Why do aging adults fall? To be honest, people don’t usually ask me this.
Instead, they want to know things like “How do I keep my mother from falling?” or “What should I do? My grandfather’s been falling.”
After all, falls are a scary thing. Most people know that falls are dangerous for older adults.
The Center for Disease Control (CDC) reports that one in five falls causes a serious injury such as a broken bone or head injury. Fear of falling can also seriously affect an aging adult’s quality of life and sadly, can keep a person from being active and thriving.
So, many older adults and family caregivers are interested in fall prevention because the risks are so great. (According to Google, “balance exercises for seniors” is a popular search query; I do like balance exercises in aging, especially when combined with strength training and other exercises.)
And the good news is that although it’s not possible to prevent all falls, it almost always IS possible to take actions that will reduce the chance of a bad fall.
And it’s easier to take action once we understand more about why an older person has fallen.
If you want to learn more, you’re in the right place. In this article, I’ll cover:
- How understanding why aging adults fall can help you keep an older parent — or yourself — safer,
- Why personalized fall prevention plans work better than relying on general fall prevention tips,
- The four-step process I use to help older adults prevent falls,
- A practical example showing you how to use these steps to avoid falls yourself.
First, understand why older people fall
There are many reasons that aging adults fall. Most older people will be falling due to their own unique combination of reasons.
So how, exactly, should YOU go about reducing fall risk?
Now, you can — and should — try to implement the general tips that are often listed in most fall prevention resources: exercise, medication review with the doctor, vision checks, and home safety reviews.
But if you really want to help an older loved one avoid falls, I recommend you learn to better understand why he or she, in particular, might fall.
Why? Because when you understand the specific reasons an older person may be falling, you’ll then be able to:
- Identify which fall prevention strategies are most likely to help the person you worry about,
- Recognize risky situations, and take steps to avoid them,
- Know which medical conditions — and which medications — to ask your doctors to look into,
- Understand what may have caused a specific fall, which can help you avoid future falls.
In other words, learning why older people fall means that you’ll be able to figure out why YOUR older relative is likely to fall — and take steps to help them.
Why personalized fall prevention works better than general fall prevention
Once you understand the particular factors contributing to your older loved one’s risk, it will be easier to focus on the fall prevention strategies that are most relevant to your situation. In other words, you’ll be able to personalize your approach to fall prevention.
Personalizing fall prevention is critical. You don’t want your mom to start by spending a lot of time on tai chi or some form of balance exercise for seniors, if her current major risk for falls might be that her blood pressure medications are too strong, or her eyesight is terrible.
Also, don’t assume that most doctors will identify and manage the most important risk factors for falls. In my experience, busy doctors often miss opportunities to reduce fall risk, unless a family is proactive in asking for the right kind of help.
Now that we’ve covered how understanding falls can help you, let’s talk about falls. First, I’ll explain why any fall happens. Then I’ll share my framework for understanding why a particular older person might fall.
Why a fall happens
Why does a fall happen? Fundamentally, no matter who you are and what age you are, here’s why:
Challenge to balance or strength > Ability to stay upright”
In other words, we fall when we experience some kind of event that challenges our balance or strength. If this event overwhelms our ability to remain upright, down we go.
When we’re young and healthy, we tend to have lots of ability to stay upright. So if we stumble, we can often catch ourselves and recover before we fall. But of course, a big enough knock off-balance will send even a 20-year-old sprawling. And if that 20-year-old happens to be tipsy, it will take even less of a trigger to provoke a fall.
Illness or weakness is another situation that will reduce anyone’s ability to stay upright. (This is why people of all ages are prone to fall in the hospital.) But of course, older adults often have many other things going on which affect their ability to stay on their feet.
4 Steps to Reduce Fall Risk
Falls in older people are almost always “multifactorial.” This means there are usually several factors that are contributing to a fall, or to a person’s fall risk.
It can be hard to try to address every single factor. And some, such as slower reflexes, may be impossible to reverse.
Still, it’s often useful to go through them and try to spot a few that are either easy to fix, or potentially offer a big reduction in fall risk.
As a geriatrician, here’s what I do:
- Create a list of factors contributing to an individual older person’s fall risk.
- Identify risk factors and triggers related to recent or recurrent falls.
- Identify the factors that are easiest to modify or change. This is partly about the factor itself, and partly about what’s feasible for my patient to try to change. (Stairs can be a risk, but changing houses can be tricky.)
