Medicare Can Save Billions of Dollars By Reducing Falls And Related Hospitalizations.



Falls are a major cause of hospitalizations accounting for 40% of hospital admissions for seniors covered by medicare. More than 1/3 of seniors 65 and older fall annually. Neuromuscular orthotics help reduce the numbers of patients falls.

THE RISK OF FALLING IS A MAJOR CONCERN FOR OLDER ADULTS BUT FALLING IS APPARENTLY A PROBLEM AT ALL AGES. A recent article in Science Daily reported on the incidence of falls and a newly developed Comprehensive Screening Test for Falling Risk.

PUBMED lists over 880 articles when “cost” and “falls” are entered as keywords.

Neuromuscular Dentistry can lower the risk of dangerous falls. The question is whether Neuromuscular Dentistry can save medicare billions of dollars and pay for the recently passed health bill that President Obama signed into law? According to an article in Science Daily 40% of all senior hospital admissions are related to falls. If neuromuscular dental appliances could reduce falls by only 10% it would save medicare tens of billions of dollars and prevent deterioration to the quality of seniors lives.

Neuromuscular Dentistry is based on the work of Dr Barney Jankelson who applied physiological measurements to dentistry. His work has resulted in help for patients with migraines, tension headaches and TMJ disorders ( It is also extremely effective in helping balance and postural issues.

The New Orleans Saints utilized Neuromuscular Dentistry to help win the Superbowl. The PPM Mouthguard or Pure Power Mouthguard was developed by Neuromuscular Dentist Anil Makkar to improve physical performance including balance strength and flexibility. A Rutger’s Study confirmed these effects.

The Pure Power Mouthpiece mproves balance in athletes but can proper application of Neuromuscular Dentistry do the same for seniors or other patients with balance problems? If the number of falls could be reduced even 10% the savings to Medicare would be astronomical and could reduce or eliminate the forecasted budget shortfalls. An explanation of the science behind Neuromuscular Dentistry can be found in Sleep and Health Journal at

ICCMO, the International College of CranioMandibular Orthopedics is the professional association that consists of medical professionals (pimarily dentists) who are trained in Neuromuscular Dentistry and in correcting the physiology of the stomatognathic and trigeminal systems. Neuromuscular Dentistry primarily addresses the health of the Trigeminal Nerve that accounts for over 50% of the total input to the brain. The trigemono-vascular system is a primary agent of almost all chronic headaches including Migraines,Chronic Daily Headaches, Tension-Type Headaches, Episodic Tension-Type Headaches, Sinus Pain, TMD, Retroorbital Headaches, Morning headaches, Facial Pain and other common pain syndromes.

An excellent article on Neuromuscular Dentistry originally published by the American Equilibration Society (AES) is available at Sleep and Health Journal another article in Sleep and Health “SUFFER NO MORE: DEALING WITH THE GREAT IMPOSTER” discusses how TMJ disorders (TMD) can effect patients lives. The National Heart Lung and Blood Institute (NHLBI) of the NIH issued a report on “CARDIOVASCULAR AND SLEEP RELATED CONSEQUENCES OF TEMPOROMANDIBULAR DISORDERS”.

The NIH has numerous studies on alternative medicine techniques. I believe that the NIH should evaluate the Rutger’s study and use it as a template for a study addressing balance and avoidance of falls universally but especially in seniors. Forward head posture increases problems with balance and can be addressed by orthopedic correction of mandibular position utilizing diagnostic neuromuscular orthotics. Unfortunately the NICDR, The National Institute of Dental and Cranial Research of the NIH has focused most of its attention on the psychological aspects of TMJ disorders and ignored the underlying physiology. The research that is funded by the NICDR focuses on drug treatments that are more easily studied and meet current criteria of “evidence based medicine” The NHLBI is less influenced by dental politics.

