Most falls occur when older adults with one or more physical conditions that impair mobility or balance encounter an environmental hazard.
Many people have no symptoms before a fall, but some feel dizzy or have other symptoms.
After a fall, people may have broken bones or bruises.
Doctors often do tests to evaluate whether an underlying condition contributed to the fall.
Falls around the home may often be prevented by taking precautions.
After injuries are treated, people work with physical therapists to help reduce the risk of subsequent falls.
Falls are common among older adults. In the United States, about one in four people age 65 or over report falling each year. resulting in a total of about 36 million falls each year, according to the Centers for Disease Control and Prevention (CDC).
A person who has had a fall is more likely to fall again.
Not all falls result in an injury. However, more than one third of people who fall report an injury that required medical treatment or that restricted their activity for at least a day. That translates into an estimated 8 million fall injuries each year. About 20% of falls cause a serious injury such as fractures (including a broken hip Hip Fractures Hip fractures may occur in the round upper end (head) of the thighbone, in the narrow part of the thighbone just below the head (neck), or in the bumps in the broader area just below the neck... read more ) or a head injury. Older adults are more likely to break bones in falls because many older adults have porous, fragile bones (a condition called osteoporosis Osteoporosis Osteoporosis is a condition in which a decrease in the density of bones weakens the bones, making breaks (fractures) likely. Aging, estrogen deficiency, low vitamin D or calcium intake, and... read more ). Some injuries caused by a fall are fatal.
Many older adults fear falling. Fear of falling can lead to problems. People may worry about doing their usual activities and thus lose their self-confidence and even their independence. Older adults can do many things to help overcome their fears and to reduce their risk of falling. Knowing what causes falls can help.
Many older adults are reluctant to report a fall because they mistakenly think falling is a normal part of growing older. Or they fear that their activities will be restricted or they will be institutionalized. However, people should report falls to their health care practitioner, even if the practitioner does not ask because their health care practitioner can suggest ways to help them prevent future falls.
Did You Know...
Causes of Falls
Most falls occur when several factors interact. Factors include
Physical conditions that impair mobility or balance
Use of certain medications
Hazards in the environment
Potentially hazardous situations
For example, people with Parkinson disease Parkinson Disease (PD) Parkinson disease is a slowly progressive degenerative disorder of specific areas of the brain. It is characterized by tremor when muscles are at rest (resting tremor), increased muscle tone... read more and impaired vision (physical conditions that impair mobility or balance) may trip on an extension cord (an environmental hazard) while rushing to answer the telephone (a potentially hazardous situation).
A person's physical condition is affected by changes due to aging itself, physical fitness, disorders present, and medications used. The physical condition probably has a greater effect on the risk of falling than do environmental hazards and hazardous situations. Not only does a poor or impaired physical condition increase the risk of falls, but it also affects how people respond to hazards and hazardous situations.
Physical conditions that increase the risk of falling include impairments in the following:
Balance or walking
Sensation, particularly in the feet
Blood pressure or heartbeat
For example, loss of muscle strength may prevent older adults from maintaining or recovering balance when they step on an uneven surface or are bumped. With aging, people become less able to judge where objects are in relation to each other and may need brighter light to see well. Cognitive impairment may prevent older adults from remembering to take safety measures when walking—for example, to hold onto the railing when going up and down stairs. Low blood pressure or a slow heartbeat can cause dizziness fainting, or loss of consciousness. The reason is that heart problems can reduce the amount of blood reaching the brain.
Use of certain medications can also increase the risk of falling. These medications include those that affect attention (such as opioid analgesics, antianxiety medications, and some antidepressants) or lower blood pressure (such as antihypertensives, diuretics, and some heart medications).
Hazards in the environment are involved in many falls. Falls may occur when people do not notice a hazard or do not respond quickly enough after a hazard is noticed.
Environmental hazards that increase the risk of falling include
Electrical or extension cords or objects that are in the way of walking
Uneven sidewalks and broken curbs
Most falls occur indoors. Some happen while people are standing still. But most occur while people are moving—getting in or out of bed or a chair, getting on or off a toilet seat, walking, or going up or down stairs. While moving, people may stumble or trip, or balance may be lost. Any movement can be hazardous. But if people are rushing or if their attention is divided, movement becomes even more hazardous. For example, rushing to the bathroom (especially at night when not fully awake or when lighting may be poor) or to answer the telephone or walking while talking on a cordless phone can make walking more hazardous.
