Falls Among Persons Aged ≥65 Years With and Without Severe Vision Impairment - United States, 2014.

In 2014, an estimated 2.8 million persons aged ≥65 years in the United States reported severe vision impairment* defined as being blind or having severe difficulty seeing, even with eyeglasses. Good vision is important for maintaining balance as well as for identifying low-contrast hazards, estimating distances, and discerning spatial relationships. Conversely, having poor vision increases the risk for falls (1,2). Falls among older adults are common and can cause serious injuries, disabilities, and premature death (1,3). To date, no state-level investigations have examined the annual prevalence of falls among persons with and without severe vision impairment. CDC analyzed data from the 2014 Behavioral Risk Factor Surveillance System (BRFSS) to estimate the state-specific annual prevalence of falls among persons aged ≥65 years with and without self-reported severe vision impairment. Overall, 46.7% of persons with, and 27.7% of older adults without, self-reported severe vision impairment reported having fallen during the previous year. The state-specific annual prevalence of falls among persons aged ≥65 years with severe vision impairment ranged from 30.8% (Hawaii) to 59.1% (California). In contrast, the prevalence of falls among persons aged ≥65 years without severe vision impairment ranged from 20.4% (Hawaii) to 32.4% (Alaska). Developing fall-prevention interventions intended for persons with severe vision impairment will help states manage the impact of vision impairment and falls on health care resources, and can inform state-specific fall prevention initiatives.

Falls and fall injuries among adults with arthritis--United States, 2012.

Falls are the leading cause of injury-related morbidity and mortality among older adults, with more than one in three older adults falling each year, resulting in direct medical costs of nearly $30 billion. Some of the major consequences of falls among older adults are hip fractures, brain injuries, decline in functional abilities, and reductions in social and physical activities. Although the burden of falls among older adults is well-documented, research suggests that falls and fall injuries are also common among middle-aged adults. One risk factor for falling is poor neuromuscular function (i.e., gait speed and balance), which is common among persons with arthritis. In the United States, the prevalence of arthritis is highest among middle-aged adults (aged 45-64 years) (30.2%) and older adults (aged ≥65 years) (49.7%), and these populations account for 52% of U.S. adults. Moreover, arthritis is the most common cause of disability. To examine the prevalence of falls among middle-aged and older adults with arthritis in different states/territories, CDC analyzed data from the 2012 Behavioral Risk Factor Surveillance System (BRFSS) to assess the state-specific prevalence of having fallen and having experienced a fall injury in the past 12 months among adults aged ≥45 years with and without doctor-diagnosed arthritis. This report summarizes the results of that analysis, which found that for all 50 states and the District of Columbia (DC), the prevalence of any fall (one or more), two or more falls, and fall injuries in the past 12 months was significantly higher among adults with arthritis compared with those without arthritis. The prevalence of falls and fall injuries is high among adults with arthritis but can be addressed through greater dissemination of arthritis management and fall prevention programs in clinical and community practice.

Bathroom injuries in children less than 15 years old.

OBJECTIVE: To quantify and describe non-fatal, unintentional bathroom injuries among children less than 15 years of age treated in US hospital emergency departments (EDs). METHODS: This study used 2008 data from a nationally representative sample of EDs, available from the National Electronic Injury Surveillance System-All Injury Program. We examined unintentional non-fatal bathroom injuries in any setting (eg, home, school or public place) among children less than 15 years of age and identified types of injuries, major locations within the bathroom and precipitating events. RESULTS: Based on 1099 cases, an estimated 51 132 non-fatal bathroom injuries in children less than 15 years of age were treated in US EDs in 2008. Most injuries (73.8%) were caused by falls. The highest rate was for injuries that occurred in or around the shower or bathtub (65.9 per 100 000). Children less than 15 years of age sustained the greatest number of injuries and had the highest injury rate (151 per 100 000 (95% CI 108.7 to 193.3)), while children 10-14 years of age had the lowest rate (28.7 (95% CI 20.6 to 36.8)). The rates differed significantly by age group (p<0.001). A majority of the patients (96.9%) were treated in the ED and released. CONCLUSIONS: Most bathroom injuries in children occurred while they were showering or bathing and were caused by falling or hitting an object. Such injuries might be reduced by improving caregiver supervision for younger children. For older children, a combination of bathroom safety education and environmental modifications, such as installing grab bars inside and outside the shower or tub, may reduce bathroom injuries.

Development of STEADI: a fall prevention resource for health care providers.