While research based on occlusal concepts has lost favor at the NIH a recent study by The University of Chicago on NUCCA Chiropractic adjustments lowering blood pressure was groundbreaking. Correction of underlying Neuromuscular Dental issues makes NUCCA adjustments much more stable allowing permanent postural corrections. Forward head posture is closely related to both airway issues and the neuromuscular position and vertical dimension of the jaws.

An article published by Dr Barry Cooper in CRANIO Journal showed that Neuromuscular Dentistry was “overwhelmingly successful” in treating TMJ disorders. If the problem of falls could be answered for only 10% of patients it would answer all funding problems for Medicare for many years and Neuromuscular Dentistry and Dental Sleep Medicine have the potential of making national healthcare a economic success. Another article in CRANIO by Shimshak et al showed that patients with a diagnosis of TMJ disorders had a 300% increase in medical costs across all field of medicine.

If the promise of Neuromuscular Dentistry could be fulfilled it could also drastically cut medical costs for patients of all ages. Dr Norman Thomas is the world’s leading expert on Neuromuscular Dentistry. Dr Thomas has recently taken over as the head of research and education for Neuromuscular Dentistry at the prestigious Las Vegas Institute. LVI is the world’s leading educator in Neuromuscular Dentistry.

Dr Ira L Shapira is an author and section editor of Sleep and Health Journal, President of I HATE CPAP LLC, President Dato-TECH, and has a Dental Practice in Gurnee, Illinois with his partner Dr Mark Amidei. Dr Shapira recently formed Chicagoland Dental Sleep Medicine Associates. He is a Regent of ICCMO and its representative to the TMD Alliance, He was a founding and certified member of the Sleep Disorder Dental Society which became the American Academy of Dental Sleep Medicine, A founding member of DOSA the Dental Organization for Sleep Apnea. He is a Diplomate of the American Board of Dental Sleep Medicine, A Diplomat of the American Academy of Pain Management, a graduate of LVI. He is a former assistant professor at Rush Medical School’s Sleep Service where he worked with Dr Rosalind Cartwright who is a founder of Sleep Medicine and Dental Sleep Medicine. Dr Shapira is a consultant to numerous sleep centers and teaches courses in Dental Sleep Medicine in his office to doctors from around the U.S. He is the Founder of I HATE CPAP LLC and Dr Shapira also holds several patents on methods and devices for the prophylactic minimally invasive early removal of wisdom teeth and collection of bone marrow and stem cells. Dr Shapira is a licensed general dentist in Illinois and Wisconsin.


Falls Among Older Adults: An Overview
How big is the problem?
More than one third of adults 65 and older fall each year in the United States (Hornbrook et al. 1994; Hausdorff et al. 2001).
Among older adults, falls are the leading cause of injury deaths. They are also the most common cause of nonfatal injuries and hospital admissions for trauma (CDC 2005).
In 2005, 15,800 people 65 and older died from injuries related to unintentional falls; about 1.8 million people 65 and older were treated in emergency departments for nonfatal injuries from falls, and more than 433,000 of these patients were hospitalized (CDC 2005).
The rates of fall-related deaths among older adults rose significantly over the past decade (Stevens 2006).
What outcomes are linked to falls?
Twenty percent to 30% of people who fall suffer moderate to severe injuries such as bruises, hip fractures, or head traumas. These injuries can make it hard to get around and limit independent living. They also can increase the risk of early death (Alexander et al. 1992; Sterling et al. 2001).
Falls are the most common cause of traumatic brain injuries, or TBI (Jager et al. 2000). In 2000, TBI accounted for 46% of fatal falls among older adults (Stevens et al. 2006).
Most fractures among older adults are caused by falls (Bell et al. 2000).
The most common fractures are of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand (Scott 1990).
Many people who fall, even those who are not injured, develop a fear of falling. This fear may cause them to limit their activities, leading to reduced mobility and physical fitness, and increasing their actual risk of falling (Vellas et al. 1997).
In 2000, direct medical costs totaled $0.2 billion ($179 million) for fatal falls and $19 billion for nonfatal fall injuries (Stevens et al. 2006).
Who is at risk?
Men are more likely to die from a fall. After adjusting for age, the fall fatality rate in 2004 was 49% higher for men than for women (CDC 2005).
Women are 67% more likely than men to have a nonfatal fall injury (CDC 2005).
Rates of fall-related fractures among older adults are more than twice as high for women as for men (Stevens et al. 2005).
In 2003, about 72% of older adults admitted to the hospital for hip fractures were women (CDC 2005).
The risk of being seriously injured in a fall increases with age. In 2001, the rates of fall injuries for adults 85 and older were four to five times that of adults 65 to 74 (Stevens et al. 2005)
Nearly 85% of deaths from falls in 2004 were among people 75 and older (CDC 2005).
People 75 and older who fall are four to five times more likely to be admitted to a long-term care facility for a year or longer (Donald et al. 1999).
There is little difference in fatal fall rates between whites and blacks, ages 65 to 74 (CDC 2006).
After age 75, white men have the highest fatality rates, followed by white women, black men, and black women (CDC 2005).
White women have significantly higher rates of fall–related hip fractures than black women (Stevens 2005).
Among older adults, non–Hispanics have higher fatal fall rates than Hispanics (Stevens et al. 2002).
How can older adults prevent falls?
Older adults can take several steps to protect their independence and reduce their risk of falling. They can:

