Trends and Epidemiology of Fall-Related Hospitalizations Among Older Adults in the Split-Dalmatia County, Croatia: A Retrospective Descriptive Study from 2020 to 2024
Abstract
1. Introduction
2. Materials and Methods
2.1. Study Design, Setting and Data Sources
2.2. Study Population and Case Definition
2.3. Variables
2.4. Statistical Analysis
3. Results
3.1. Hospitalizations and Demographic Characteristics
3.2. Hospitalization Rates
3.3. Injury Types
3.4. Length of Hospital Stay
3.5. In-Hospital Mortality
4. Discussion
4.1. Strengths and Limitations
4.2. Clinical Implications
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Abbreviations
| AAPC | Average Annual Percent Change |
| CI | Confidence Interval |
| ICD-10 | International Classification of Diseases, 10th Revision |
| IQR | Interquartile Range |
| RR | Rate Ratio |
| STROBE | STrengthening the Reporting of OBservational studies in Epidemiology |
References
- World Health Organization. Step Safely: Strategies for Preventing and Managing Falls Across the Life-Course; World Health Organization: Geneva, Switzerland, 2021; Available online: https://www.who.int/publications/i/item/978924002191-4 (accessed on 28 February 2026).
- Da Silva, T.H.R. Falls prevention in older people and the role of nursing. Br. J. Community Nurs. 2024, 29, 335–339. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Ageing and Health. Available online: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health (accessed on 27 February 2026).
- Eurostat. Population Structure and Ageing. Available online: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Population_structure_and_ageing (accessed on 27 February 2026).
- Marasović Šušnjara, I. Demografska obilježja stanovništva Splitsko-dalmatinske županije. Javno Zdr. 2024, 2, 50–55. [Google Scholar]
- Dondi, A.; Davis, K. Evaluation of intrinsic and extrinsic fall risk factors in hospitals, long-term facilities, and homes: A narrative review. Hum. Factors Healthc. 2026, 9, 100125. [Google Scholar] [CrossRef]
- Moreland, B.L.; Kakara, R.; Haddad, Y.K.; Shakya, I.; Bergen, G. A descriptive analysis of location of older adult falls that resulted in emergency department visits in the United States, 2015. Am. J. Lifestyle Med. 2020, 15, 590–597. [Google Scholar] [CrossRef] [PubMed]
- Ambrose, A.F.; Paul, G.; Hausdorff, J.M. Risk factors for falls among older adults: A review of the literature. Maturitas 2013, 75, 51–61. [Google Scholar] [CrossRef] [PubMed]
- Cameron, I.D.; Dyer, S.M.; Panagoda, C.E.; Murray, G.R.; Hill, K.D.; Cumming, R.G.; Kerse, N. Interventions for preventing falls in older people in care facilities and hospitals. Cochrane Database Syst. Rev. 2018, 9, CD005465. [Google Scholar] [CrossRef] [PubMed]
- LeLaurin, J.H.; Shorr, R.I. Preventing falls in hospitalized patients: State of the science. Clin. Geriatr. Med. 2019, 35, 273–283. [Google Scholar] [CrossRef] [PubMed]
- Brkić Biloš, I. Ozljede u Republici Hrvatskoj u 2022. Godini; Hrvatski Zavod za Javno Zdravstvo: Zagreb, Croatia, 2024. [Google Scholar]
- Chmura, M. Hip fracture burden to nearly double worldwide by 2050. J. Bone Miner. Res. 2023, 38, 454. [Google Scholar] [CrossRef] [PubMed]
