Understanding public awareness of fall epidemiology in the United States: A national cross-sectional study

1 Introduction

Falls are a leading cause of injury and mortality in the United States (US), resulting in $50 billion in medical costs annually [1,2]. Despite extensive research, community programs, and government-funded initiatives to focus on fall prevention, falls have risen from 24th to the 15th leading cause of US disability-adjusted life years (DALYs) between 1990 and 2010, with fall death rates among older adults increasing by 30% between 2007 and 2016 [3,4,5]. While evidence-based fall prevention strategies exist, ranging from exercise-based programs to home modifications, and often accessible at no cost to the recipient, their adoption rates remain low [6,7,8]. Education effectively reduces fall risk, yet the gap between available prevention resources and their utilization suggests a potential disconnect in public awareness [1,9]. Currently, no studies have assessed the American public’s baseline awareness of fall epidemiology, limiting the ability to develop targeted educational interventions. This study addresses this critical knowledge gap by evaluating US adults’ awareness of falls, which could inform more effective public health messaging and ultimately improve prevention strategy adoption.

2 Methods

This cross-sectional study utilized a convenience sample recruited through ResearchMatch, a secure NIH-sponsored volunteer registry that includes individuals of all ages and backgrounds from across the US. A sample size was calculated using the formula for cross-sectional studies with categorical outcomes, assuming a 50% response distribution, 95% confidence level, and 5% margin of error, which indicated a minimum required sample of 385 participants. Adults aged 18 and older, residing in the US, and able to comprehend English were eligible to participate. Individuals on the registry who met inclusion criteria were routed a message with a brief description of the study and an option to participate. Those who opted in were sent a link to an online survey. The survey instrument developed for this pilot study consisted of three components: sociodemographic characteristics (sex, age, race, education, employment, household income, marital status, and state of residence), personal connections to fall-related injuries (family member, extended family member, friend, co-worker, acquaintance, or none), and knowledge of fall epidemiology. The knowledge assessment included multiple choice and true/false questions adapted from the CDC’s publicly available fact sheet on older adult fall prevention, supplemented with questions about fall timing based on recent literature [1,10]. Face validation was conducted with three subject matter experts in fall epidemiology who reviewed the survey for clarity, relevance, and alignment with the CDC content. The survey was refined based on expert feedback to improve comprehensibility before final administration via REDCap, with an approximate completion time of five minutes.

3 Results

The survey had 1,069 respondents, and 966 (90.4%) completed the survey. Participant demographics are presented in Table 1.

3.3 Timing of falls

Most participants believed falls and fall-related injuries were most likely to occur at night and least likely to occur during the afternoon (Figures 1 and 2).

Figure 1

Time of day participants thought falls most likely to occur.

Figure 2

Time of day participants thought an injury from a fall was most likely to occur.

4 Discussion

Our survey captured perspectives from a demographically diverse sample across the US, with respondents spanning ages 18–91, though notably skewed toward higher education and income levels. Most respondents (86.8%) knew someone who had been injured by a fall, emphasizing the broad impact of falls [12]. Interestingly, younger adults aged 26–34 were least likely to have personal connections to fall-related injuries, suggesting potential gaps in fall awareness among this demographic.

Regarding fall epidemiology awareness, our findings reveal concerning knowledge gaps despite high recognition of falls being preventable (97.9%) and primarily occurring at home (94.8%). Only half of the CDC-sourced facts were answered correctly by the majority of participants. The questions that most participants missed were related to the severity of falls, including the rate, costs, and likelihood of injury. Worryingly, most participants believed that falls are a normal part of aging. This misconception not only poses a significant barrier to effective prevention strategies but may also reflect underlying ageist attitudes in society. Ageism refers to cognitive biases (e.g., stereotypes and prejudice) and the resulting behavior toward oneself or others on the basis of age [13]. Falls are frequently the focus of prevention for older adults, yet a recent study found that of the annual 9.9 million fall-related injuries in the US, incidence was fairly evenly distributed among older adults (32.3%), middle-aged adults (35.3%), and younger adults (32.3%) [12]. Furthermore, this perspective fails to take into account the fact that falls are preventable, which a notable majority of the survey respondents understood. It is imperative to correct inaccurate views of aging not only for the sake of older adults but also to improve the quality of life for young and middle-aged adults in the present and future [13,14].