Exercise regularly; exercise programs like Tai Chi that increase strength and improve balance are especially good.
Ask their doctor or pharmacist to review their medicines–both prescription and over-the counter–to reduce side effects and interactions.
Have their eyes checked by an eye doctor at least once a year.
Improve the lighting in their home.
Reduce hazards in their home that can lead to falls.
What is CDC doing to prevent falls among older adults?
CDC supports research and dissemination on ways to help prevent falls among older adults. To read about these activities, follow the link to CDC Fall Prevention Activities.

CDC has also developed brochures and posters, in partnership with the CDC Foundation and MetLife Foundation, to educate older adults and those who care for them about preventing falls and the injuries that result.

Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall–related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3.
Bell AJ, Talbot-Stern JK, Hennessy A. Characteristics and outcomes of older patients presenting to the emergency department after a fall: a retrospective analysis. Medical Journal of Australia 2000;173(4):176–7.
Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web–based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [cited 2007 Jan 15]. Available from URL:
Donald IP, Bulpitt CJ. The prognosis of falls in elderly people living at home. Age and Ageing 1999;28:121–5.
Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community–living older adults: a 1–year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8):1050–6.
Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community–dwelling older persons: results from a randomized trial. The Gerontologist 1994:34(1):16–23.
Jager TE, Weiss HB, Coben JH, Pepe PE. Traumatic brain injuries evaluated in U.S. emergency departments, 1992–1994. Academic Emergency Medicine 2000&359;7(2):134–40.
Scott JC. Osteoporosis and hip fractures. Rheumatic Diseases Clinics of North America 1990; 16(3): 717–40.
Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. Journal of Trauma–Injury, Infection and Critical Care 2001;50(1):116–9.
Stevens JA. Falls among older adults–risk factors and prevention strategies. NCOA Falls Free: Promoting a National Falls Prevention Action Plan. Research Review Papers. Washington &340;DC)&358; The National Council on the Aging; 2005.
Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006;12:290–5.
Stevens JA, Dellinger AM. Motor vehicle and fall related deaths among older Americans 1990–98: sex, race, and ethnic disparities. Injury Prevention 2002;8:272–5.
Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Injury Prevention 2005;11:115–9.
Stevens JA. Fatalities and injuries from falls among older adults – United States, 1993–2003 and 2001–2005. MMWR 2006;55(45).
Vellas BJ, Wayne SJ, Romero LJ, Baumgartner RN, Garry PJ. Fear of falling and restriction of mobility in elderly fallers. Age and Ageing 1997;26:189–193.

