Falls overtake auto wrecks as leading cause of spinal cord injuries

New research has found that slips and falls – particularly among the elderly – has overtaken car crashes as the leading cause of traumatic spinal cord injuries.

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“I’ve fallen … and I can’t get up!” is a well-known line from a campy late-1980s television commercial, but it’s also something that is apparently happening to more and more elderly people these days.

New Johns Hopkins research has found that slips and falls – particularly among the elderly – has overtaken motor vehicle crashes as the leading cause of traumatic spinal cord injuries in the U.S.

The number of serious spinal cord injuries is on the rise in the U.S., and the research shows rates of these injuries are indeed rising fastest among older people. This also suggests that increased efforts to prevent falls by the elderly could significantly curb the number of spinal injuries.

“We have demonstrated how costly traumatic spinal cord injury is and how lethal and disabling it can be among older people,” says Shalini Selvarajah, M.D., M.P.H., a postdoctoral surgical research fellow at the Johns Hopkins University School of Medicine and leader of the study published online in the Journal of Neurotrauma. “It’s an area that is ripe for prevention.”

For their study, the Johns Hopkins researchers analyzed a nationally representative sample of 43,137 adults treated in hospital emergency rooms for spinal cord injury in the U.S. between 2007 and 2009. While the incidence among those aged 18 to 64 ranged from 52.3 per million in 2007 to 49.9 per million in 2009, the incidence per million in those 65 and older increased from 79.4 in 2007 to 87.7 in 2009. Falls were the leading cause of traumatic spinal cord injury over the 3-year study period (41.5%), followed by motor vehicle crashes (35.5%). Fall-related spinal cord injuries increased during the study period overall. Among the elderly, they increased from 23.6% to 30% of injuries.

The average age of adults with a traumatic spinal cord injury in a previous study that covered the years 2000 to 2005 was 41; the new study suggests it is now 51.

The investigators say that even when taking into account injury severity and other illnesses experienced by the patients, older adults with traumatic spinal cord injury are four times more likely to die in the emergency room from such an injury compared to younger adults. If they survive and are admitted, they are six times more likely to die during their inpatient stay.

While the researchers say they can’t pinpoint the exact reason that falls have surpassed car crashes as a cause of traumatic spinal injuries, they believe it may be a combination of the general aging of the population, the more active lifestyles of many Americans over 65, and airbags and seatbelt laws that allow drivers and passengers to survive crashes.

Beyond the personal toll of disability and death, spinal cord injuries are a growing financial burden on the healthcare system, the researchers say. They estimate that from 2007 to 2009, emergency room charges alone for traumatic spinal cord injury patients totaled $1.6 billion. But that is “just the first drop in a long-filling bucket,” says Eric B. Schneider, Ph.D., an epidemiologist at the Johns Hopkins University School of Medicine’s Center for Surgical Trials and Outcomes Research. Those charges increased by 20 percent over the study period, far more than just the cost of inflation.

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