Falls among people aged ≥65 years are the leading cause of both injury deaths and emergency department visits for trauma. Research shows that many falls are preventable. In the clinical setting, an effective fall intervention involves assessing and addressing an individual's fall risk factors. This individualized approach is recommended in the American and British Geriatrics Societies' (AGS/BGS) practice guideline. This article describes the development of STEADI (Stopping Elderly Accidents, Deaths, and Injuries), a fall prevention tool kit that contains an array of health care provider resources for assessing and addressing fall risk in clinical settings. As researchers at the Centers for Disease Control and Prevention's Injury Center, we reviewed relevant literature and conducted in-depth interviews with health care providers to determine current knowledge and practices related to older adult fall prevention. We developed draft resources based on the AGS/BGS guideline, incorporated provider input, and addressed identified knowledge and practice gaps. Draft resources were reviewed by six focus groups of health care providers and revised. The completed STEADI tool kit, Preventing Falls in Older Patients-A Provider Tool Kit, is designed to help health care providers incorporate fall risk assessment and individualized fall interventions into routine clinical practice and to link clinical care with community-based fall prevention programs.

Increase in fall-related hospitalizations in the United States, 2001-2008.

BACKGROUND: The objective was to determine secular trends in unintentional fall-related hospitalizations in people aged 65 years and older in the United States. MATERIALS: Data were obtained from a nationally representative sample of emergency department visits from January 1, 2001, to December 31, 2008, available through the National Electronic Injury Surveillance System-All Injury Program. These data were weighted to estimate the number, incidence rates, and the annual percent change of fall-related hospitalizations. RESULTS: From 2001 to 2008, the estimated number of fall-related hospitalizations in older adults increased 50%, from 373,128 to 559,355 cases. During the same time period, the age-adjusted incidence rate, expressed per 100,000 population, increased from 1,046 to 1,368. Rates were higher in women compared with men throughout the study period. The age-adjusted incidence rate showed an average annual increase of 3.3% (95% CI, 1.66-4.95). DISCUSSION: Both the number and rate of fall-related hospitalizations in the United States increased significantly over the 8-year study period. Unless preventive action is taken, rising hospitalization rates in combination with the aging US population over the next decades will exacerbate the already stressed healthcare system and may result in poorer health outcomes for older adults in the future. Further research is needed to determine the underlying causes for this rising trend.

Factors influencing hip protector use among community-dwelling older adults.

PURPOSE: To obtain a better understanding of the issues that influence hip protector use among community-dwelling older adults. METHODS: The study used a longitudinal, crossover design. A convenience sample of 32 participants used four different brands of hip protectors, each for a 1-week period. Data were collected by weekly telephone interviews and a mailed questionnaire administered at baseline and follow-up. Participant perceptions regarding hip protectors were assessed using both open-ended questions and Likert-type items. RESULTS: The most common concerns about hip protectors mentioned in response to open-ended questions involved: discomfort, poor fit, inconvenience and unfavourable effects on appearance. Participants spontaneously mentioned at least one of these barriers in over 70% of the interviews. In contrast, participants spontaneously mentioned the protective benefits offered by hip protectors in only 16% of the interviews. The intention to continue using a particular hip protector after the study ended was associated with the number of hours the hip protector was worn during the study (p<0.01). After controlling for other variables, beliefs concerning the amount of protection that a hip protector provided was positively associated with the number of hours the hip protector was worn during the study (p<0.05) and the intention to continue using the hip protector after the study (p<0.01). CONCLUSION: Study findings suggest that the use of hip protectors by community-dwelling older adults is influenced by beliefs about both barriers to use and the amount of protection provided.

Implementing a Clinically Based Fall Prevention Program.

Introduction. Among people aged 65 and older, falls are the leading cause of both fatal and nonfatal injuries. The burden of falls is expected to increase as the US population ages. The Centers for Disease Control and Prevention (CDC) developed the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative to help primary care providers incorporate fall risk screening, assessment of patients' modifiable risk factors, and implementation of evidence-based treatment strategies. Methods. In 2010, CDC funded the New York State Department of Health to implement STEADI in primary care sites in selected communities. The Medical Director of United Health Services championed integrating fall prevention into clinical practice and oversaw staff training. Components of STEADI were integrated into the health system's electronic health record (EHR), and fall risk screening questions were added to the nursing staff's patient intake forms. Results. In the first 12 months, 14 practices saw 10 702 patients aged 65 and older. Of these, 8457 patients (79.0%) were screened for fall risk and 1534 (18.1%) screened positive. About 52% of positive patients completed the Timed Up and Go gait and balance assessment. Screening declined to 49% in the second 12 months, with 21% of the patients screening positive. Conclusions. Fall prevention can be successfully integrated into primary care when it is supported by a clinical champion, coupled with timely staff training/retraining, incorporated into the EHR, and adapted to fit into the practice workflow.

