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.]
Naveen Chandra Narayana says
Greetings from India!!
My father is 82 who is suffering from Diabetes and takes insulin twice a day falls a lot due to imbalance. He falls specially while getting up from a chair/ toilet seat and stool which he uses in bathroom while taking bath. While walking also he tends to go fast in the forward motion and if someone is not holding him for sure he will fall. Last year in Jan we go physiotherapy done and he was able to balance better. But off lately his falling down has increased and last month we had to rush him to ER after a bad fall. Luckily nothing happened to him. We got CT scan and all done.
What will you recommend we can do to reduce his falls. I’m trying my best to make sure he is active and I take him for walks in the morning,
I will be obliged and will really appreciate if you can guide me.
Thanks and Regards
Nicole Didyk, MD says
I’m sorry to hear that your father is having falls and balance problems. Usually, the cause of falls is multifactorial, that is there are many contributing factors. For example, diabetes can cause nerve damage in the feet which affects balance, but medications, prior strokes and other medical conditions can affect balance too.
When I hear about people walking quickly and pitching forward, I think of festination. This is a pattern of walking that can happen with Parkinson’s disease. The person walks forward, getting faster and more unsteady as they go. Here’s a video of festination: https://youtu.be/-oJM2wUUjws
You don’t mention if your dad has a gait aid but a four wheeled walker can provide a lot of stability and help prevent falls. A physiotherapist should be able to tell you if a walker would help your father.
Carrie Sorensen says
I am getting a lot of great information from your articles. My Dad is 77 with type 2 diabetes and high blood pressure, taking medication for both. He recently started losing his balance and falling. Never dizzy or numbness just balance issues it seems. Last fall landed him in the hospital and now in a rehabilitation facility. When he first got to the hospital his glucose was 335 next day it was 295. Brain scans read this:
There are areas of bilateral calcification.There are areas of cerebral white matter low attentuation bilaterally non specific Most likely representing a combination of chronic microangiopathic Ischemic changes and age related changes. I’m not sure what all this means and how to help him. He was always active and then suddenly just declined. Any input would be greatly appreciated!
Nicole Didyk, MD says
I’m sorry to hear about your dad’s balance issues and I hope he does well at rehab. I’m glad you find the articles helpful!
Dr. K has some excellent articles about the kind of changes you describe. It has various names including: white matter change, small vessel disease and microangiopathic change. Check out this post: https://betterhealthwhileaging.net/cerebral-small-vessel-disease/, and this podcast: https://betterhealthwhileaging.net/podcast/bhwa/about-cerebral-small-vessel-disease-in-aging/
Michael Papworth says
I might be wrong here.
I run exercise classes for Older Active Adults. Many of my exercises are designed to promote agility … the ability to move rapidly in any direction. When a person stumbles, their centre of mass lies outside their base. The only way to prevent a stumble from turning into a fall is to extend the base with sufficient force to arrest the momentum.
I, therefore, practice long strides forwards and backwards and rapid sideways movements (as in the line dancers’ weave) to aid in arresting a stumble. We also practice knee lifts to reduce the chance of stumbling when going upstairs. (You can’t recover from a stumble on stairs unless you have a good strong grip on the bannister rail — so I work on grip strength as well.)
I keep on stressing agility as an essential component of fitness for older folks. I even use an agility ladder and slalom walk exercises outdoors when the weather is not too bad.
I also take issue with your ideas on reaction time. It can be improved with deliberate practice … not by much, I will admit. But anything is better than nothing.
I take my classes very seriously. I can help older folks stay more active for longer. My ambition is to die when I’m strong and healthy. I’m determined to march into my grave, not shuffle into it.
Nicole Didyk, MD says
It sounds like you’re really committed to promoting fitness for older adults – thank you for the work you do!
Agility training as you describe could definitely help with strength and balance, and probably gives a good cardiovascular workout as well.
I found this article about agility, which indicates the need for more research in its role in falls prevention in older adults: https://link.springer.com/article/10.1007%2Fs40279-015-0389-5
Linda ayotte says
I have Parkinson’s PSP and l fall backward a lot I’m getting scared to get up what is the best thing for me
Nicole Didyk, MD says
Progressive Supranuclear Palsy is a Parkinson’s-related condition. Some of the symptoms are the same as in Parkinson’s, but people with PSP are more likely to have falls. Falling backward is a common pattern.
For some, levodopa can help (this medication is used in Parkinson’s disease), but often its effects are not very strong. I recommend physical therapy and exercise, as well as an environmental assessment to ensure that the person is using the right gait aid (cane or walker) and has removed any tripping hazards from the home.
There are PSP support groups that may have be useful for you. You’re not alone in living with PSP or Parkinson’s.
San says
What would be the most appropriate course of action for older people fall who had problem with eyesight
Nicole Didyk, MD says
Visual impairment is definitely a risk factor for falls, and I usually work with my colleagues in optometry to screen for and correct any visual impairment that can be treated with lenses or adaptive aids.
Some causes of visual impairment need the attention of an ophthalmologist, which requires a doctor’s referral.
Many regions have agencies that are dedicated to promoting healthy living for persons with visual impairment, and they would be good to try to find and contact, to learn what local resources are available. In Canada, we have the Canadian Institute for the Blind (CNIB) and in Australia, it’s Vision Australia.