- Implement practical strategies to address modifiable fall risk factors.
3 types of fall risk factors you should consider
I also find it helpful to think of the factors as belonging to one of three categories:
- Health-based risks. This includes things like balance problems, weakness, chronic illnesses, vision problems, and medication side-effects. They are specific to an individual person.
- Environmental risks. These are things like home hazards (e.g. loose throw rugs), outside hazards (e.g. icy sidewalks), or risky footwear (e.g. high heels). This category can also include improper use of a walker, cane, or other assistive device.
- Triggers: These are the sudden or occasional events that cause a challenge to balance or strength. They can be things like a strong dog pulling on a leash, or even health-related events like a moment of low blood sugar (hypoglycemia) in a person with diabetes.
Now, you will probably find it hard to make a list of all these factors on your own. The health-based factors, in particular, tend to be closely related to medical problems. So they can be hard to properly sort out unless you’ve learned a lot about medicine.
Still, I encourage older adults and family caregivers to learn to think about fall risk factors, since this can help people get better at asking their doctors the right questions.
It’s also a good idea to ask lots of questions after a fall. You can learn more about what to ask here: 8 Things to Have the Doctor Check After an Aging Person Falls.
Example: Why is Mr. Jones falling?
Let’s consider an example together, to illustrate how you can put this understanding to work.
Mr. Jones is 82 years old. He lives at home with his wife, and takes a daily walk in his neighborhood. He has had diabetes for a long time, and has chronic numbness in his feet. He is on medication for diabetes, high blood pressure, and also uses Tylenol PM.
His daughter Wendy subscribes to a newsletter about elder care, and she recently read the CDC’s fact sheet on how important fall prevention is. Her father has had a few falls, which has made Wendy concerned. She would like to keep her father from falling.
What should Wendy do? As I mentioned earlier, the usual recommendations to lower fall risk are a good place to start. So Wendy could encourage her father to remain physically active and do balance exercises, and she might want to take a closer look at the house to remove common trip hazards.
She might also want to help him get evaluated for vision problems and for low leg strength, since these are common fall risk factors among people Mr. Jones’ age. Furthermore, diabetes can cause or worsen vision problems.
But if Wendy wants to personalize the fall prevention plan, she should also consider asking the doctor to help make a list of Mr. Jones’ health-based risk factors.
In Mr. Jones’ case, some additional factors that jump out at me are:
- Chronic numbness in feet. This is a common problem in people who have had diabetes for a long time, and it can definitely affect how easily people stay on their feet.
- It’s good to be aware of this risk, however, this problem usually can’t be cured or reversed.
- Diabetes. Some people with diabetes are prone to episodes of low blood sugar (hypoglycemia), especially if they take insulin or other drugs to actively lower blood sugar.
- Wendy could ask her father if he ever has low blood sugar episodes, which could trigger a fall. If he does, she should make sure this is addressed with the doctor.
- It is often appropriate to relax blood sugar control as people become older and frailer. This is because as people age, tight control brings fewer benefits but more risks.
- Blood pressure medication. This could increase fall risk, especially if Mr. Jones’ blood pressure is often below 120/80.
- Wendy may want to take steps to make sure her father isn’t being over-treated for high blood pressure.
- Tylenol PM. Any over-the-counter medication labeled “PM” contains a sedative, usually in the form of an antihistamine such as diphenhydramine (brand name Benadryl). Older adults are often sensitive to these drugs, which can worsen balance or even thinking.
- Wendy should help her father review his medications. She should focus on spotting sedatives or any other medications with strong “anticholinergic” effects, such as a medication for overactive bladder. (For a link to a good list of anticholinergic drugs to avoid, see this post.) All sedating or anticholinergic drugs increase fall risk, but doctors may forget to avoid or minimize them unless a family specifically requests this.
You may have noticed that in this example, I’ve particularly focused on medications.
That’s for three key reasons:
- Medications are among the most common causes of increased fall risk in older people.
- Medications are often a fixable risk factor, when it comes to falls in older adults.
- Medication-based risks are often missed by busy regular doctors. Family caregivers can make a big difference by being proactive in this area.
If you’re concerned that you or your older relative might be on medications that are increasing your fall risk, see this article: 10 Types of Medications to Review if You’re Concerned About Falling.