Evaluating a Two-Level vs. Three-Level Fall Risk Screening Algorithm for Predicting Falls Among Older Adults.

Background and Objectives: Falls account for the highest proportion of preventable injury among older adults. Thus, the United States' Centers for Disease Control and Prevention (CDC) developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) algorithm to screen for fall risk. We referred to our STEADI algorithm adaptation as "Quick-STEADI" and compared the predictive abilities of the three-level (low, moderate, and high risk) and two-level (at-risk and not at-risk) Quick-STEADI algorithms. We additionally assessed the qualitative implementation of the Quick-STEADI algorithm in clinical settings. Research Design and Methods: We followed a prospective cohort (N = 200) of adults (65+ years) in the Bassett Healthcare Network (Cooperstown, NY) for 6 months in 2019. We conducted a generalized linear mixed model, adjusting for sociodemographic variables, to determine how baseline fall risk predicted subsequent daily falls. We plotted receiver operating characteristic (ROC) curves and measured the area under the curve (AUC) to determine the predictive ability of the Quick-STEADI algorithm. We identified a participant sample (N = 8) to gauge the experience of the screening process and a screener sample (N = 3) to evaluate the screening implementation. Results: For the three-level Quick-STEADI algorithm, participants at low and moderate risk for falls had a reduced likelihood of daily falls compared to those at high risk (-1.09, p = 0.04; -0.99, p = 0.04). For the two-level Quick-STEADI algorithm, participants not at risk for falls were not associated with a reduced likelihood of daily falls compared to those at risk (-0.89, p = 0.13). The discriminatory ability of the three-level and two-level Quick-STEADI algorithm demonstrated similar predictability of daily falls, based on AUC (0.653; 0.6570). Furthermore, participants and screeners found the Quick-STEADI algorithm to be efficient and viable. Discussion and Implications: The Quick-STEADI is a suitable, alternative fall risk screening algorithm. Qualitative assessments of the Quick-STEADI algorithm demonstrated feasibility in integrating a falls screening program in a clinical setting. Future research should address the validation and the implementation of the Quick-STEADI algorithm in community health settings to determine if falls screening and prevention can be streamlined in these settings. This may increase engagement in fall prevention programs and decrease overall fall risk among older adults.

Falls and fear of falling: burden, beliefs and behaviours.

OBJECTIVES: this study estimated the frequency of recent falls and prevalence of fear of falling among adults aged 65 and older. DESIGN: a cross-sectional, list-assisted random digit dialling telephone survey of US adults from 2001 to 2003. SUBJECTS: 1,709 adults aged 65 or older who spoke either English or Spanish. METHODS: prevalence estimates were calculated for recent falls, fall injuries, fear of falling and fall prevention beliefs and behaviours. RESULTS: an estimated 3.5 million, or 9.6%, of older adults reported falling at least once in the past 3 months. About 36.2% of all older adults said that they were moderately or very afraid of falling. Few older adults who fell in the past 3 months reported making any changes to prevent future falls. CONCLUSIONS: the high prevalence of falls and fear of falling among US older adults is of concern. Both can result in adverse health outcomes including decreased quality of life, functional limitations, restricted activity and depression. Older adults' fear of falling and their reluctance to adopt behaviours that could prevent future falls should be considered when designing fall prevention programmes.

CDC's research portfolio in older adult fall prevention: a review of progress, 1985-2005, and future research directions.