Symptoms of Falls
Often before falling, people have no symptoms. When an environmental hazard or a hazardous situation results in a fall, there is little or no warning. However, if a fall is partly or completely due to a person’s physical condition, symptoms may be noticed before falling. Symptoms may include
After a fall, injuries are common and tend to be more severe as people age. Over half of all falls result in at least a slight injury, such as a bruise, sprained ligament, or strained muscle. More serious injuries include broken bones, torn ligaments, deep cuts, and damage to organs such as a kidney or the liver. About 2% of falls result in a broken hip. Other bones (in the upper arm, wrist, and pelvis) are broken in about 5% of falls. Some falls result in loss of consciousness or a head injury Overview of Head Injuries Head injuries that involve the brain are particularly concerning. Common causes of head injuries include falls, motor vehicle crashes, assaults, and mishaps during sports and recreational activities... read more .
Falls can cause even more problems if people cannot get up right away or summon help. Such a situation may be frightening and may make people feel helpless. Remaining on the floor, even for a few hours, can lead to problems such as
Rhabdomyolysis Rhabdomyolysis Rhabdomyolysis occurs when muscle fibers damaged by disease, injury, or toxic substances break down and release their contents into the bloodstream. Severe disease can cause acute kidney injury... read more (muscle breakdown that can lead to kidney damage or failure)
The effects of a fall may last a long time. About half of people who could walk before they fell and broke a hip cannot walk as well afterward, even after treatment and rehabilitation. People who have fallen may develop a fear of falling that robs them of their self-confidence. As a result, they may stay at home and give up activities, such as shopping, visiting friends, and cleaning. When people become less active, joints can become stiff and muscles can become weak. Stiff joints and weak muscles can further increase the risk of falling and make remaining active and independent more difficult. For many people, falls seem to be an important factor in their decision to move to a nursing home Nursing Homes Nursing homes are for people who need help with health care for chronic conditions but do not need to be hospitalized. The decision to move to a nursing home may be triggered by a change in... read more or an assisted-living facility Assisted–Living Communities Assisted-living communities are designed for people who need some help with daily activities (for example, with bathing, dressing, or taking their medications as prescribed). These communities... read more . For all these reasons, falls can greatly reduce quality of life.
Some falls can be serious and result in death. Death may occur immediately—for example, when the head hits a hard surface and causes uncontrolled bleeding in or around the brain. Much more commonly, death occurs later, resulting from complications of serious injuries caused by the fall.
Diagnosis of Falls
A doctor's evaluation
Sometimes laboratory tests
It is vitally important for people to tell their doctor if they have fallen, even if the doctor has not asked, so that the doctor can uncover treatable reasons behind the fall. People who have fallen may be reluctant to tell their doctor because they think falling is just part of getting older, especially if they have not been injured. Even people who have been seriously injured during a fall and have been treated in an emergency department may be reluctant to admit they have fallen. They may not want others to think they are helpless and now must move from their home into a more supervised environment such as a nursing home.
To identify the cause of the fall, doctors ask about the circumstances of the fall, including any symptoms experienced just before the fall (such as dizziness, vertigo Dizziness and Vertigo Dizziness is an inexact term people often use to describe various related sensations, including Faintness (feeling about to pass out) Light-headedness Dysequilibrium (feeling off balance or... read more , and palpitations Palpitations Palpitations are the awareness of heartbeats. The sensation may feel like pounding, fluttering, racing, or skipping beats. Other symptoms—for example, chest discomfort or shortness of breath—may... read more ) and any activities that may have contributed to the fall. They ask any witnesses to the fall to describe what they saw. Doctors also ask about the use of prescription and nonprescription medications or alcohol that may have contributed to the fall. Doctors ask people whether they lost consciousness and whether they were able to get up without help.
Doctors do a physical examination first to check for injuries and to obtain information about possible causes of the fall. Parts of the examination include the following:
Blood pressure measurement Diagnosis High blood pressure (hypertension) is persistently high pressure in the arteries. Often no cause for high blood pressure can be identified, but sometimes it occurs as a result of an underlying... read more : If blood pressure decreases when people stand up, the fall may have been caused by orthostatic hypotension Dizziness or Light-Headedness When Standing Up In some people, particularly older people, blood pressure drops excessively when they sit or stand up (a condition called orthostatic or postural hypotension). Symptoms of faintness, light-headedness... read more .
Heart sounds Physical Examination : With a stethoscope, doctors listen to the heart for evidence of a very slow heart rate, abnormal rhythms Overview of Abnormal Heart Rhythms Abnormal heart rhythms (arrhythmias) are sequences of heartbeats that are irregular, too fast, too slow, or conducted via an abnormal electrical pathway through the heart. Heart disorders are... read more , heart valve problems Overview of Heart Valve Disorders Heart valves regulate the flow of blood through the heart's four chambers—two small, round upper chambers (atria) and two larger, cone-shaped lower chambers (ventricles). Each ventricle has... read more , and heart failure Heart Failure (HF) Heart failure is a disorder in which the heart is unable to keep up with the demands of the body, leading to reduced blood flow, back-up (congestion) of blood in the veins and lungs, and/or... read more .