Costs of Falls Among Older Adults
In 2000, the total direct cost of all fall injuries for people 65 and older exceeded $19 billion.¹ The financial toll for older adult falls is expected to increase as the population ages, and may reach $54.9 billion by 2020 (adjusted to 2007 dollars).²

How big is the problem?
One in three adults 65 and older falls each year.³, 4
Of those who fall, 20% to 30% suffer moderate to severe injuries that make it hard for them to get around or live independently and increase their chances of early death.5
Older adults are hospitalized for fall-related injuries five times more often than they are for injuries from other causes.5
How are costs calculated?
The costs of fall-related injuries are often shown in terms of direct costs.

Direct costs are what patients and insurance companies pay for treating fall-related injuries. These costs include fees for hospital and nursing home care, doctors and other professional services, rehabilitation, community-based services, use of medical equipment, prescription drugs, changes made to the home, and insurance processing.²
Direct costs do not account for the long-term effects of these injuries such as disability, dependence on others, lost time from work and household duties, and reduced quality of life.
How costly are fall-related injuries among older adults?
In 2000, the total direct cost of all fall injuries for people 65 and older exceeded $19 billion: $0.2 billion for fatal falls, and $19 billion for nonfatal falls.1
By 2020, the annual direct and indirect cost of fall injuries is expected to reach $54.9 billion (in 2007 dollars).2
In a study of people age 72 and older, the average health care cost of a fall injury totaled $19,440, which included hospital, nursing home, emergency room, and home health care, but not doctors’ services.6
How do these costs break down?
Age and sex

The costs of fall injuries increase rapidly with age.¹
In 2000, the costs of both fatal and nonfatal falls were higher for women than for men.7
Medical costs in 2000 for women, who comprised 58% of older adults, were two to three times higher than for men.¹
Type of injury and treatment setting

In 2000, traumatic brain injuries (TBI) and injuries to the hips, legs, and feet were the most common and costly fatal fall injuries, and accounted for 78% of fatalities and 79% of costs.¹
Injuries to internal organs caused 28% of deaths and accounted for 29% of costs from fatal falls.¹
Hospitalizations accounted for nearly two thirds of the costs of nonfatal fall injuries, and emergency department treatment accounted for 20%.¹
On average, the hospitalization cost for a fall injury was $17,500.7
Fractures were both the most common and most costly type of nonfatal injuries. Just over one third of nonfatal injuries were fractures, but they accounted for 61% of costs—or $12 billion.¹
Hip fractures are the most frequent type of fall-related fractures. The cost of hospitalization for hip fracture averaged about $18,000 and accounted for 44% of direct medical costs for hip fractures.8
¹Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and nonfatal falls among older adults. Injury Prevention 2006;12:290–5.
²Englander F, Hodson TJ, Terregrossa RA. Economic dimensions of slip and fall injuries. Journal of Forensic Science 1996;41(5):733–46.
³Hausdorff JM, Rios DA, Edelber HK. Gait variability and fall risk in community-living older adults: a 1-year prospective study. Archives of Physical Medicine and Rehabilitation 2001;82(8):1050–6.
4Hornbrook MC, Stevens VJ, Wingfield DJ, Hollis JF, Greenlick MR, Ory MG. Preventing falls among community-dwelling older persons: results from a randomized trial. The Gerontologist 1994;34(1):16–23.
5Alexander BH, Rivara FP, Wolf ME. The cost and frequency of hospitalization for fall-related injuries in older adults. American Journal of Public Health 1992;82(7):1020–3.
6Rizzo JA, Friedkin R, Williams CS, Nabors J, Acampora D, Tinetti ME. Health care utilization and costs in a Medicare population by fall status. Medical Care 1998;36(8):1174–88.
7Roudsari BS, Ebel BE, Corso PS, Molinari, NM, Koepsell TD. The acute medical care costs of fall-related injuries among the U.S. older adults. Injury, Int J Care Injured 2005;36:1316-22.
8Barrett-Connor E. The economic and human costs of osteoporotic fracture. American Journal of Medicine 1995;98(suppl 2A):2A–3S to 2A–8S.