It was a cold, winter night in Central Wisconsin and Mark Jones, nearly 80, was scratched, bleeding and lying in the bushes outside his house, unable to get to his feet. His wife walked through the house as part of her nightly routine, not thinking much about his absence.
Mark had spent more time in his backyard shed since retiring from his job as a machinist, so she stepped outside to check on him before going to bed. After spotting him sprawled out in the bushes, she called 911. An ambulance took him to the emergency room, where a doctor patched him up.
His next stop was detox. Mark had been drinking before he fell.
Wisconsin’s elderly death rate from falls is twice the national average. While few public health experts offer explanations, some are now linking the falls to elevated binge drinking rates among elderly residents. They are a population that is now drinking more than any other point in the past decade.
“Alcohol is hitting you harder and your balance is a little off because you’re older and your bones are more brittle,” said Julia Sherman, chair of the Wisconsin Alcohol Policy Project at the University of Wisconsin Law School. “You add that all together and the danger is obvious in hindsight.”
Falls that involve alcohol killed more than 400 of Wisconsin’s senior citizens in 2016, a dramatic increase that some experts are calling an emerging health crisis for Wisconsin’s booming 65-and-older population.
According to statistics compiled from multiple sources, alcohol-attributed falls have resulted in more lives lost than drunk driving every year since 2008. Since that year, alcohol-related falls among the elderly resulted in 2,784 deaths while drunk driving claimed 1,820 lives across all ages.
“At this point, we’re seeing that falls are expected to become the major health problem in communities across the world,” said Cecilia Jayme, a director of clinical services at Hazelden, an addiction treatment center in Minnesota. “It’s already a major crisis here. I believe it’s a public health crisis ... and no one’s aware of it.”
Had Mark not fallen, his evening would have gone much like every other evening in the winter of 2015. Mark, whose name has been changed to protect his identity, spent most of the day in the shed, working and drinking brandy or whiskey, definitely a dark liquor. That’s what older Wisconsin men like to drink, his sister said.
He often made the trek back to the house after it got dark. But this time, he fell, bringing a regular concern of his family to life.
“(His wife) was terrified, just really afraid. She was shaking, because she realized how close she was to missing him completely,” his sister said. “He would have died out there that night if she hadn’t double-checked for him.”
Sneaking drinks, retreating to the shed and consuming alone had become his routine since he retired in his late 60s, but this was his first major fall. After everything that happened this night — the ambulance trip, detox visit, hospital bills and mandated treatment post-release — Mark was lucky: He lived.
From 2010 to 2016, according to data from Wisconsin’s Department of Health Services, 2,266 senior citizens in Wisconsin died from alcohol-attributed falls.
Wisconsin seniors falling down drunk
While experts said falls by seniors attributed to alcohol consumption were becoming an issue around the world, they paint a more dire picture in Wisconsin.
Data show the trend worsening: Between 2010 and 2016, Wisconsin saw a nearly 50-percent increase in alcohol-related fatal falls among seniors in the state. That could be because this type of fall brings two of Wisconsin’s worst health problems together.
The first issue is clear: Wisconsin is known for drinking and drinking a lot. According to a report from UW-Madison’s Population Health Institute, since around 2000, Wisconsin has ranked among the worst states in the nation for unsafe alcohol consumption in several categories: underage drinking, drunk driving and excessive drinking for senior citizens, among others.
Most of those figures have dropped, or at least stayed the same. Wisconsin now ranks around the national average for underage drinking. Deaths from drunken driving have decreased, as have self-reported incidents of drunk driving.
From 2005 to 2014, the percentages of people that reported heavy drinking (more than two drinks a day for men, more than one for women) in age groups of 18 to 24 and 25 to 44 dropped. The percent of people age 45 to 64 who reported heavy drinking stayed the same.
But consumption among seniors shows a different trend: They’re drinking more now than ever.
In that 10-year span, the percentage of senior citizens identifying as heavy drinkers doubled, going from 3 to 6 percent. The same is true for binge drinking (defined as five or more drinks on one occasion for men, four or more for women), as rates jumped from 4 to 9 percent.
