trips and falls in the elderly

Falls in Older Adults

• Diagnosis |
• Treatment |
• Prevention |
• More Information |

A fall is defined as unintentionally or accidentally dropping down to the ground or another lower level.

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 ) 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 ). 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 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

Muscle strength

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

Inadequate lighting

Slippery floors

Electrical or extension cords or objects that are in the way of walking

Uneven sidewalks and broken curbs

Unfamiliar surroundings

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

Dizziness or vertigo

Light-headedness

Irregular or rapid, pounding heartbeats ( palpitations )

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 .

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

Dehydration

Low body temperature ( hypothermia )

Rhabdomyolysis (muscle breakdown that can lead to kidney damage or failure)

Pressure sores

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 or an assisted-living facility . 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 , and palpitations ) 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 : If blood pressure decreases when people stand up, the fall may have been caused by orthostatic hypotension .

Heart sounds : With a stethoscope, doctors listen to the heart for evidence of a very slow heart rate, abnormal rhythms , heart valve problems , and heart failure .

Muscle strength and range of motion assessment : Doctors assess the back and legs and check for problems in the feet.

Vision assessment and nervous system assessment : 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 (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 ) for 1 or 2 days. Blood tests, such as a complete blood count and measurements of electrolyte levels , 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

Physical therapy

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 and occupational therapists 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 : 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 may help some older adults who have a type of vertigo called benign paroxysmal positional vertigo (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 : Getting the correct glasses and wearing them can help prevent falls. Treatment of glaucoma or cataracts , which limit vision, can also help.

Consulting with a physical therapist 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 Just the Right Height ). 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

Hazards in the environment can sometimes be removed or corrected (see table Checklist for Preventing Falls in the Home ).

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 nursing or residential care facilities 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.

More Information

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

7 Causes of Falls in the Elderly

Why do elderly people fall, declines in physical fitness, impaired vision, medication side effects, chronic diseases, surgical procedures, environmental hazards, behavioral hazards, recent questions, popular questions, related questions.

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Prevention of Falls in Older Adults

• 1 Associate Editor, JAMA
• Editorial Preventing Falls in Older Persons David B. Reuben, MD; David A. Ganz, MD, PhD JAMA
• US Preventive Services Task Force USPSTF Recommendation: Interventions to Prevent Falls in Community-Dwelling Older Adults US Preventive Services Task Force; Wanda K. Nicholson, MD, MPH, MBA; Michael Silverstein, MD, MPH; John B. Wong, MD; Michael J. Barry, MD; David Chelmow, MD; Tumaini Rucker Coker, MD, MBA; Esa M. Davis, MD, MPH; Carlos Roberto Jaén, MD, PhD, MS; Marie Krousel-Wood, MD, MSPH; Sei Lee, MD, MAS; Li Li, MD, PhD, MPH; Goutham Rao, MD; John M. Ruiz, PhD; James Stevermer, MD, MSPH; Joel Tsevat, MD, MPH; Sandra Millon Underwood, PhD, RN; Sarah Wiehe, MD, MPH JAMA
• US Preventive Services Task Force USPSTF Review: Interventions to Prevent Falls in Older Adults Janelle M. Guirguis-Blake, MD; Leslie A. Perdue, MPH; Erin L. Coppola, MPH; Sarah I. Bean, MPH JAMA

Falls are the leading cause of injury in adults aged 65 years or older.

Falls are common among older adults. In a 2018 survey, more than one-fourth of US older adults living in the community reported at least 1 fall in the past year. A serious fall in an older adult can result in injury (such as hip fracture) that causes decreased independence and decreased quality of life. The risk of falling increases with age for many reasons, including overall weakness and frailty; problems with balance, cognition, and vision; certain medications; acute illness; and other environmental hazards. Those who have fallen in the past are at high risk of falling again.

How Can Primary Care Clinicians Aim to Prevent Falls in Older Adults?

To answer this question, the US Preventive Services Task Force (USPSTF) reviewed many studies about interventions for older adults living in the community (not in a nursing home or other institutional care setting). These interventions include exercise therapy (such as working on gait, balance, and leg muscle strengthening), environmental assessments, medication reviews, and multifactorial interventions, which involve creating a customized plan based on individual risk factors. Among all of these interventions, exercise therapy was found to be most beneficial.

