Increase in Fall-Related Fatalities in the Home Following the COVID-19 Pandemic Onset

Falls are a leading cause of injury and death in older adults (age ≥ 65 years). The onset of the COVID-19 pandemic in the United States (US) marked a transition into a period of greater social isolation to curb the spread of disease. The pandemic additionally greatly strained the US healthcare system. As a result, older adults participated in less physical activity and experienced greater hesitancy to seek medical care in an effort to minimize their risk of infection. They additionally may have experienced delays and incomplete access to such care. It is possible that such changes worsened frailty and increased vulnerability to falls and fall-related sequelae among this population. We hypothesized that the COVID-19 pandemic led to an increase in fall-related fatalities generally and an increase in fall-related fatalities that occurred in the home.

We conducted an interrupted time series analysis using a regression model on monthly fall fatalities among older adults from January 2015 through December 2020. Fall fatality data were extracted from the Centers for Disease Control and Prevention Wide-ranging ONline Data for Epidemiologic Research (CDC WONDER), along with the estimated annual population of US residents aged ≥ 65. The COVID-19 pandemic, defined as starting in the US in March 2020, was the interruption variable.

There were 192,586 fall fatalities among older adults in the study period, with a mean of 2614 deaths per month ( $\sigma$  = 228.4) pre-pandemic, and 3051 deaths per month ( $\sigma$  = 215.1) post-pandemic onset. There was no statistically significant change in the incidence of all fall-related fatalities following pandemic onset. However, there was a 25% increase in incidence of fall-related fatalities that occurred within fall victims' homes, specifically (IRR = 1.25, 95% CI 1.14, 1.36).

There was a significant increase in fall-related fatalities within homes among older adults in the US after the onset of the COVID-19 pandemic. During pandemic type situations and times of social distancing, increased social supports and resources must be maintained for older adults to reduce the incidence of falls within the home and fall-related injuries.