These figures are high enough to place Wisconsin as the worst state in the nation for excessive drinking among senior citizens, with a rate nearly double the national average, according to America’s Health Rankings from the United Health Foundation.
“We have more of our seniors drinking, that’s where we can start,” said the UW’s Sherman. “We’ve got, in essence, the same thing we had among younger individuals and that is more people drinking more. So we shouldn’t be too surprised when we have more negative alcohol-related consequences for (the 65-and-older population).”
Wisconsin’s rate of alcohol-attributed fatal falls was roughly 35 per 100,000 people 65 years and older, according to 2010 population figures from the U.S. Census Bureau and data from 2006 to 2010 collected by the Centers for Disease Control and Prevention. This placed Wisconsin second only to Vermont.
But since 2010, Wisconsin’s rate has steadily climbed, and the upward trend doesn’t show any signs of slowing. By 2015, it rose by about 17 percent to a per capita figure of roughly 41 per 100,000 people 65 years and older.
Many experts say this rate represents the floor, a conservative estimate of deaths by Wisconsin’s seniors due to alcohol-related falls. Because of the cost of gathering data and lack of honest self-reporting, more accurate figures aren’t available.
Instead, the number of alcohol-attributed fatal falls is an estimate from the Alcohol-Related Disease Impact, an online application used by the CDC to determine a variety of health impacts from alcohol consumption. For an estimate that is used in every state, the ARDI puts alcohol-related fatal falls at 32 percent of all falls.
But the drinking rates of each state aren’t factored into these estimates. So, while the current nationwide rate, which has been used since 2008, may be accurate in states where seniors drink less, several experts said it greatly underrepresents how many seniors are dying from drunken falls in Wisconsin.
“It’s underestimated,” Sherman said. “Many people say the ARDI is a fantastic tool, but it’s just a tool, it’s not a prediction. We notice that seniors are drinking more alcohol here and a number of people are concerned that that number represents the baseline and it is much likelier to be higher in reality.”
Why so many seniors fall
For decades, the routine of going to work every day was important to Mark. It signaled that he was accomplishing something tangible. He worked as a machinist before retiring, and regularly traveled around the country to install machinery, his sister said.
When he stopped working, he lost that feeling of accomplishment and, with nothing to take its place, he started drinking more, according to his sister.
“He is a person who produces things. He is a very fine craftsman. He worked all of his life, and working was what was important to him,” his sister said. “So, when he didn’t work anymore and he didn’t have that, he had no real outlet. He lost a lot, a lot of his self-esteem and self-worth when he retired.”
His drinking didn’t start when he retired, but that’s when it “definitely got worse,” according his sister, who explained that it was more intermittent when he was employed. Concerns about his behavior became more serious as he aged, though he had been drinking somewhat regularly for three or four decades before he retired.
“The falls have just been a fairly recent phenomenon, as he’s gotten older,” his sister said. “The falls have been the most concerning.”
As he aged, alcohol affected Mark differently, hitting him harder. That’s not unique to him, it’s a natural part of growing older.
It sneaks up on nearly everyone, according to UW-Madison professor of geriatrics Gerald Pankratz, who leads the UW Health Mobility and Falls clinic. At the clinic, he said he typically sees “frail, older adults” in their 80s.
“I think it’s human nature that people think things are going to be the same forever,” Pankratz said. “Of course, it’s not and until a disaster happens, oftentimes you don’t have any awareness that things have changed.”
Experts stress that falls are not a normal part of growing old. The falls — whether they involve alcohol or not — are 100 percent preventable, Sherman said. Bodies handle alcohol differently at older ages and a moderate amount of drinks at a younger age — say three or four beers — could be a dangerous binge for someone who just celebrated their 70th birthday.
Their skeletons just aren’t as durable as younger adults, Pankratz said, explaining that as the body ages, it naturally transitions away from lean body mass and the risk of osteoporosis (a medical condition resulting in bones becoming more fragile) greatly increases. In addition, the body breaks down alcohol at a much slower rate because the enzyme levels responsible for metabolizing alcohol decrease as people age.