- Berry, S.D.; Miller, R.R. Falls: Epidemiology, pathophysiology, and relationship to fracture. Curr. Osteoporos. Rep. 2008, 6, 149–154. [Google Scholar] [CrossRef] [PubMed]
- Kelsey, J.L.; Samelson, E.J. Variation in risk factors for fractures at different sites. Curr. Osteoporos. Rep. 2009, 7, 127–133. [Google Scholar] [CrossRef] [PubMed]
- Haagsma, J.A.; Olij, B.F.; Majdan, M.; van Beeck, E.F.; Vos, T.; Castle, C.D. Falls in older aged adults in Western Europe: Incidence, mortality and burden of disease 1990–2017. Injury 2020, 51, 2091–2097. [Google Scholar]
- Pesonen, T.; Siira, H.; Väisänen, V.; Edgren, J.; Elo, S. The role of impaired vision and declined cognition in falls and fall-related risk factors among older people receiving home care in Finland: A cross-sectional register study. Eur. J. Ageing 2025, 22, 22. [Google Scholar] [CrossRef] [PubMed]
- Hallford, D.J.; Nicholson, G.; Sanders, K.; McCabe, M.P. The association between anxiety and falls: A meta-analysis. J. Gerontol. B Psychol. Sci. Soc. Sci. 2017, 72, 729–741. [Google Scholar] [CrossRef] [PubMed]
- Pillay, J.; Gaudet, L.A.; Saba, S.; Vandermeer, B.; Ashiq, A.R.; Wingert, A.; Hartling, L. Falls prevention interventions for community-dwelling older adults: Systematic review and meta-analysis of benefits, harms, and patient values and preferences. Syst. Rev. 2024, 13, 289. [Google Scholar] [CrossRef] [PubMed]
- Džakula, A.; Vočanec, D.; Banadinović, M.; Vajagić, M.; Lončarek, K.; Lukačević Lovrenčić, I.; Radin, D.; Rechel, B. Croatia: Health System Summary, 2024; European Observatory on Health Systems and Policies; WHO Regional Office for Europe: Copenhagen, Denmark, 2024; Available online: https://iris.who.int/handle/10665/379910 (accessed on 14 May 2026).
- World Health Organization. International Statistical Classification of Diseases and Related Health Problems, Tenth Revision. Available online: https://icd.who.int/browse10/2019/en#/ (accessed on 28 February 2026).
- Vuković Baras, S.; Rota Čeprnja, A.; Pivalica, D.; Kožul Blaževski, R.; Jukić, A.; Barić, L.; Martinović Kaliterna, D.; Aljinović, J. Increased Three-Year Mortality Was Observed During COVID-19 Pandemic Among Patients Discharged from the Acute Rehabilitation Ward After Acetabular and Femoral Fracture Surgery. Medicina 2026, 62, 650. [Google Scholar] [CrossRef] [PubMed]
- Marasović Šušnjara, I.; Mijaković, M.; Jurčev Savičević, A. The Influence of the COVID-19 Pandemic on Hospitalizations for Ambulatory Care-Sensitive Conditions in Split-Dalmatia County, Croatia. Medicina 2024, 60, 523. [Google Scholar] [CrossRef] [PubMed]
- Gunčić Car, R.; Vučković, M.; Budimir, D.; Budimir Medić, R.; Marijančić, V.; Sorta-Bilajac Turina, I. Padovi u trećoj životnoj dobi-javno-zdravstveni pogled i izazovi za budućnost. Med. Flum. 2025, 61, 157–162. [Google Scholar] [CrossRef]
- Alves, T.; Silva, S.; Braz, P.; Papadakaki, M.; Aniceto, C.; Mexia, R.; Matias-Dias, C. Epidemiology of Falls Among Older Adults in Portugal: Analysis of Unintentional Injuries Reported by a National Emergency Surveillance System. Healthcare 2025, 13, 1160. [Google Scholar] [CrossRef] [PubMed]