PROBLEM: Falls are a leading cause of mortality and morbidity among adults age 65 and older. Population models predict steep increases in the 65 and older population bands in the next 10-15 years and in turn, public health is bracing for increased fall rates and the strain they place on health care systems and society. To assess progress in fall prevention, the Centers for Disease Control and Prevention conducted a research portfolio review to examine the quality, relevance, outcomes and successes of the CDC fall prevention program and its impact on public health. METHODS: A peer review panel was charged with reviewing 20 years of funded research and conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis for extramural and intramural research activities. Information was collected from grantees (via a survey instrument), staff were interviewed, and progress reports and products were reviewed and analyzed. RESULTS: CDC has invested over $24,900,000 in fall-related research and programs over 20 years. The portfolio has had positive impacts on research, policies and programs, increasing the public health injury prevention workforce, and delivering effective fall prevention programs. DISCUSSION: Public health agencies, practitioners, and policy makers recognize that while there are some evidence-based older adult fall prevention interventions available, many remain unused or are infeasible to implement. Specific recommendations across the public health model, include: additional research in gathering robust epidemiologic data on trends and patterns of fall-related injuries at all levels; researching risk factors by setting or sub-population; developing and testing innovative interventions; and engaging in translation and dissemination research on best practices to increase uptake and adoption of fall prevention strategies. CDC has responded to a number of suggestions from the portfolio review including: funding translation research of a proven Tai Chi fall intervention; beginning to address gaps in gender, ethnic, and racial differences in falls; and collaborating with partner organizations who share in CDC's mission to improve public health by preventing falls and reducing fall-related injuries. IMPACT ON INDUSTRY: Industry has an opportunity to develop more accessible and usable devices to reduce injury from falls (for example, hip protectors and force reducing flooring). By implementing effective, evidence-based interventions to prevent falls and reduce injuries from falls, significant decreases in health care costs can be expected.

The Potential to Reduce Falls and Avert Costs by Clinically Managing Fall Risk.

INTRODUCTION: Falls often cause severe injuries and are one of the most costly health conditions among older adults. Yet, many falls are preventable. The number of preventable medically treated falls and associated costs averted were estimated by applying evidence-based fall interventions in clinical settings. METHODS: A review of peer-reviewed literature was conducted in 2017 using literature published between 1994 and 2017, the authors estimated the prevalence of seven fall risk factors and the effectiveness of seven evidence-based fall interventions. Then authors estimated the number of older adults (aged ≥65 years) who would be eligible to receive one of seven fall interventions (e.g., Tai Chi, Otago, medication management, vitamin D supplementation, expedited first eye cataract surgery, single-vision distance lenses for outdoor activities, and home modifications led by an occupational therapist). Using the reported effectiveness of each intervention, the number of medically treated falls that could be prevented and the associated direct medical costs averted were calculated. RESULTS: Depending on the size of the eligible population, implementing a single intervention could prevent between 9,563 and 45,164 medically treated falls and avert $94-$442 million in direct medical costs annually. The interventions with the potential to help the greatest number of older adults were those that provided home modification delivered by an occupational therapist (38.2 million), and recommended daily vitamin D supplements (16.7 million). CONCLUSIONS: This report is the first to estimate the number of medically treated falls that could be prevented and the direct medical costs that could be adverted. Preventing falls can benefit older adults substantially by improving their health, independence, and quality of life.

The Influence of Older Adults' Beliefs and Attitudes on Adopting Fall Prevention Behaviors.

Among Americans aged 65 years and older, falls are the leading cause of injury death and disability, and finding effective methods to prevent older adult falls has become a public health priority. While research has identified effective interventions delivered in community and clinical settings, persuading older adults to adopt these interventions has been challenging. Older adults often do not acknowledge or recognize their fall risk. Many see falls as an inevitable consequence of aging. Health care providers can play an important role by identifying older adults who are likely to fall and providing clinical interventions to help reduce fall risks. Many older people respect the information and advice they receive from their providers. Health care practitioners can encourage patients to adopt effective fall prevention strategies by helping them understand and acknowledge their fall risk while emphasizing the positive benefits of fall prevention such as remaining independent. To help clinicians integrate fall prevention into their practice, the Centers for Disease Control and Prevention launched the STEADI (Stopping Elderly Accidents, Deaths, and Injuries) initiative. It provides health care providers in primary care settings with resources to help them screen older adult patients, assess their fall risk, and provide effective interventions.

Medical Costs of Fatal and Nonfatal Falls in Older Adults.

OBJECTIVES: To estimate medical expenditures attributable to older adult falls using a methodology that can be updated annually to track these expenditures over time. DESIGN: Population data from the National Vital Statistics System (NVSS) and cost estimates from the Web-based Injury Statistics Query and Reporting System (WISQARS) for fatal falls, quasi-experimental regression analysis of data from the Medicare Current Beneficiaries Survey (MCBS) for nonfatal falls. SETTING: U.S. population aged 65 and older during 2015. PARTICIPANTS: Fatal falls from the 2015 NVSS (N=28,486); respondents to the 2011 MCBS (N=3,460). MEASUREMENTS: Total spending attributable to older adult falls in the United States in 2015, in dollars. RESULTS: In 2015, the estimated medical costs attributable to fatal and nonfatal falls was approximately $50.0 billion. For nonfatal falls, Medicare paid approximately $28.9 billion, Medicaid $8.7 billion, and private and other payers $12.0 billion. Overall medical spending for fatal falls was estimated to be $754 million. CONCLUSION: Older adult falls result in substantial medical costs. Measuring medical costs attributable to falls will provide vital information about the magnitude of the problem and the potential financial effect of effective prevention strategies.

