Marlene Hellenbrand went to get Christmas decorations from her basement in Waunakee when she fell down the stairs and died at age 74.
Jack Kammer of Madison tried to clear snow from his satellite dish so he could watch basketball. He fell and died two months later at 84.
Dorothy Seeman got up at night to use the bathroom in her apartment in Janesville. Fourteen hours later, she was found on the floor with cuts and bruises. After short stays in a hospital and a nursing home, she died at 85.
“It was a very quick downward spiral,” said Angie Sullivan, Seeman’s granddaughter.
Wisconsin has the nation’s highest rate of deadly falls among the elderly, according to a report last year by the Centers for Disease Control and Prevention. Some 1,365 residents 65 or older died from falls in 2016, giving the state a rate more than double the national average.
Deaths from falls in Wisconsin outnumber deaths from breast and prostate cancer combined. Falls resulted in about 129,000 emergency room visits and nearly 16,000 hospitalizations in 2017, according to the state Department of Health Services. Medical charges for falls, paid mostly by the taxpayer-supported Medicare and Medicaid programs, exceeded $1 billion.
Exactly why Wisconsin tops the charts in fatal falls is not clear, but experts cite a few possible reasons: icy winters; excessive drinking, including among the elderly; the population is older and whiter than the U.S. average; and officials here might report falls as a cause of death better than in other states.
“It’s multi-factorial,” said Dr. Jane Mahoney, a UW-Madison geriatrician who has done extensive research on falls. “You add in alcohol, winter weather ... reporting differences ... those all play a role.”
Wisconsin’s rate of deadly falls among older adults, which has consistently ranked at or near the top among states, climbed 50 percent from 2007 to 2016, greater than the 31 percent increase nationally. With the state’s elderly population projected to grow six times faster than the overall population by 2040, the burden of falls is expected to rise.
The state Legislature approved $200,000 a year for falls prevention and other healthy aging efforts in 2015. Two years later, when advocates requested $600,000 a year, lawmakers dropped the funding altogether. Gov. Tony Evers’ proposed biennial budget, released Thursday, calls for $250,000 a year.
“It’s an incredibly prudent investment financially, and in humanity,” said Betsy Abramson, executive director of the Wisconsin Institute for Healthy Aging. “How the state can not invest in prevention in this is beyond me.”
Melissa Heinz, injury and violence prevention coordinator for the state health department, said some state money given to local health departments and Aging and Disability Resource Centers is used to help prevent falls. But no state money is designated for reducing falls, as is the case for other problems such as poisoning, child abuse and motor vehicle injuries.
“Falls prevention is of high concern, but it’s not specifically singled out as more important than all the other matters of public health,” Heinz said.
However, she said, “We definitely need to build awareness around the risk of falls, particularly among the elderly.”
In Wisconsin, the month with the most deaths from falls is December, followed by January, March and November, according to a Wisconsin State Journal analysis of state falls data from 2014 to 2017.
Cold temperatures and snow, which can make for slippery sidewalks, could be a reason. But other considerations call into question the influence of winter weather in rates of deadly falls.
Some states with similar winters — Vermont, Minnesota, Colorado and South Dakota — rank immediately after Wisconsin in the CDC report. But others, including Michigan, Illinois and Indiana, have low rates, presenting a mixed picture.
Weather can be a contributing factor for outdoor falls, but most falls among older adults happen indoors, said Elizabeth Burns, a CDC health scientist and lead author of the falls report. Deaths attributed to falls can occur months afterward and be reported in subsequent seasons, making it hard to pinpoint the role of weather, Burns said.
“It’s not a slam dunk,” she said.
Wisconsin, known for breweries, leads the nation in excessive drinking, with 24.2 percent of adults saying they binge drink or drink chronically, compared to 19 percent nationally.
Among people 65 and older, the distinction doesn’t fade: 8.8 percent of state residents reported binge drinking and 6.3 percent reported heavy drinking in 2017, compared to national figures of 4.9 percent and 4.1 percent, according to the CDC.
Of the 1,383 deadly falls among older adults in Wisconsin in 2017, an estimated 443 were related to alcohol use, according to the state health department.
Since older adults in Wisconsin are more likely to drink too much, it makes sense that the state’s high rate of deadly falls stems in part from alcohol use, said Dr. Gerald Pankratz, a geriatrician who runs UW Health’s Mobility and Falls Clinic.
As people age, their stomachs and livers break down alcohol more slowly, and their brains retain alcohol longer, Pankratz said.
“It takes less to get inebriated, and you’re inebriated for longer,” he said. “Intoxication is definitely going to have a negative impact on your balance and your judgment.”
