It's been called an epidemic and can have deadly consequences, but falls among the elderly often get less attention than other pressing health concerns like opioids, obesity and diabetes.
Still, health officials around Wisconsin say falls are taking a financial and physical toll that can't be ignored, especially in a state that is older than most.
Wisconsin ranks second in fall-related deaths in the U.S. among those 65 and older, with a rate that's twice the U.S. average, according to the Wisconsin Institute for Healthy Aging.
That fatality rate has risen over the last two decades said University of Wisconsin-Madison geriatrics professor Jane Mahoney.
"Our fall-related emergency department visits have also increased over that time and there are many reasons for this but one is just the sheer numbers related to the aging of the population," Mahoney said.
During an Evidence Based Health Policy Project forum in September, Mahoney brought up estimates showing that by 2030, as many as a quarter of the state's residents will be elderly, with fewer younger people to care for them.
"That is going to put a disproportionate burden of falls in our rural, northern population," Mahoney said.
But it's a concern in every corner of the state. As residents get older, muscle loss and medications can cause instability that lead to an ER visit or nursing home stay.
"Falls are increasing in our county and they're costly. It is our number one injury," said Barb Michaels with the Aging and Disability Resource Center in Brown County.
In 2013, Green Bay's four hospitals treated an average of 21 serious falls every day, at a cost of nearly $15 million annually. The number of patients and the cost have both increased since then: 23 serious falls in area ERs each day at a cost of nearly $19 million a year, said Michaels.
Two-thirds of those hospitalized for falls will go to a nursing home for either a short or long term stay, said Mahoney, the UW professor. Some don't survive.
With Wisconsin's especially high elderly death rate, health providers want to get more elderly people into fall prevention programs like Stepping On, which teach balance and strength exercises. A UW-Madison study of 3,000 Wisconsin seniors who took the program showed a 50-percent reduction in falls six months after participating.
"In a subsequent study we also found it reduced emergency department visits for falls by 70 percent. So very important," said Mahoney.
But less than 1 percent of those at risk for falls have participated in the Stepping On program. Mahoney and others say it's not lack of interest, but limited public funding that's preventing more elderly Wisconsinites from learning skills that could be life saving.
In Douglas County, Senior Connections offers a free eight-week course, Matters of Balance, at least twice a year. Instructors are willing to bring the evidence-based class anywhere in the community — churches, assisted living centers, senior housing units, civic groups. There must be a free site to meet and at least eight participants for the class to be held.
The course's combination of exercises and instruction helps participants gain strength and balance, leading to fewer falls.
"If people follow-through, they're less likely to be fearful of falling," said Luanne Teige, deputy director of Senior Connections.
Since 2011, more than 100 Douglas County seniors have taken the Matters of Balance course. When they wrap up, instructors point them to additional exercise resources in the area. Seniors even learn how to get themselves upright after a fall if they weren't injured.
For more information or to sign up for an upcoming class, call (715) 394-3611 and ask for Luann.
Wisconsin Public Radio, Copyright 2017, Board of Regents of the University of Wisconsin System and Wisconsin Educational Communications Board. Wisconsin Public Radio can be heard locally on 91.3 KUWS-FM and online at www.wpr.org.
Telegram reporter Maria Lockwood contributed to this report.