Seasonal patterns of fatal and nonfatal falls among older adults in the U.S.

INTRODUCTION: While many believe that older adults fall more often during the winter months, research on this is inconclusive. This study used nationally representative data from 2001 to 2002 to examine unintentional fatal fall rates among older men and women by season and climate, and nonfatal fall rates by season. METHODS: We studied fatal and nonfatal unintentional falls among U.S. adults aged > or =65 during December 2001-November 2002 by season. Fatal fall data were obtained from National Center for Health Statistics' annual mortality tapes; nonfatal fall data for injuries treated in emergency departments were obtained from the National Electronic Injury Surveillance System All Injury Program. Fatal falls were also analyzed by climate based on each state's average January 1, 2001 temperature (colder climates < or =32 degrees F (0 degrees C) and warmer climates >32 degrees F (0 degrees C)). RESULTS: From December 2001 through November 2002, neither fatal nor nonfatal fall injury rates showed any seasonal patterns. For fatal falls, the average rate was 9.1 percent higher in colder climates, regardless of season. CONCLUSION: Among older adults, fatal fall rates appear to be influenced more by climate than by season. Additional research is needed to clarify the mechanisms underlying these observations.

The injury problem among older adults: mortality, morbidity and costs.

The Journal of Safety Research has partnered with the National Center for Injury Prevention and Control at the Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia, USA, to briefly report on some of the latest findings in the research community. This report is the seventh in a series of CDC articles.

Recent trends in mortality from unintentional injury in the United States.

INTRODUCTION: Recent observations suggest that the unintentional injury mortality rate may be increasing in the United States for the first time since 1979. METHOD: This study examined trends in unintentional injury mortality by sex, race, mechanism, and age group to better understand these increases. RESULTS: From 1992 to 2002, mortality increased 11.0% (6.5% for males, 18.5% for females). The mortality rate increased 16.5% among whites, but declined among African Americans and other races. Rates among whites exceeded rates among African Americans for the first time since 1998. Fall rates increased 39.5% from 1992 to 2002, and poisoning rates increased 121.5%. Motor-vehicle rates did not increase overall. Rates in age groups from 40-64 years of age increased for falls, poisoning, and motor-vehicle crashes. Only fall rates increased for the 65+ age group. CONCLUSIONS: These results raise the issue of whether these increases have one or more risk factors in common, such as recent increases in the use of alcohol and prescription drugs.

The direct costs of fatal and non-fatal falls among older adults - United States.

INTRODUCTION: This study sought to estimate the incidence, average cost, and total direct medical costs for fatal and non-fatal fall injuries in hospital, ED, and out-patient settings among U.S. adults aged 65 or older in 2012, by sex and age group and to report total direct medical costs for falls inflated to 2015 dollars. METHOD: Incidence data came from the 2012 National Vital Statistics System, 2012 Healthcare Cost and Utilization Project-Nationwide Inpatient Sample, 2012 Health Care Utilization Program National Emergency Department Sample, and 2007 Medical Expenditure Panel Survey. Costs for fatal falls were derived from the Centers for Disease Control and Prevention's Web-based Injury Statistics Query and Reporting System; costs for non-fatal falls were based on claims from the 1998/1999 Medicare fee-for-service 5% Standard Analytical Files. Costs were inflated to 2015 estimates using the health care component of the Personal Consumption Expenditure index. RESULTS: In 2012, there were 24,190 fatal and 3.2 million medically treated non-fatal fall related injuries. Direct medical costs totaled $616.5 million for fatal and $30.3 billion for non-fatal injuries in 2012 and rose to $637.5 million and $31.3 billion, respectively, in 2015. Fall incidence as well as total cost increased with age and were higher among women. CONCLUSION: Medically treated falls among older adults, especially among older women, are associated with substantial economic costs. PRACTICAL APPLICATION: Widely implementing evidence-based interventions for fall prevention is essential to decrease the incidence and healthcare costs associated with these injuries.

Unintentional injuries treated in hospital emergency departments among persons aged 65 years and older, United States, 2006-2011.