You can also learn more about how to prevent injuries from a fall here: 3 Ways to Prevent Injury From a Fall (Plus 3 Ways That Don’t Work as Well as You’d Think)
Take the next step: create a personalized fall prevention plan
Remember, older adults usually fall because a) multiple risk factors make them vulnerable to falling, and b) a stumble or moment of weakness triggers the actual fall.
Most fall risk factors are health-based, and are related to chronic medical conditions or medications. And then some fall risk factors are environmental, and involve the home or outside environment.
You can definitely reduce fall risk by encouraging strength and balance exercises, and by optimizing the home environment. (Learn more about good strength and balance exercises here: Videos Illustrating Otago Exercises for Fall Prevention.)
But you’ll be most effective in preventing falls if you can get your doctors to help you understand your loved one’s personal fall risk factors.
This way, you’ll be able to develop a more personalized fall prevention plan…one that targets the risks and vulnerabilities most relevant to your situation.
[This article was last updated by Dr. Kernisan in March 2024.]
Murray Ward says
My 69 yr old father has been falling recently from his legs being suddenly weak. The doctor says he may get weaker during hot weather?? Does that make sense?
He has diabetes although his levels are where they should be. He has no apparent neuropathy, no nerve damage in his feet or legs. Bloodwork came back fine but he still has falling episodes.
He does have heart disease as well. His heart was checked out and said to be doing well. Blood pressure is a bit off, usually 110/60?? The second number is always lower than it should be.
He is also having anxiety attacks where he breaks down and cries for no reason. Trouble sleeping-staying asleep and sleeps with very odd dreams.
Do you perhaps have any guidance please?
Leslie Kernisan, MD MPH says
Hm. Well, if he is having falls, he needs a detailed evaluation to identify as many risk factors and contributors as possible.
Getting weaker during hot weather is sometimes related to mild dehydration. I have more on dehydration here: How to Prevent, Detect, & Treat Dehydration in Aging Adults
It might also be a good idea to ask your health providers to check your father’s blood pressure sitting and standing, to see if he’s experiencing a drop. (This can be made worse during hot weather or dehydration, too). You might also want to discuss what his goal blood pressure should be; if he’s having falls, it might be reasonable to consider a goal blood pressure in the 130s to 140s. A systolic BP (the top number) of 110 sounds a bit low to me for someone who is having falls and weakness.
I would also recommend bringing up his anxiety attacks and your other concerns with his usual doctors. Be careful about treating anxiety with medication, as most anti-anxiety medication does worsen balance. Good luck!
Anne Tobey says
because of recent falls I have had with no apparent reason, I am wondering if Tai Chi or Yoga would be good for improving balance.
I am very healthy; I do have hearing impairment and am deaf in the left ear.
I also tend to fall on my left side.
I do have good hearing aids and do wear them.
Thanks for replying.
I appreciate all your advice on aging etc.
Anne
Leslie Kernisan, MD MPH says
Sorry to hear of your recent falls. I think either Tai Chi or yoga could help, but Tai Chi has a more substantial track record in clinical studies, in part because the movements are more standardized whereas there are many different types of yoga.
I discuss different types of exercise for fall prevention in this podcast episode with Tiffany Shubert, a physical therapist and expert on fall prevention: 052 – Maintaining Mobility & Preventing Falls in Aging: Myths & Truths.
I would also recommend discussing your recent falls with your health provider, so that they can assess you for issues that might be contributing to your falls. You might also benefit from exercises that strengthen the body, especially the legs. Good luck and take care!
Brian says
My wife is 48 and is getting her second knee replacement soon. She generally walks fine, but twice in the last 6 months, she has stumbled on uneven sidewalks and fallen down. Both times I was holding her hand, but when she started to go down, I held on, but I couldn’t keep it from happening.
When she wore a gait belt after her last knee replacement, I was able to keep her from falling, but she’s not going to wear a gait belt forever. I’m strong enough to keep her from falling, if I knew how to do it.
Any advice?
Leslie Kernisan, MD MPH says
Honestly, I don’t know much about how to hold up a person who is falling. I would recommend talking to a physical therapist as they have experience doing this and also they will be able to advise you as to how to protect your own body while doing it.
I would also encourage you to talk to your wife’s doctor about why she is falling, especially if you think the falls may continue. Good luck!
Beverly Hill says
I recently started falling. One time was in front of a group of people. The best advice I received was from someone in the group. She said a doctor had told her that older people don’t tend to pick up their feet when they walk. (My rubber soled shoe had just just scraped the rubber tiled floor when I fell and was thrown forward.). This advice has stayed with me and has made a big difference.