Pros and Cons of Trying to Prevent Falls in Older Adults

The pros of trying to prevent falls is avoiding potentially serious injuries or death. Although current evidence suggests that exercise therapy helps decrease falls and injury from falls, no studies have shown a direct link between any interventions to prevent falls and overall risk of death.

The cons of trying to prevent falls include injury (including falling itself) from exercise therapy; however, this risk is small.

Should Primary Care Clinicians Provide Interventions to Prevent Falls?

The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults aged 65 years or older who are at increased risk of falls. For multifactorial interventions, there may be a small benefit, and primary care clinicians should consider multifactorial interventions for patients at higher risk of falling on a case-by-case basis.

For More Information

US Preventive Services Task Force www.uspreventiveservicestaskforce.org/uspstf/topic_search_results?topic_status=P

To find this and other JAMA Patient Pages, go to the Patient Information collection at jamanetworkpatientpages.com .

Published Online: June 4, 2024. doi:10.1001/jama.2024.9713

Conflict of Interest Disclosures: None reported.

Source: US Preventive Services Task Force. Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. JAMA . Published June 4, 2024. doi:10.1001/jama.2024.8481

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Jin J. Prevention of Falls in Older Adults. JAMA. Published online June 04, 2024. doi:10.1001/jama.2024.9713

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• Avoiding the slip: Winter fall prevention

Jan. 03, 2019

Seemingly simple, everyday actions such as padding out the front door in slippers, stepping out of a car in a parking lot or going on an afternoon walk can suddenly become treacherous in Minnesota in the dead of winter, leading to falls and injury.

"Anywhere outside can be somewhere hazardous in winter in our state," says Kimberly (Kim) J. Lombard, injury prevention coordinator at Mayo Clinic Trauma Center in Rochester, Minnesota.

Orthopedic injuries from falls, such as broken bones in the wrist, arm, ankle or hip, are common in all seasons. For older adults, falls are the most common cause of traumatic brain injury, which ultimately can be fatal. Even for elderly patients who do not die due to injury from a fall, consequences can lead to nursing home stays and subsequent health decline.

According to the May 11, 2018, Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report, Minnesota has the third highest fall mortality rate in the U.S.

According to Minnesota Department of Health 2013 Death Certificate Data, 5.3 percent of the state's falls occur in the outdoors. Of total fatal falls, 1 percent was due to snow and ice (ICD-10 code W00).

Risk factors for falls

General risk factors for falling, in winter or in other seasons, include:

• Previous fall
• Poor vision
• Chronic conditions
• Use of multiple medications
• Fear of falling

Fall prevention

What can be done to decrease the number of winter falls, or at least diminish morbidity from a fall?

Lombard offers the following tips to share with patients and community members to help prevent or lessen injury from wintertime falls:

Take care in risky locations

Lombard suggests treating many areas as risky or unsafe in the winter, as it's not always possible to see icy spots. When getting in or out of a vehicle, first check to see if the ground is slippery.

Be cautious and allow for extra time

Being in a hurry and scrambling into the service station for a gallon of milk can be asking for trouble.

Change your walking style for greater stability

Use a slower and wider gait to better protect against falls.

Dress appropriately

Though it may seem harmless to go out to get the mail in your robe, doing so increases your chances of injury or exposure if you take a tumble on an icy driveway or walk. Wear gloves, warm clothing that covers you well, and footwear with treads and good traction — even consider purchasing ice grippers for your shoes.

Bring a cellphone

If you should fall, you will be glad you brought your phone along to call a neighbor, spouse or emergency medical help.

Clear your walks

Even if this requires asking for help from others to accomplish, it's worth the trouble to prevent a fall.

Carry kitty litter or sand in a bag

These can be tossed onto the ground in front of you to provide better traction while walking.

Ask your doctor to assess your personal risk of falling

If certain factors put you at higher risk, such as low vision, a physician can help develop a preventive action plan.

Protect your bone health

Taking in calcium from food sources or supplements and getting vitamin D from sun exposure are important for bone health, which protects against falls. As all northern U.S. states are too far away from the sun to get adequate vitamin D in the winter, ask your physician about supplementation.

Immediate action steps when a fall occurs

What are the best actions for patients to take if they fall or someone nearby takes a tumble on the ice and snow?