Wisconsin had 12,963 bars and restaurants licensed to sell alcohol in 2017, twice as many per person as the national average, according to the Beverage Information Group, which publishes data about the alcohol industry.
Some municipalities have approved “click and collect” policies that allow customers to order groceries, including alcohol, online and pick up the goods in their vehicles. That could be especially attractive for seniors with limited mobility, said Julia Sherman, coordinator of the Wisconsin Alcohol Policy Project at UW-Madison Law School.
“We’re making it easier, all of the time, to get alcohol,” Sherman said.
Demographics could help explain Wisconsin’s high rate of deadly falls. About 16.5 percent of the state’s population is 65 or older, compared to 15.6 percent nationally. The CDC adjusts for that difference in its rankings, Burns said.
But 2.1 percent of state residents are 85 or older, compared to 1.8 percent nationally, which the CDC may not fully take into account, Burns said. That group is more likely to die from falls, she said.
In Wisconsin, 87.3 percent of people are white and 6.7 percent are black. Nationally, the figures are 76.6 percent and 13.4 percent.
Nationally, among older adults, blacks report 24 percent fewer falls than whites, according to a 2014 study in the Journal of Aging and Health. Older blacks might be less likely to fall because they are less mobile or because they are more likely to live with relatives, which protects against falls, researchers said.
Reporting of deadly falls
Wisconsin might report deaths from falls more thoroughly than other states, making its rate of deadly falls seem comparatively higher. “I think Wisconsin’s data is probably more complete,” Burns said.
Dr. Brian Peterson, medical examiner in Milwaukee County, the state’s most populous county, said deaths that appear to be caused by pneumonia or other conditions can result from falls months earlier. If investigators don’t ask the right questions, they might not discover that and report it, he said.
“We look harder, and we’re more careful,” Peterson said.
Death investigators in Wisconsin are trained to be more aware of falls, said Barry Irmen, director of operations for the medical examiner’s office in Dane County, which includes Madison and is the second most populous county.
Wisconsin’s death reporting requirements are similar to those in other states. But Michelle Smith, vital records supervisor for the state health department, said the state presses medical examiners and coroners to redo death certificates if information is incomplete, which might contribute to better data about falls.
Still, Dr. Jonathan Lucas, medical examiner of Los Angeles County, the most populous county in California, said he and his colleagues carefully investigate falls. California had the fifth lowest rate of deadly falls among the elderly in 2016, with a rate less than one-third that of Wisconsin’s.
“I’m confident we’re identifying those deaths,” Lucas said. “It’s hard to believe that big of a difference is only due to the reporting.”
‘She didn’t listen to me’
Hellenbrand, who died falling down her stairs in late November, had Parkinson’s disease, which affects balance. She sometimes used a walker, and her husband got rid of throw rugs and put grab bars in their bathroom to help prevent falls.
“I told her she shouldn’t be going up and down the steps unless I was at home,” said Marv Hellenbrand, former chief of the Waunakee Fire Department.
When she died, he was at a pharmacy picking up one of her prescriptions. “I guess she didn’t listen to me,” he said.
The couple had adorned their home for Christmas, but she apparently went to retrieve more ornaments from the basement. “She was never done decorating,” he said.
Kammer, a dentist who was well known in Madison for displaying tens of thousands of holiday lights each year along University Avenue, died in May 2010, two months after his fall.
He climbed a ladder to try to get to his satellite dish but fell, hitting his head on the side of the house, said his son Chris Kammer, of Madison. “He had his sights on watching March Madness,” Chris Kammer said.
Jack Kammer had been in relatively good health. After the fall, he had surgery for the head injury but didn’t recover.
“Clearly, he would not have died (at that time) if he had not fallen,” Chris Kammer said.
Steps to prevent falls
Seeman was also living independently, in her senior apartment, before falling in her bathroom in 2012. She was found 14 hours later after she missed a hair appointment.
The fall didn’t cause her to break bones, and her scrapes and bruises weren’t severe. But as she lay on the floor, her skin started to break down, causing an open wound, said Sullivan, her granddaughter.
Seeman never regained the ability to walk without assistance and died five weeks later in a nursing home. “It’s amazing how quickly she went downhill,” Sullivan said.
Sullivan, who lives near Milton, now works in health promotion for the elderly and leads classes on preventing falls.
Her grandmother didn’t have grab bars in her bathroom, a raised toilet seat or night lights. She didn’t carry a cellphone or alert system, and nobody checked on her each morning. She took an unnecessary seizure medication, which can impair balance, until after she fell.
Sullivan now realizes — and teaches — the importance of such precautions.
“There are some really simple things people just don’t think about that can really make an impact,” she said.
This article was supported by a journalism fellowship from the Gerontological Society of America, Journalists Network on Generations and the John A. Hartford Foundation.