- Giovannini, S.; Brau, S.; Galluzzo, V.; Santagada, D.A.; Loreti, C.; Biscotti, L.; Laudisio, A.; Zuccala, G.; Bernabei, R. Falls among Older Adults: Screening, Identification, Rehabilitation, and Management. Appl. Sci. 2022, 12, 7934. [Google Scholar] [CrossRef]
- Jakovčević, A.; Ćurković, M. Prevencija padova starijih osoba. Med. Jadert. 2024, 54, 195–202. [Google Scholar] [CrossRef]
- James, S.L.; Lucchesi, L.R.; Bisignano, C.; Castle, C.D.; Dingels, Z.V.; Fox, J.T.; Hamilton, E.B.; Henry, N.J.; Krohn, K.J.; Liu, Z.; et al. The global burden of falls: Global, regional and national estimates of morbidity and mortality from the Global Burden of Disease Study 2017. Inj. Prev. 2020, 26, i3–i11. [Google Scholar] [CrossRef] [PubMed]
- Yao, X.; Champagne, A.S.; McFaull, S.R.; Thompson, W. Temporal trends and characteristics of fall-related deaths, hospitalizations and emergency department visits among older adults in Canada. Health Promot. Chronic Dis. Prev. Can. 2024, 44, 482–487. [Google Scholar] [CrossRef] [PubMed]
- Bergen, G.; Stevens, M.R.; Burns, E.R. Falls and fall injuries among adults aged ≥65 years—United States, 2014. MMWR Morb. Mortal. Wkly. Rep. 2016, 65, 993–998. [Google Scholar] [CrossRef] [PubMed]
- Stevens, J.A.; Sogolow, E.D. Gender differences for non-fatal unintentional fall related injuries among older adults. Inj. Prev. 2005, 11, 115–119. [Google Scholar] [CrossRef] [PubMed]
- Zhang, Q.; Zhao, X.; Liu, H.; Ding, H. Frailty as a predictor of future falls and disability: A four-year follow-up study of Chinese older adults. BMC Geriatr. 2020, 20, 388. [Google Scholar] [CrossRef] [PubMed]
- Liu, W.; Qin, R.; Qiu, Y.; Luan, T.; Qiu, B.; Zan, K.; Chen, Z.; Mia, B.; Liu, Y. Multidimensional frailty as a predictor of mortality among older adults: A systematic review and meta-analysis. BMC Geriatr. 2024, 24, 793. [Google Scholar] [CrossRef] [PubMed]
- Berecki-Gisolf, J.; Rezaei-Darzi, E.; Natora, A.H. Gender differences in the incidence, characteristics and hospital admission outcomes of fall-related injuries in older adults. Front. Public Health 2024, 12, 1426726. [Google Scholar] [CrossRef] [PubMed]
- Centers for Disease Control and Prevention. Fatalities and injuries from falls among older adults in the United States, 1993–2003 and 2001–2005. MMWR Morb. Mortal. Wkly. Rep. 2006, 55, 1221–1224. [Google Scholar] [PubMed]
- Gale, C.R.; Cooper, C.; Sayer, A.A. Prevalence and risk factors for falls in older men and women: The English Longitudinal Study of Ageing. Age Ageing 2016, 45, 789–794. [Google Scholar] [CrossRef] [PubMed]
- Do, M.T.; Chang, V.C.; Kuran, N.; Thompson, W. Fall-related injuries among Canadian seniors, 2005–2013. Health Promot. Chronic Dis. Prev. Can. 2015, 35, 99–108. [Google Scholar] [CrossRef] [PubMed]
- Smit, A.E.; Meijer, O.C.; Winter, E.M. The multi-faceted nature of age-associated osteoporosis. Bone Rep. 2024, 20, 101750. [Google Scholar] [CrossRef] [PubMed]
- Deandrea, S.; Bravi, F.; Turati, F.; Lucenteforte, E.; La Vecchia, C.; Negri, E. Risk factors for falls in older people in nursing homes and hospitals: A systematic review and meta-analysis. Arch. Gerontol. Geriatr. 2013, 56, 407–415. [Google Scholar] [CrossRef] [PubMed]