Muscle strength and range of motion assessment Physical Examination The musculoskeletal system comprises bones, muscles, joints, ligaments, tendons, and bursae (see Introduction to Biology of the Musculoskeletal System). Any of these components can be injured... read more : Doctors assess the back and legs and check for problems in the feet.
Vision assessment The Eye Examination A person who has eye symptoms should be checked by a doctor. However, some eye disorders cause few or no symptoms in their early stages, so the eyes should be checked regularly (every 1 to 2... read more and nervous system assessment Neurologic Examination When a neurologic disorder is suspected, doctors usually evaluate all of the body systems during the physical examination, but they focus on the different parts of the nervous system. Examination... read more : Doctors check nervous system functions such as muscle strength, coordination, sense of position, and balance.
Doctors sometimes ask people to do some usual activities, such as sitting in a chair and then standing up and walking or stepping up on a step. Observing these activities may help doctors identify conditions that contributed to the fall.
If the fall resulted from an environmental hazard and no major injury occurred, no tests may be done. However, when people’s physical condition could have contributed to the fall, tests may be needed. For example, when the physical examination detects evidence of a heart problem, heart rate and rhythm may be recorded using electrocardiography Electrocardiography Electrocardiography (ECG) is a quick, simple, painless procedure in which the heart’s electrical impulses are amplified and recorded. This record, the electrocardiogram (also known as an ECG)... read more (ECG). This test may take a few minutes and be done in the doctor’s office, or people may be asked to wear a portable ECG device (Holter monitor Holter Monitor: Continuous ECG Readings ) for 1 or 2 days. Blood tests, such as a complete blood count and measurements of electrolyte levels Overview of Electrolytes More than half of a person's body weight is water. Doctors think about water in the body as being restricted to various spaces, called fluid compartments. The three main compartments are Fluid... read more , may be helpful in people who have been experiencing dizziness or light-headedness. If the nervous system appears to be malfunctioning, computed tomography (CT) or magnetic resonance imaging (MRI) of the head may be helpful.
Treatment of Falls
Treatment of injuries from falls
Treatment of any disorders that could lead to falls
The first priority is treatment of injuries, such as head injuries, fractures, sprained ligaments, and strained muscles.
The next priority is to prevent subsequent falls by treating disorders that may have contributed to the fall. For example, in people who have a very slow heart rate accompanied by light-headedness, a pacemaker for the heart may be implanted. If possible, potentially harmful medications are stopped, the dose is reduced, or another medication is substituted.
Physical Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more and occupational therapists Occupational Therapy (OT) Occupational therapy, a component of rehabilitation, is intended to enhance a person's ability to do basic self-care activities, useful work, and leisure activities. These activities include... read more can help improve people’s walking and balance as well as their self-confidence after a fall. They can provide tips on how to avoid falling. Therapists can also encourage people to remain active. Physical therapy and supervised balance training and stretching can help reduce the risk of falling.
Prevention of Falls
Older adults can do many simple, practical things to help reduce the risk of falling.
Exercising regularly Exercise in Older Adults Most people over age 65 do not exercise at recommended levels despite the known health benefits of exercise including Longer survival Improved quality of life (for example, endurance, strength... read more : Weight training or resistance training may help strengthen weak legs and thus may improve steadiness during walking. Tai Chi and balancing exercises such as standing on one leg can help improve balance. Exercise programs should be tailored to a person's needs. Many senior citizen centers, YMCAs, or other health clubs offer free or low-cost group exercise classes tailored to senior citizens.
Wearing appropriate shoes: Shoes that have firm, nonslip soles, some ankle support, and flat heels are best.
Standing up slowly after sitting or lying down and taking a moment before starting to move: This strategy can help prevent dizziness because it gives the body time to adjust to the change in position.
Learning a simple head maneuver: A simple head maneuver called the Epley maneuver Treatment Benign paroxysmal positional vertigo (BPPV) is a common disorder causing short episodes of vertigo (a false sensation of moving or spinning) in response to changes in head position that stimulate... read more may help some older adults who have a type of vertigo called benign paroxysmal positional vertigo Benign Paroxysmal Positional Vertigo Benign paroxysmal positional vertigo (BPPV) is a common disorder causing short episodes of vertigo (a false sensation of moving or spinning) in response to changes in head position that stimulate... read more (BPPV). The Epley maneuver involves turning the head in specific ways. Doctors usually do the maneuver the first time, but people can learn how to do it themselves if it needs to be repeated.
Reviewing medications being taken: People can ask a doctor or another health care practitioner to review all prescription and nonprescription medications being taken to see if any of the medications could increase the risk of falling. If such medications are being used, doctors may be able to lower the dose or people may be able to stop taking the medication.