Leslie Kernisan, MD MPH says
Thanks for sharing your story. Yes, it’s true that some older adults seem to pick up their feet less. A physical therapy evaluation can help assess an older person’s walking pattern, to see if this is the case. Physical therapists are also able to assess balance and leg strength; many older adults at high risk for falls benefit from doing exercises that improve balance and leg strength. Good luck preventing future falls.
Susan says
My mother kept falling over a period of 3 years. Head-hitting falls from a standing position, usually as she was cooking/preparing food. She had many things that could cause it (anemia, diabetes, recurrent UTI, and BP meds). The doctor worked on each thing, adjusted BP meds, and she responded well and was only falling once every 3 or 4 months, vice several times a month as in the beginning. Her doctor asked if it looked like a seizure. It didn’t. But that’s what it was. Mini-seizures caused by a mini-stroke that damaged part of her brain. We didn’t even know she had a stroke. Unfortunately, we found this out as she was recovering from a broken hip. Then she fell again before the hip was healed and didn’t recover that time. We didn’t know this was a possibility, so I’m posting for others’ awareness.
Leslie Kernisan, MD MPH says
Thank you for sharing your story. So sorry to hear that your mother eventually didn’t recover from a fall.
Seizures are indeed possible but they can be very hard to diagnose if a person doesn’t have obvious seizure activity. Actually, since we don’t routinely check for seizures when people fall, we probably don’t really know how common it is…it’s presumed to be uncommon, but if we did EEGs on every older person who falls, who knows what we might find. Here is a related article
Fall related to epileptic seizures in the elderly
Kate Boyela says
Thank you very much for your article. Do you know of any research regarding Alka Seltzer addiction/fall risk? It jumps out at me as potentially problematic when I read your article. Thanks so much.
Leslie Kernisan, MD MPH says
No, I don’t think Alka Seltzer and fall risk have been studied. Alka-seltzer contains aspirin, so I suppose a heavy Alka Seltzer user would be at risk for side-effects and adverse events associated with aspirin, such as developing bleeding somewhere in the bowel.
This could cause anemia, which can increase fall risk. Alka-seltzer can also interact with a variety of medications, which could be problematic and depending on the interaction, increase fall risk. Really, Alka-seltzer is not meant to be taken more than occasionally, as far as I know, so if you or someone in your family is using it more than occasionally, I would certainly recommend discussing it with your healthcare providers.
Bradenly says
what is your opinion about the sign of falling risk in hospital. do we have to tag on to every older people?
thank you
Leslie Kernisan, MD MPH says
Sounds like you are referring to some of the fall prevention initiatives going on in hospitals. In many hospitals, they have attempted to reduce falls by identifying people at higher fall risk.
It’s not clear to me if this is in of itself effective, since most older adults end up qualifying as being at high-risk. If nothing else, when they are in the hospital is when they are sicker and weaker than usual.
Most hospital-based fall prevention initiatives involve multiple components, so it’s hard to know what is the effect of “tagging” at-risk people in particular.
Hospital Fall Prevention: A Systematic Review of Implementation, Components, Adherence, and Effectiveness
Angela says
yesterday during the afternoon period, my mum told me that she fall, when she was trying to sweep her shop and she is 52year old, please what can be the cause of this?…
Leslie Kernisan, MD MPH says
There are many many reasons that a person can fall. I explain the most common things that doctors check for in this article:
8 Things
A careful evaluation can usually determine why the person fell, and what other risk factors they might have for falling. I would highly recommend you have your mother see a health professional for further evaluation. Good luck!
Victoria Young says
My husband’s aunt 95yo lives with us. She has starting falling occasionally. It is usually related to her not wanting to use her walker. She also refuses to leave her door open while she is in her room. She has Dementia and advance stage Alzheimer. Short of removing her door or putting cameras in her room, what are my options? She is on medications but they are anti-depressant/anti-psychotics (sp) to regulate her mood swings. Otherwise, she is prone to violence if she doesn’t get her way and trying to leave the house (3 incidents prior to medications, 2 since) I had teeth marks from her biting me when I prevented her from leaving. She also spends much of her time talking to her dead sister and brother.
Leslie Kernisan, MD MPH says
Well, if she is still able to walk, argue about whether the door should be open, and attempt to leave the house, I would say she’s moderate stage or perhaps in the moderate-severe stage. This can be when behavior is the most difficult to manage, because the person is still physically able to do quite a lot.
