From Medical Research by Michael K. Appedu and Bruno Bordoni 

What Is a Fall? 

A fall happens when a person ends up on the ground or floor without meaning to. This doesn’t include falls that happen because of major health problems like strokes or dangerous situations. 

Falls are one of the most common and serious problems that can cause disabilities, especially in older people. 

Why Do Falls Happen More as People Get Older? 

Walking normally requires many parts of your body to work together: your brain, muscles, balance, vision, hearing, and sense of where your body is in space. As people get older, these systems don’t work as well as they used to. 

Here are the main reasons older adults fall more often: 

1. Body changes with age: Older adults often walk with their feet farther apart, move more slowly, take shorter steps, and have weaker leg muscles. 

2. More health problems: The older you get, the more likely you are to have medical conditions that affect balance and movement. 

3. More medications: Older adults often take more medicines, and some of these can make falls more likely. 

Who Is Most Likely to Fall? 

Risk factors (things that make falls more likely) include: 

• Having fallen before 

• Problems with balance 

• Weak muscles 

• Vision problems 

• Taking more than four medications or certain types of medicine 

• Trouble walking 

• Feeling sad or depressed 

• Getting dizzy when standing up 

• Being over 80 years old 

• Being female 

• Having bladder control problems 

• Memory or thinking problems 

• Arthritis, diabetes, or chronic pain 

Important fact: The more risk factors you have, the more likely you are to fall. With no risk factors, only 8% of people fall in a year. With four risk factors, 78% of people fall! 

How Common Are Falls? 

• More than 30% of people over 65 fall every year 

• About half of these people fall more than once 

• For people 85 and older, about 40% fall each year 

• About 10% of falls cause serious injuries like broken bones or head injuries 

• Falls are the most common type of accident in people 65 and older 

What Causes Falls? 

Inside the body causes: 

• Sarcopenia: This is when muscles get smaller and weaker as people age 

• Brain problems: Memory issues or confusion can make falls more likely 

• Blood pressure drops: Some people’s blood pressure drops after eating, making them dizzy 

• Being overweight: Extra weight can make it harder to balance 

• Weak bones: Osteoporosis makes bones break more easily 

• Weak breathing muscles: When the diaphragm (main breathing muscle) gets weak, it can affect balance 

Outside the body causes: 

• Poor lighting 

• Uneven floors 

• Slippery surfaces 

• Missing steps 

• These environmental factors cause 30-50% of falls in older adults 

What Do Doctors Look For? 

When checking someone who has fallen, doctors ask about: 

• Previous falls: Have you fallen before? 

• Medications: What medicines do you take? 

• Health conditions: Do you have any diseases that might cause falls? 

• Living situation: Do you live alone? 

• Daily activities: Can you do things like bathing, dressing, and cooking by yourself? 

Physical exam includes: 

• Checking blood pressure when lying down and standing up 

• Looking at feet for problems 

• Testing vision and hearing 

• Checking muscle strength 

• Testing balance 

How Are Falls Prevented? 

Prevention works best when it addresses multiple causes at once. Here are proven ways to prevent falls: 

Single Approaches 

1. Home Safety Checks 

• Have someone (like an occupational therapist) look at your home for dangers 

• Remove tripping hazards 

• Add better lighting 

• Install grab bars in bathrooms 

2. Exercise Programs 

• Any type of exercise helps prevent falls 

• Tai Chi is especially good – it involves slow, flowing movements that improve balance 

• Balance exercises like walking heel-to-toe or standing on one foot 

• Strength training to keep muscles strong 

3. Medicine Reviews 

• Have a doctor or pharmacist check all your medications 

• Some medicines (especially sleeping pills, antidepressants, and anxiety medicines) increase fall risk 

• Stop unnecessary medications 

4. Vitamin D 

• Taking 700-1000 IU of Vitamin D daily can reduce falls by 19% 

• Vitamin D helps muscles and bones stay strong 

Multiple Approaches Work Best 

Research shows that combining several prevention methods works better than just doing one thing. The best programs include: 

• Home safety improvements 

• Exercise programs 

• Medication reviews 

• Vitamin D supplements 

• Treatment for vision problems like cataracts 

What Happens After a Fall? 

Falls can cause: 

• Broken bones (especially hips) 

• Head injuries 

• Bruises and cuts 

• Fear of falling again 

• Less independence 

• Moving to a nursing home 

• Depression 

• Death (in serious cases) 

Other Conditions That Look Like Falls 

Sometimes what looks like a fall is actually: 

• Fainting (syncope) – when you lose consciousness 

• Mini-stroke (TIA) 

• Seizure 

• Heart problems 

• Infections 

Doctors need to figure out if it was really just a fall or one of these other problems. 

How to Get Help 

If you’re worried about falling, talk to your doctor. A team of healthcare workers can help, including: 

• Doctors 

• Nurses 

• Physical therapists 

• Occupational therapists 

• Pharmacists 

They can do a Comprehensive Geriatric Assessment – a complete check-up that looks at all the things that might make you more likely to fall. 

Patient Education Tips 

To prevent falls, you should: 

• Do exercises at home to stay strong and improve balance 

• Make your home safer by removing tripping hazards 

• Eat a healthy diet with enough Vitamin D 

• Know what side effects your medicines might have 

• Have emergency contact numbers ready 

• Practice balance exercises regularly 

The Bottom Line 

Falls are serious but preventable. The key is to: 

1. Identify your risk factors 

2. Work with healthcare providers to address multiple causes 

3. Stay active and strong 

4. Make your home environment safer 

5. Review your medications regularly 

Remember: It’s never too late to start preventing falls! 

Original medical article: “Falls and Fall Prevention in Older Adults” by Michael K. Appeadu and Bruno Bordoni, last updated June 4, 2023.