The Hidden Cost of Falls: How Data Supports Physical Therapy for Prevention
Falls are a major source of physical and emotional trauma in older adults. They are also very costly. According to a 2018 study, fatal and non-fatal falls cost $50.0 billion dollars in 2015. The good news is that these falls are often preventable with modifications to the environment, improved strength and balance, or the use of an assistive device to allow older adults to age safely at home. Licensed physical therapists are uniquely positioned to address each of these issues to prevent falls.
A 2018 study from the Journal of the American Geriatric Society evaluated a sample of 3,460 Medicare beneficiaries aged 65 years and older, 827 of whom reported a fall. While about 50% of those included in the study had 1 fall, 45% experienced multiple falls while 23% reported a fall the year before. Despite these numbers, only roughly one third of the people who fell sought medical care. Not only does this mean that medical issues go untreated, it does not allow the healthcare system to intervene and prevent future falls.
Physical therapists serve an important function in the system by not only treating the patient after a fall occurs but by helping prevent falls before they happen. While it may seem like a burdensome cost to send more people to physical therapy, consider that the cost of a typical course of physical therapy is about the same as that of a fall. A typical outpatient fall-prevention program might include two sessions a week for 12 weeks. Such a program focuses on building strength, improving balance, and teaching safe movement. Assuming the therapist bills 4 units per session for 2 sessions per week over 12 weeks, this would cost roughly $3,500. That is about the same as the average cost of a single fall. For those who can’t leave home, a home health version costs in the range of $5,000. When we consider that about 45% of fallers fall again, investing in physical therapy can reduce both the physical harm and the financial burden of falls.
Physical therapists use several screening tools to predict fall risks. They are quick, reliable, and inexpensive. Some of the best include:
| Test | Reliability | Sensitivity | Specificity |
|---|---|---|---|
| Berg Balance Scale (BBS) | 0.97–0.98 | 71–79% | 60–80% |
| Tinetti Balance & Gait | 0.92–0.96 | 61–94% | 56–84% |
| Dynamic Gait Index (DGI) | 0.81–0.98 | 73% | 81% |
| Timed Up and Go (TUG) | 0.87–0.99 | 87% | 87% |
| 5x Sit-to-Stand (5xSTS) | 0.89–0.99 | ~70% | ~75% |
In simple terms, reliability tells us the test is consistent, sensitivity shows how well it can identify people truly at risk, and specificity indicates how well it avoids false alarms. Using these tests together increases predictive accuracy, ensuring that high-risk individuals aren’t missed while steady individuals aren’t falsely flagged. For example, a person who can safely complete the 5x Sit-to-Stand may perform poorly on the Dynamic Gait Index. While they may be safe getting up and down from a chair—part of what the 5x STS assesses—they may struggle to walk and turn their head to talk to someone nearby, something the DGI would detect.
Beyond identifying risk, a therapist can use screening results to design a patient-specific program for the example patient addressing gait training with head turns, stepping strategies, and reactive balance. Combined with therapist-guided home modifications—such as removing tripping hazards, improving lighting, and clearing pathways—these interventions create a comprehensive fall-prevention program. By targeting both environmental and physical risk factors, physical therapy helps patients stay safer, more confident, and independent in their daily lives.
With a growing aging population and the increasing number of older adults living with chronic illnesses, the healthcare system must assume more adults will be at risk of falling. By investing in preventive physical therapy, we can reduce injuries, lower healthcare costs, and keep older adults independent longer. Although every fall may not be preventable, with early screening, targeted therapy, and education, many falls can be prevented. Physical therapy isn’t just about rehab after an injury. It’s about keeping people upright, confident, and living life to the fullest.
References:
Florence CS, Bergen G, Atherly A, Burns E, Stevens J, Drake C. Medical costs of fatal and nonfatal falls in older adults. J Am Geriatr Soc. 2018;66(4):693-698. doi:10.1111/jgs.15304
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