Having vision checked regularly The Eye Examination A person who has eye symptoms should be checked by a doctor. However, some eye disorders cause few or no symptoms in their early stages, so the eyes should be checked regularly (every 1 to 2... read more : Getting the correct glasses and wearing them can help prevent falls. Treatment of glaucoma Glaucoma Glaucomas are a group of eye disorders characterized by progressive optic nerve damage (often, but not always, associated with increased eye pressure) that can lead to irreversible loss of vision... read more or cataracts Cataract A cataract is a clouding (opacity) of the lens of the eye that causes a progressive, painless loss of vision. Vision may be blurred, contrast may be lost, and halos may be visible around lights... read more , which limit vision, can also help.
Consulting with a physical therapist Physical Therapy (PT) Physical therapy, a component of rehabilitation, involves exercising and manipulating the body with an emphasis on the back, upper arms, and legs. It can improve joint and muscle function, helping... read more about ways to reduce the risk of falling: Some older adults need a physical therapist to train them to walk, particularly if they need to use an assistive device such as a walker or cane (see figure ). Physical therapists can help fit or size people for other assisted devices (such as removable foot plates on wheelchairs) and teach them how to use them.
Just the Right Height
For people who are recovering from a leg injury or surgery, using a cane that is the correct height is important. A cane that is too long or too short can cause low back pain, poor posture, and instability. The cane should be held on the side opposite of an injured leg.
Hazards in the environment can sometimes be removed or corrected (see table ).
Lighting can be improved by increasing the number of lights or changing the types of lights.
Light switches can be positioned so that they are easily reached. Motion-sensitive lights or lights that turn on when they are touched can be used. Nightlights can be helpful.
Adequate lighting for steps (inside and outside) and for outdoor areas used at night is particularly important. Steps should have nonskid treads and sturdy, secure handrails. Bright-colored adhesive strips can be applied to clearly mark steps.
Electrical or extension cords that are in the way of walking can be eliminated by adding more electrical outlets, or the cords may be tacked over doorways or beneath floor coverings.
Items that clutter floors, hallways, and stairways can be stored out of the way of walking.
Flooring (including rugs and linoleum) with tears or curled edges should be repaired, tacked down, or replaced.
Loose throw rugs can be removed, taped, or tacked down, or rugs with nonskid backs can be used.
Furniture should be stable enough to support the weight of a person leaning on table edges or chair arms and back.
Grab bars can be installed next to toilets, tubs, and other places for people who need something to hold onto when they stand up. Grab bars must be installed correctly, so that they do not pull out of the wall.
Elevated toilet seats can help.
The shower can be equipped with skid-resistant strips, a rubber mat, or a seat.
Nonslip mats should be used in the bathroom and kitchen.
Frequently used household items can be stored in cabinets, cupboards, or other spaces between waist and eye level, so that they can be reached without stretching or bending.
Learning how to safely handle potentially hazardous situations may be more important than removing an environmental hazard. Sometimes people need to pay more attention to potential hazards and think about ways to accomplish daily tasks more safely. For example, they can place cordless phones around the home or carry a mobile phone in their pocket so that they do not have to rush to answer phone calls.
Falls cannot always be prevented. So, people who are likely to fracture a hip, such as people who have osteoporosis Osteoporosis Osteoporosis is a condition in which a decrease in the density of bones weakens the bones, making breaks (fractures) likely. Aging, estrogen deficiency, low vitamin D or calcium intake, and... read more , should maximize the strength of their bones by taking adequate calcium and vitamin D and taking additional prescription medications to slow their bone loss. Some people in nursing or residential care facilities Nursing Homes Nursing homes are for people who need help with health care for chronic conditions but do not need to be hospitalized. The decision to move to a nursing home may be triggered by a change in... read more may consider wearing a hip protector, an undergarment with a plastic and foam pad placed over the hip. Hip protectors may prevent hip fractures if worn regularly by people in care facilities, but they have not been shown to be as effective for people living independently at home.
Knowing what to do if a fall occurs can help older adults be less afraid of falling. If they fall and cannot get up, they can turn onto their stomach, crawl to a piece of furniture (or other structure that can support their weight), and pull themselves up.
Older adults should also have a good way to call for help. People who have fallen several times may keep a telephone in a place that can be reached from the floor. Another option is installing a personal emergency response system (a medical alert device) that signals someone to check in on them. Most of these systems include an alert button worn on a necklace. Pressing the button calls for help.
The following English-language resources may be useful. Please note that THE MANUAL is not responsible for the content of these resources.
Centers for Disease Control and Prevention: This web site provides statistics about falls in older adults and links to discussions about ways to prevent falls,
National Council on Aging (NCOA): This web site provides links to articles that discuss statistics about falls in older adults, ways to prevent them, and myths about falling.
National Safety Council: Fall-prevention measures to keep older adults independent