You generally can’t “reason” with someone with Alzheimer’s, to get them to change their behavior or feelings, but sometimes the right approach to fibbing can work. There’s no exact right answer: you could remove the door and tell her it was taken away for repair, or you could try cameras. For other suggestions, I recommend relaying your situation in an online support group; there’s a very active one at AgingCare.com.
In terms of getting her to use the walker or accept supervision: she will likely continue to either forget or decline to use her walker, unless you are there to coax/encourage her (and even then you might have difficulty, if she’s the kind to get angry and bite when frustrated). Some families change the bed to a mattress on the floor, so that the person can’t get out of bed alone, but this can seem restrictive to those with moderate dementia. Some families use cameras but you will still need some type of alert to know when she’s starting to move about in a way that might be unsafe. Families have used bed alarms and motion sensors. None of these have been rigorously studied to my knowledge. Again, a support group is a good place to get practical suggestions.
Otherwise, in terms of reducing fall risk:
– antidepressants and antipsychotics both increase fall risk. You may want to look into whether there might be other ways to manage her difficult behaviors. Sometimes treating pain or constipation helps an older person with dementia become less reactive. I have more on this here: 5 Types of Medication Used to Treat Difficult Dementia Behaviors
– She might benefit from strength or balance exercises, but it can be hard to get a person with dementia to do exercises regularly.
– If the falls are a newer problem, or seem to be getting worse, consider having her checked for other medical problems that might be increasing fall risk. I explain what doctors often check for here: 8 Things to Have the Doctor Check After an Aging Person Falls
I’m sorry she’s giving you such a hard time…she’s very lucky to have family taking care of her but it sounds like she may not be very appreciative. Good luck and take care!
Chris says
My father is 96 and has fallen several times recently while doing yard work, to include a face plant using a leaf blower in a tight space. He fell on the running leafblower. I found him unresponsive. He awoke and took charge of his own recovery (he’s a control freak) and would not allow me to call 911, even though he sustained a gash in his forehead that was bleeding and was in a narrow space. He still drives. He is secretive about his health issues. I want to discover who is PCP is and consult about my father’s falling history and driving. His reasoning ability is declining, he’s frail and very difficult to deal with. He says he falls due to a leg giving out or losing his equilibtium. Should he be driving? Thanks for your help.
Leslie Kernisan, MD MPH says
Oh wow, that is a tough situation. Hmm. If he is 96 and you’ve noticed declines in his reasoning abilities, it’s certainly possible that it’s unsafe for him to drive. The ideal would be for him to be evaluated, and for him to let a family member accompany him. But sounds like he’s likely to resist that.
Particular issues you raise:
– Why is he falling? What could be done to reduce or prevent his falls? For this, he needs a good evaluation for falls.
– What can you do if he falls, might be hurt, but refuses 911? Well, you can still call over his objections, you will just have to weigh whether the likely benefits outweigh the stress this puts on your relationship with him (he will be mad at you).
You should also carefully consider whether his reasoning and thinking might be so impaired that he no longer has capacity to make the decision; I have more on decision-making capacity here:
Incompetence & Losing Capacity: Answers to 7 FAQs
– If you aren’t sure who his PCP is: you would have to sleuth around on your own. Otherwise, I’m not sure you can find out without a court getting involved. An elderlaw attorney would be able to advise you of your options. If you do find out who his doctor is, you can learn more about what the doctor is allowed to tell you here: 10 Things to Know About HIPAA & Access to a Relative’s Health Information. There are actually circumstances under which doctors can reveal information to family even if the older patient doesn’t give permission, or objects. HIPAA also doesn’t prevent you from relaying your concerns to a person’s doctor, which you can do without anyone’s permission. (Although again, you have to consider the impact this could have on your relationship with your dad.)
– If you are truly worried about his safety and wellbeing, you can call Adult Protective Services. Your local Area Agency on Aging can help direct you. Your state may also have a mechanism for you to report a potentially unsafe older driver.
Still another option is to hire a professional to help you talk with your father, such as an aging life care professional (formerly known as geriatric care managers), or other expert with experience helping people in your situation. This does cost money, but it can be a very worthwhile investment if you find a good person to work with.
In short, there’s no easy answer for your situation. I do cover some additional ways to communicate with resistant older parents in these two articles:
QA: Helping a Paranoid Older Parent and Checking Safety
4 Things to Do When an Older Person Resists Help
Good luck!