- El-Menyar, A.; El-Hennawy, H.; Al-Thani, H.; Asim, M.; Abdelrahman, H.; Zarour, A.; Parchani, A.; Peralta, R.; Latifi, R. Traumatic injury among females: Does gender matter? J. Trauma Manag. Outcomes 2014, 8, 8. [Google Scholar] [CrossRef] [PubMed]
- Fakler, J.K.; Pieroh, P.; Höch, A.; Roth, A.; Kleber, C.; Loffler, M.; Heyde, C.E.; Zeynalova, S. Predictors of long-term mortality in older patients with hip fractures managed by hemiarthroplasty. Patient Saf. Surg. 2024, 18, 15. [Google Scholar] [CrossRef] [PubMed]
- Bäcker, H.C.; Wu, C.H.; Maniglio, M.; Wittekindt, S.; Hardt, S.; Perka, C. Epidemiology of proximal femoral fractures. J. Clin. Orthop. Trauma 2021, 12, 161–165. [Google Scholar] [CrossRef] [PubMed]
- Holden, E.; Devin, R.; Bhattacharya, J.; Waldie, F.; Watt, I.; Wu, C.J. Prevalence of older hospitalised adults with sustained fractures after a fall in regional Australian hospitals. Healthcare 2024, 12, 1318. [Google Scholar] [CrossRef] [PubMed]
- Sanders, K.M.; Lim, K.; Stuart, A.L.; Macleod, A.; Scott, D.; Nicholson, G.C.; Busija, L. Diversity in fall characteristics hampers effective prevention. Osteoporos. Int. 2017, 28, 3005–3015. [Google Scholar] [CrossRef] [PubMed]
- OECD. Health at a Glance 2023: OECD Indicators; OECD Publishing: Paris, France, 2023. [Google Scholar] [CrossRef]
- Montero-Odasso, M.; van der Velde, N.; Martin, F.C.; Petrovic, M.; Tan, M.P.; Ryg, J.; Aguilar-Navarro, S.; Alexander, N.B.; Becker, C.; Blain, H.; et al. World guidelines for falls prevention and management for older adults. Age Ageing 2022, 51, afac205. [Google Scholar] [CrossRef] [PubMed]


| Year | 65–74 n (%) | 75–84 n (%) | ≥85 n (%) | Total n | χ2 * | p |
|---|---|---|---|---|---|---|
| 2020 | 275 (30.32) | 393 (43.33) | 239 (26.35) | 907 | 42.93 | <0.001 |
| 2021 | 309 (29.91) | 402 (38.92) | 322 (31.17) | 1033 | 14.73 | 0.001 |
| 2022 | 289 (30.29) | 373 (39.10) | 292 (30.61) | 954 | 14.28 | 0.001 |
| 2023 | 309 (34.72) | 316 (35.51) | 265 (29.78) | 890 | 5.15 | 0.076 |
| 2024 | 296 (31.06) | 347 (36.41) | 310 (32.53) | 953 | 4.37 | 0.112 |
| Total | 1478 (31.20) | 1831 (38.65) | 1428 (30.15) | 4737 | 61.12 | <0.001 |
| Year | Male n (%) | Female n (%) | Total (n) | χ2 * | p Value |
|---|---|---|---|---|---|
| 2020 | 279 (30.76) | 628 (69.24) | 907 | 134.29 | <0.001 |
| 2021 | 295 (28.56) | 738 (71.44) | 1033 | 189.98 | <0.001 |
| 2022 | 296 (31.03) | 658 (68.97) | 954 | 137.63 | <0.001 |
| 2023 | 259 (29.10) | 631 (70.90) | 890 | 155.49 | <0.001 |
| 2024 | 300 (31.48) | 653 (68.52) | 953 | 130.75 | <0.001 |
| Total | 1429 (30.17) | 3308 (69.83) | 4737 | 745.33 | <0.001 |
| ICD-10 * | Injury Type | Total n (%) | Male n (%) | Female n (%) | p-Value |
|---|---|---|---|---|---|
| S00–S09 | Head | 558 (11.78) | 273 (48.92) | 285 (51.08) | 0.611 |
| S10–S19 | Neck | 38 (0.8) | 24 (63.16) | 14 (36.84) | 0.105 |
| S20–S29 | Thorax | 520 (10.98) | 248 (47.69) | 272 (52.31) | 0.293 |
| S30–S39 | Abdomen and pelvis | 479 (10.11) | 146 (30.48) | 333 (69.52) | <0.001 |
| S40–S49 | Shoulder and upper arm | 165 (3.48) | 46 (27.88) | 119 (72.12) | <0.001 |
| S50–S59 | Elbow and forearm | 134 (2.83) | 30 (22.39) | 104 (77.61) | <0.001 |
