A scoping review on the economic burden of falls among older adults

Vollständiger Abstract

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Abstract Background Falls are the second leading cause of unintentional injury death globally, and the World Health Organization estimates that approximately 82% of fall-related mortality occurs in low- and middle-income countries (LMICs). Despite this disproportionate burden, the economic impact of falls among older adults in resource-limited settings remains poorly documented. This scoping review aimed to map the existing evidence on the economic burden of falls among older adults, describe the extent and nature of available cost data, and identify evidence gaps, with particular attention to LMICs. Methods A scoping review was conducted following the Joanna Briggs Institute (JBI) methodology and reported in accordance with the PRISMA-ScR guidelines. The protocol was registered with the Open Science Framework ( https://doi.org/10.17605/OSF.IO/N23H5 ). PubMed/MEDLINE, Scopus, and Semantic Scholar were searched for studies published between January 2010 and January 2026. Two reviewers independently screened records and charted data, and findings were summarised using narrative synthesis. Eligible studies reported quantitative monetary cost data associated with falls or fall-related injuries in populations aged 60 years and older. Results Of 198 records identified (183 after de-duplication), 33 studies met the inclusion criteria, originating from 12 countries and one multi-country European study. Most studies ( n = 30, 90.9%) were conducted in high-income countries (HICs); two (6.1%) were from upper-middle-income countries (Iran and Mexico) and one (3.0%) from a lower-middle-income country (India). No studies were identified from low-income countries, Sub-Saharan Africa, or most of Southeast Asia. In the United States, reported total medical costs of falls rose from US$50.0 billion (2015) to US$80.0 billion (2020). Reported per-episode costs ranged from US$5,974 (emergency department) to US$48,679 (inpatient admission). Hip fractures were consistently reported as the most costly injury type. Seven studies (21.2%) reported indirect costs, and a single study quantified informal caregiving costs (US$4,274 per faller per year). Fifteen studies (45.5%) included cost-effectiveness components, all conducted in HIC settings. Conclusion This review maps a marked geographic mismatch: although LMICs are estimated to bear the majority of global fall-related mortality, only 9.1% of the economic evidence identified originated from these settings. The limited cost data from LMICs constrains evidence-based fall-prevention policy in the regions where the demographic transition is most rapid. Further investment in LMIC-specific economic research on falls among older adults would help inform resource allocation and policy in ageing low-resource settings.