Systematic review