| S60–S69 | Wrist and hand | 8 (0.17) | 6 (75.0) | 2 (25.0) | — |
| S70–S79 | Hip and thigh | 2387 (50.39) | 533 (22.33) | 1854 (77.67) | <0.001 |
| S80–S89 | Knee and lower leg | 332 (7.0) | 81 (24.4) | 251 (75.6) | <0.001 |
| S90–S99 | Ankle and foot | 26 (0.55) | 16 (61.54) | 10 (38.46) | 0.239 |
| Year | ≤7 Days n (%) | ≥8 Days n (%) | Total (n) | p-Value * |
|---|---|---|---|---|
| 2020 | 414 (45.64) | 493 (54.36) | 907 | 0.009 |
| 2021 | 447 (43.27) | 586 (56.73) | 1033 | <0.001 |
| 2022 | 437 (45.81) | 517 (54.19) | 954 | 0.010 |
| 2023 | 457 (51.35) | 433 (48.65) | 890 | 0.421 |
| 2024 | 519 (54.46) | 434 (45.54) | 953 | 0.006 |
| Total | 2274 (48.01) | 2463 (51.99) | 4737 | 0.006 |
| Year | Sex | Alive n (%) | Death n (%) | Total n | p-Value * |
|---|---|---|---|---|---|
| 2020 | Total | 878 (96.80) | 29 (3.20) | 907 | 0.004 |
| Male | 263 (94.27) | 16 (5.73) | 279 | ||
| Female | 615 (97.93) | 13 (2.07) | 628 | ||
| 2021 | Total | 992 (96.03) | 41 (3.97) | 1033 | 0.010 |
| Male | 276 (93.56) | 19 (6.44) | 295 | ||
| Female | 716 (97.02) | 22 (2.98) | 738 | ||
| 2022 | Total | 929 (97.38) | 25 (2.62) | 954 | <0.001 |
| Male | 280 (94.59) | 16 (5.41) | 296 | ||
| Female | 649 (98.63) | 9 (1.37) | 658 | ||
| 2023 | Total | 862 (96.85) | 28 (3.15) | 890 | 0.013 |
| Male | 245 (94.59) | 14 (5.41) | 259 | ||
| Female | 617 (97.78) | 14 (2.22) | 631 | ||
| 2024 | Total | 933 (97.90) | 20 (2.10) | 953 | 0.734 |
| Male | 293 (97.67) | 7 (2.33) | 300 | ||
| Female | 640 (98.01) | 13 (1.99) | 653 | ||
| Total | 4594 (96.98) | 143 (3.02) | 4737 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2026 by the authors. Published by MDPI on behalf of the Lithuanian University of Health Sciences. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.
Share and Cite
Marasović Šušnjara, I.; Glavaš, G.; Parlov, M.; Savičević, N.J.; Jurčev Savičević, A.; Šušnjara, H. Trends and Epidemiology of Fall-Related Hospitalizations Among Older Adults in the Split-Dalmatia County, Croatia: A Retrospective Descriptive Study from 2020 to 2024. Medicina 2026, 62, 1270. https://doi.org/10.3390/medicina62071270
Marasović Šušnjara I, Glavaš G, Parlov M, Savičević NJ, Jurčev Savičević A, Šušnjara H. Trends and Epidemiology of Fall-Related Hospitalizations Among Older Adults in the Split-Dalmatia County, Croatia: A Retrospective Descriptive Study from 2020 to 2024. Medicina. 2026; 62(7):1270. https://doi.org/10.3390/medicina62071270
Chicago/Turabian StyleMarasović Šušnjara, Ivana, Gabriela Glavaš, Mladenka Parlov, Nora Josipa Savičević, Anamarija Jurčev Savičević, and Hrvoje Šušnjara. 2026. "Trends and Epidemiology of Fall-Related Hospitalizations Among Older Adults in the Split-Dalmatia County, Croatia: A Retrospective Descriptive Study from 2020 to 2024" Medicina 62, no. 7: 1270. https://doi.org/10.3390/medicina62071270
APA StyleMarasović Šušnjara, I., Glavaš, G., Parlov, M., Savičević, N. J., Jurčev Savičević, A., & Šušnjara, H. (2026). Trends and Epidemiology of Fall-Related Hospitalizations Among Older Adults in the Split-Dalmatia County, Croatia: A Retrospective Descriptive Study from 2020 to 2024. Medicina, 62(7), 1270. https://doi.org/10.3390/medicina62071270