Bronwen King says
I have found your article most informative and has helped me address my problem by trying to accept the my imbalance is due to the inevitable aging process. For me, now I have a better understanding of my increased imbalance comes greater depression. They say walking is one of the best forms of exercise but wobbling around like a drunken sailor is not only embarrassing, it tends to increase the chances of a fall. The big Catch 22. I have recovered very well from a pontine stroke and now take x-ralto. I also take aspirin – is this a good idea? I am 76 and female.
Thank you for reading this.
Leslie Kernisan, MD MPH says
Glad the article was helpful.
Xarelto is one of the newer blood thinners that has replaced warfarin. Aspirin is also used to prevent strokes; it doesn’t thin the blood the same way, but does reduce the risk of a clot. Both types of medication increase one’s risk of accidental bleeding.
Being on both a blood thinner and aspirin is occasionally recommended, but often the likely benefit of being on both (as opposed to just the blood thinner) doesn’t warrant the extra bleeding risk you have when you take both types of medication at the same time. And frequent falls are a risk for bleeding, because you can hit your head or otherwise provoke a bleed.
So, for anyone on both a blood thinner and aspirin, I generally recommend asking your doctors to explain why it’s absolutely necessary to be on both. In many cases, it’s possible to stop one of them.
I would also recommend balance and strength exercises, which can help reduce fall risk. Your wobbling sounds like it’s due to more than just aging but either way, balance exercises usually help.
Good luck!
GC Johnson says
On the looking down versus forward issue – I look around, the floor, furniture, etc. before moving, note any obstacles and take whatever action is needed to remove or avoid hazards. Then I look forward and move with confidence that I know what is or isn’t a risk factor for falls. Never do I hurry. The few seconds it takes to be aware of your environment is much better spent than falling and having to recover.
Leslie Kernisan, MD MPH says
Those are good ideas. Thank you for sharing them!
Elles Fredrix says
I am a physiotherapist in Europe and i am telling my older clients to look forward instead of down at the floor while walking. I am tought this is the right way to walk and it will prevent falling. But most older clients tell me they feel safer looking down, because they can see when the floor is uneven or a curb is comming. Most of the time they have glasses and vision is good enough.
I wonder if the risk of falling is bigger when looking down (change in postur) or when looking forward.
I have tried to find articles on this matter, i have not found one.
Will you share your expertise in this matter?
Leslie Kernisan, MD MPH says
Thanks for this question. I’m not aware of any research that answers this question. I think looking up and forward seems better for posture and body mechanics, but I understand why older adults may be looking down.
Ultimately I think the important question is what is feasible for the older adult. You can encourage them to look forward, but if they find it very difficult…it may be better to devote your energy and theirs to getting them to change something else…like doing their exercises to improve balance.
shreya Das says
Hi My father had a cerebral stroke on November 2018. He is now 69 years old. now he is diagnosed with Pixel disease and alpha synuclein dementia. He is taking Amlodipine 2.5 mg, clopidogerl 75 mg, escitalopram 5 mg and bupropion HCl sustained-release tablet 300 mg. He is a diabetic patient taking mixtard 70/30.
Now a days tendency of falling has been increased. Please suggest how we can overcome the tendency of fall.
Leslie Kernisan, MD MPH says
Sorry for delayed reply, we had a glitch in our system that we have just resolved.
Your father sounds like he has many health problems and risk factors that contribute to falls. Dementia affects balance and gait. Diabetes drugs can make blood sugar low, which can cause falls, and also long-standing diabetes can affect nerve function.
To reduce his falls, you would need to work closely with a health provider to identify all his fall risk factors and then to modify those that you can. You can’t reverse his dementia but you can adjust medications. He may or may not be able to participate in balance and strength exercises. Physical therapy can also help identify a suitable walker or other assistive device. Good luck!
Janet Scarsdale says
My doctor prescribed a wheelchair a couple of years ago because of problems with my knees and back, but I think it’s made things worse. I’ve lost muscle tone and have become weak. I’m now going against his and my other doctors’ advice to take it easy and except that I’ll just get worse as I age and nothing can be done.
They want me to just give up, but instead I’m exercising everyday and eating very healthy. It’s not only to keep weight under control, but to build muscle, increase energy, and aid in balance to mitigate falls.
I think they mean well and I still have to use the chair for large distances, but I think it’s actually a deterrent to my health.
I’ve asked most of my doctors for physical therapy to help me stop falling and although they’ll send me for back pain therapy, they won’t do it for falls for some reason.
Since I can’t get professional help, I’m doing leg lifts in bed, arm exercises, and contracting stomach muscles. In other words, I’m modifying exercises I learned in the military and elsewhere to work with my disability. There’s already a difference.
Why do doctors take the easy way out instead of being our partners in recovery?
Leslie Kernisan, MD MPH says
Thanks for sharing your story. So sorry to hear that your health providers aren’t providing you with the support and referrals that sound needed. I think many doctors just haven’t had sufficient training in falls, and in leveraging exercise and other lifestyle methods for recovery.
You may want to keep asking them for physical therapy for gait and balance issues, as it seems to me it’s reasonable given what you describe. Sometimes persistence and being the “squeaky wheel” is necessary. good luck!