The economic impact of ineffective fall prevention strategies in the US was also severely underestimated by participants. Over half of the respondents (54.8%) estimated annual medical costs at $100–500 million, representing only 1% or less of the actual cost of nonfatal falls in the US, which is about $50 billion. Medicare and Medicaid are responsible for over 75% of these costs ($28.9 billion and $8.7 billion, respectively), highlighting a financial impact that extends beyond individuals to their greater community [2]. Targeting falls prevention activities may, therefore, also result in alleviation of a significant financial burden on healthcare resources.

Regarding fall timing, participants demonstrated a striking misalignment between perception and reality. Participants had consensus on the timing of falls, with night being considered the time of day that people are both most likely to fall and most likely to be injured from a fall, and the afternoon being the time of day that people are least likely to fall or be injured from a fall. It feels intuitive that nights would have the highest risk of accidental falls and injuries, since in many contexts, nighttime activity results in increased risk of injury [15,16]. However, most falls happen during the daytime [10]. One study found only 13.1% of falls happen between 6pm and 6am, and most falls occurred during the morning (33.5%) and afternoon (50.5%) hours [17]. This is likely due to people being less active in the evening and nighttime hours.

Healthcare providers play a pivotal role in bridging these knowledge gaps, yet less than half of older adults tell their doctor about falls, suggesting a critical missed opportunity for intervention [9,18]. This communication barrier, combined with the public’s misconceptions about fall timing and preventability, indicates a need for proactive screening and education by healthcare providers. Additionally, the widespread underestimation of fall frequency and costs suggests an opportunity to leverage social media and targeted public health messaging to reach younger demographics before they or their loved ones experience falls.

Increased awareness is an important initial step to preventing falls and may yield sustained behavior change [19]. By improving the public understanding of fall epidemiology, dispelling myths about aging, and highlighting the economic impact of falls, a more receptive environment for implementing prevention measures may be developed. This increased awareness can encourage individuals to seek out and engage with available resources and interventions.

While our study is the first to examine fall awareness in a US population, similar investigations have been conducted internationally, revealing both common themes and notable variations. Uniquely, our study recruited adults of all ages regardless of fall history, while previous studies focused exclusively on older adults. Across studies, recognition of fall preventability was consistently high – 97.9% in our US sample, 81.4% in a Saudi Arabian study by Almesned and Jahan and 89% (combined agreed/somewhat agreed) in a Canadian study by Russell et al. [20,21]. Malaysian research by Goh et al., also focused on older adults, found that non-fallers demonstrated higher fall prevention knowledge compared to those with a history of falls, suggesting that knowledge acquisition may occur too late for some older adults [22]. The variation in findings across studies suggests that population and region-specific awareness campaigns may be necessary for maximum effectiveness. Further research is needed across all regions to identify these specific knowledge gaps and determine the most effective methods for disseminating fall prevention information to diverse populations.

5 Limitations

This study is subject to several limitations. First, the times of day were defined generally, so there may have been variations in interpretation of the terms (i.e., morning, afternoon, and evening). Second, the sample featured a large representation of individuals with graduate or professional degrees and high annual household incomes. These adults are in higher proportion on the research volunteer registry than in the general population.

6 Conclusions

This study unveils a disparity between public perception and the reality of fall epidemiology among US adults. Alarmingly, the majority incorrectly believe that falls are a normal part of aging – a misconception that poses significant barrier to effective prevention strategies. This belief, coupled with limited awareness of fall timing and impact, underscores a pressing public health concern. There is also a widespread lack of awareness of the substantial financial burden falls impose on both individuals and taxpayers. Despite this, there is a promising recognition that falls are preventable. Overall, the study findings highlight a pressing need for targeted educational initiatives to bridge the gap between existing fall prevention evidence and public awareness.