Why Do People Fall?

Helpful Highlights

• There are causes of falls that are internal (physiological).

• There are causes of falls that are external (environmental).

• There are causes that you may not even realize are related to falls.

• Most falls occur at night in the bathroom or on the way to the bathroom.

As we age, we do assume additional risk factors that contribute to falling, however, falls are not a normal part of aging. You or your loved one can stay on your feet and avoid the risk of a fall.

Many things can cause a fall

Most falls are caused by a combination of factors, both internal (happening within you or your loved one) and external (happening in the environment). A fall rarely occurs due to just one cause or reason.

Internal causes (physiological)

• Poor eyesight, especially in areas with low lighting

• Poor hearing, which is usually accompanied by balance issues

• Slower reflexes that happen as we age

• Chronic conditions that can affect sensation and balance, such as diabetes, vascular diseases (heart disease, peripheral vascular disease), and foot problems

• Cognitive impairment (mild cognitive impairment, dementia, Alzheimer's)

• Depression

• Age-related loss of muscle mass (sarcopenia) or generalized weakness

• Vitamin D deficiency or osteoporosis

• Drops in blood pressure from sitting to standing (postural hypotension)

• Behavioral hazards, such as not modifying daily activities or routine exercises to account for new or increasing difficulties (examples are continuing heavy lifting or using a stepladder)

• Incontinence is also not a normal part of aging

External causes (environmental)

• Polypharmacy (taking 5 or more medications daily), especially certain medications

• Joint replacement surgery, which usually increases risk only temporarily

• Home safety hazards

  • Low lighting

  • Lack of support, such as walking aids or grab bars

  • Use of walking aids (yep, this is both a help and a hindrance!)

  • Slick or wet flooring

  • Loose rugs or frayed carpeting

  • Wires and cords

  • Cluttered walkways

  • The ambient temperature is too high

  • Ill-fitting or painful footwear

  • Pool and hot tub decks

• Community safety hazards

  • Uneven ground

  • High curbs and steps

  • Lack of railing, fences, or benches

  • Multiple obstacles to navigate, especially in the city

  • Icy surfaces

  • Pool and hot tub decks

What can I do?

Check you or your loved one's home for trip and fall dangers and help make the home safer. Start by eliminating as many of the external risk factors and hazards as possible. Make sure to have good-fitting footwear with non-skid soles, remove obvious tripping hazards, repair damaged stairs and walkways, add lighting to stairs and walkways (simple nightlights can help), carpet over slick floors and make sure all other carpet is in good shape, remove excess rugs and ensure mats placed on tile or other hard surfaces (bathroom and kitchen) are non-skid or otherwise secured, place non-skid surfaces in bathtubs/showers and on pool or hot tub decks.

Consult an occupational therapist for home modification recommendations individualized to you or your loved one.

Take a walk to see how stable you or your loved one are and report your observations to a primary care provider. Also, watch for changes in strength or balance. Likewise, listen without assumption to any worries about feeling dizzy, weak, or unsteady, and get help.

Discuss the internal risk factors with a healthcare team, such as chronic conditions, medication side effects, and cognitive impairments, and have you or your loved one's feet checked. Ask a provider about a Vitamin D supplement.

Get regular vision and hearing exams. Also, stay physically active, especially in activities that strengthen leg muscles and improve balance. Consider nighttime urine containment methods such as bed pads, briefs, and bedside commodes. Most falls occur at night in the bathroom or on the way to the bathroom.

Note that a fall may be a warning sign

A fall might be an indicator of a new or worsening health condition. New, and often temporary, health conditions that can cause falls include:

• constipation

• infection — bladder, urinary tract, or respiratory

• dehydration

• sudden confusion (sometimes called delirium)

You or your loved one should always speak to a primary care provider if there's been a fall.

The CDC has an excellent Stay Independent brochure that includes a fall risk questionnaire.