INTRODUCTION: With the aging of the United States population, unintentional injuries among older adults, and especially falls-related injuries, are an increasing public health concern. METHODS: We analyzed emergency department (ED) data from the Nationwide Emergency Department Sample, 2006-2011. We examined unintentional injury trends by 5-year age groups, sex, mechanism, body region, discharge disposition, and primary payer. For 2011, we estimated the medical costs of unintentional injury and the distribution of primary payers, plus rates by injury mechanisms and body regions injured by 5-year age groups. RESULTS: From 2006 to 2011, the age-adjusted annual rate of unintentional injury-related ED visits among persons aged ≥ 65 years increased significantly from 7987 to 8163, per 100,000 population. In 2011, 65% of injuries were due to falls. Rates for fall-related injury ED visits increased with age and the highest rate was among those aged ≥ 100. Each year, about 85% of unintentional injury-related ED visits in this population were expected to be paid by Medicare. In 2011, the estimated lifetime medical cost of unintentional injury-related ED visits among those aged ≥ 65 years was $40 billion. CONCLUSION: Increasing rates of ED-treated unintentional injuries, driven mainly by falls among older adults, will challenge our health care system and increase the economic burden on our society. Prevention efforts to reduce falls and resulting injuries among adults aged ≥ 65 years have the potential to increase well-being and reduce health care spending, especially the costs covered by Medicare. PRACTICAL APPLICATIONS: With the aging of the U.S. population, unintentional injuries, and especially fall-related injuries, will present a growing challenge to our health care system as well as an increasing economic burden. To counteract this trend, we must implement effective public health strategies, such as increasing knowledge about fall risk factors and broadly disseminating evidence-based injury and fall prevention programs in both clinical and community settings.

The CDC Injury Center's response to the growing public health problem of falls among older adults.

BACKGROUND: Older adult falls are a significant cause of morbidity and mortality in the United States. This leading cause of injury in adults aged 65 and older results in $35 billion in direct medical costs. OBJECTIVE: To project the number of older adult falls by 2030 and the associated lifetime medical cost. A secondary objective is to review what clinicians can do to incorporate falls screening and prevention into their practice for community-dwelling older adults. METHODS: Using the CDC's Web-based Injury Statistics Query and Reporting System and the US Census Bureau data, the number of older adults in 2030, fatal falls, and medical costs associated with fall injuries was projected. In addition, evidence-based interventions that can be integrated into clinical practice were reviewed. RESULTS: The number of older adult fatal falls is projected to reach 100,000 per year by 2030 with an associated cost of $100 billion. By integrating screening for falls risk into clinical practice, reviewing and modifying medications, and recommending Vitamin D supplementation, physicians can reduce future falls by nearly 25%. CONCLUSION: Falls in older adults will continue to rise substantially and become a significant cost to our health care system if we do not begin to focus on prevention in the clinical setting.

Older Adult Falls Seen by Emergency Medical Service Providers: A Prevention Opportunity.

INTRODUCTION: Among people aged ≥65 years, falling is the leading cause of emergency department visits. Emergency medical services (EMS) are often called to help older adults who have fallen, with some requiring hospital transport. Chief aims were to determine where falls occurred and the circumstances under which patients were transported by EMS, and to identify future fall prevention opportunities. METHODS: In 2012, a total of 42 states contributed ambulatory data to the National EMS Information System, which were analyzed in 2014 and 2015. Using EMS records from 911 call events, logistic regression examined patient and environmental factors associated with older adult transport. RESULTS: Among people aged ≥65 years, falls accounted for 17% of all EMS calls. More than one in five (21%) of these emergency 911 calls did not result in a transport. Most falls occurred at home (60.2%) and residential institutions such as nursing homes (21.7%). Logistic regression showed AORs for transport were greatest among people aged ≥85 years (AOR=1.14, 95% CI=1.13, 1.16) and women (AOR=1.30, 95% CI=1.29, 1.32); for falls at residential institutions or nursing homes (AOR=3.52, 95% CI=3.46, 3.58) and in rural environments (AOR=1.15, 95% CI=1.13, 1.17); and where the EMS impression was a stroke (AOR=2.96, 95% CI=2.11, 4.10), followed by hypothermia (AOR=2.36, 95% CI=1.33, 4.43). CONCLUSIONS: This study provides unique insight into fall circumstances and EMS transport activity. EMS personnel are in a prime position to provide interventions that can prevent future falls, or referrals to community-based fall prevention programs and services.