“(Imbalance) is all going to be exacerbated when alcohol is in the mix,” Pankratz said. “Then there's a whole host of medications that older people are on that carry a pretty pronounced risk for falling.”
David Mott, a professor at UW-Madison’s School of Pharmacy, agreed that medications can lead to falls among the elderly, especially when combined with alcohol.
The senior population is prescribed significantly more medicine than “any other group of people,” Mott said.
About 85 percent of older people are on a prescription that increases a risk of fall, according to Mott’s research on 2012 data. Those prescriptions, which can be taken daily, regularly or when needed, can cause sedation, confusion, impaired coordination and/or blurred vision, he said.
Again, as bodies age, they run into the same issues with breaking down drugs as they do with breaking down alcohol.
So, an older person taking a drug to help him sleep might wake up feeling groggy, almost like a hangover, Mott explained. And the medication may stay in their body longer, possibly leading someone to unknowingly mix chemicals with alcohol, even if they drink the next day.
“If these older adults are using medication and then you add alcohol on top of it, holy cow, things get pretty scary, pretty fast,” Mott said. “The effects of the alcohol, when you have these other medications that are being taken, they can probably hit faster, and maybe be more severe. It’s a bad situation.”
And for seniors who spend a lot of time at home, a fall could mean being stuck for hours, or even days.
A sense of urgency
After he was treated for his injuries and visited detox the night of his fall, Mark was told by his doctor that he had two options: seek outpatient medical treatment or start going to a recovery group.
He chose the latter.
He stopped drinking and started attending Alcoholics Anonymous meetings. But the changes didn’t stick.
“My brother is in denial that he needs help,” his sister said. “He went to AA for a while, but of course he’s back drinking now.”
So he returned to the shed and his stash of hard liquor. When his sobriety is off, so is his balance.
This past spring, after a day of drinking in the shed, Mark made it back inside. He climbed the stairs to his bedroom, but couldn’t complete the journey to his bed. He fell down in his room, where his wife later found him.
The fall was minor, especially compared to the one in the winter of 2015 — it didn’t result in an ambulance ride, injuries or hospitalization — but it still brought forward the same fears from his family: Could the next fall be fatal?
Several experts stressed that now is the time to act in order to save hundreds of lives like Mark’s.
As Wisconsin’s population continues to age — the 65-and-older population in the state is projected to almost double over the next 25 years — Sherman said an ever-increasing number of seniors will be at risk of these alcohol-related falls, with many ending fatally.
“Given our alcohol environment and people’s tendency to drink more here, (the current number) shouldn’t be comforting,” Sherman said. “It should be a wake-up call that this is what’s happening and that number is likely to go higher.”
In 2010, Wisconsin’s 65-and-older population was 777,314, roughly 13 percent of the state’s total population. But there will be 1,535,365 people 65 years or older in the state by 2040. That will account for about 24 percent of the state’s entire population. In contrast, the number of people under the age of 64 is projected to stay roughly the same during that same time period.
This coming-of-senior-age period for baby boomers will naturally make the issue of alcohol-related fatal falls, and falls in general, an increasingly pressing issue, Pankratz said.
“The diseases and culture issues (for) the generation that’s at the top of the food chain become larger and larger as time passes,” Pankratz said. “I would imagine that by and large, baby boomers drink more than the greatest generation did, so they’re going to have a higher prevalence of these alcohol-related issues, including falls.”
There could be a difference of thousands of deaths depending on how the state deals with the problem throughout the next two decades.
If the per capita rate keeps increasing the same amount it has since 2010, the annual deaths would top 1,000 by around 2036. Even if the per capita rate stagnates, the total deaths each year will still keep climbing due to the growing senior population.
As of now, Jayme — who has worked with seniors at Hazelden — said it’s clear that “elders are not receiving the care that they need” to properly combat the emerging crisis.
“We’re losing a lot of great people, a lot of wisdom, who are still giving back to society,” Jayme said. “We’re not respecting our elders, we’re setting them aside.”
Peter Coutu is a senior at the University of Wisconsin-Madison majoring in journalism and history. He’s from Appleton.