Lombard suggests that if a winter fall occurs, patients and community members should be encouraged to follow these steps:

• Don't get up right away or let anyone help you up immediately; this avoids the potential of causing further injury. Don't worry about feeling embarrassed. Rather, take your time, lie there for a moment and assess how you are feeling.
• After making an assessment of your injury status, if you can get up, roll to one side. Bend your knees toward you, push up with your arms and then use your legs to stand up the rest of the way.
• If someone assists you to your feet, ensure that he or she doesn't get hurt, too.
• Use your cellphone or mobile medical alert device if you need assistance getting up from a fall. In many communities, fire departments are available to help citizens get up from falls, even if no injury is present.
• Call 911 or emergency medical help if the fall has led to an emergency situation.

Learning from a fall

After a winter slip on the ice or snow, analyzing one's fall story can be helpful to avoid repeating it, says Lombard. Helping patients reflect on questions such as "What was I doing?" and "What could I have done differently?" can help determine preventive action for the future.

For more information

Minnesota Death Certificate Data, Minnesota Department of Health, 2013.

Burns E, et al. Deaths from falls among persons aged ≥ 65 years — United States, 2007–2016 . Morbidity and Mortality Weekly Report. 2018;67:509.

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Overview - Falls

Anyone can have a fall, but older people are more vulnerable and likely to fall, especially if they have a long-term health condition.

Falls are a common, but often overlooked, cause of injury. Around 1 in 3 adults over 65 and half of people over 80 will have at least one fall a year.

Most falls do not result in serious injury. But there's always a risk that a fall could lead to broken bones, and it can cause the person to lose confidence, become withdrawn, and feel as if they have lost their independence.

What should I do if I fall?

If you have a fall, it's important to keep calm. If you're not hurt and you feel strong enough to get up, do not get up quickly.

Roll onto your hands and knees and look for a stable piece of furniture, such as a chair or bed.

Hold on to the furniture with both hands to support yourself and, when you feel ready, slowly get up. Sit down and rest for a while before carrying on with your daily activities.

If you're hurt or unable to get up, try to get someone's attention by calling out for help, banging on the wall or floor, or using your  personal alarm or security system (if you have one). If possible, crawl to a telephone and dial 999 to ask for an ambulance.

Try to reach something warm, such as a blanket or dressing gown, to put over you, particularly your legs and feet.

Stay as comfortable as possible and try to change your position at least once every half an hour or so.

You may want to get a personal alarm system so that you can signal for help in the event of a fall.

An alternative would be to always keep a mobile phone in your pocket so you can phone for help after having a fall.

If you're living with or caring for an elderly person, read what to do after an incident .

What causes a fall?

The natural ageing process means that older people have an increased risk of having a fall.

Older people are more likely to have a fall because they may have:

• balance problems and muscle weakness
• vision loss
• a long-term health condition, such as heart disease ,  dementia or low blood pressure (hypotension) , which can lead to dizziness and a brief loss of consciousness

A fall is also more likely to happen if:

• floors are wet, such as in the bathroom, or recently polished
• the lighting in the room is dim
• rugs or carpets are not properly secured
• the person reaches for storage areas, such as a cupboard, or is going down stairs
• the person is rushing to get to the toilet during the day or at night

Another common cause of falls, particularly among older men, is falling from a ladder while carrying out home maintenance work.

In older people, falls can be particularly problematic because osteoporosis  is a fairly common problem.

It can develop in both men and women, particularly in people who smoke, drink excessive amounts of alcohol, take steroid medicine, or have a family history of hip fractures .

But older women are most at risk because osteoporosis is often associated with the hormonal changes that occur during the menopause .

Preventing a fall

There are several simple measures that can help prevent falls in the home.

For example:

• using non-slip mats in the bathroom
• mopping up spills to prevent wet, slippery floors
• ensuring all rooms, passages and staircases are well lit
• removing clutter
• getting help lifting or moving items that are heavy or difficult to lift

The charity Age UK has more advice about home adaptations to make tasks easier .

Healthcare professionals take falls in older people very seriously because of the huge consequences they can have for the health and wellbeing of this group.

As a result, there's a great deal of help and support available for older people, and it's worth asking a GP about the various options.

The GP may carry out some simple tests to check your balance. They can also review any medicines you're taking in case their side effects may increase your risk of falling.

The GP may also recommend:

• looking after your eyes with a sight test if you're having problems with your vision, even if you already wear glasses
• having an electrocardiogram (ECG) and checking your blood pressure while lying and standing
• requesting a home hazard assessment, where a healthcare professional visits your home to identify potential hazards and give advice
• doing exercises to improve your strength and balance ( read about physical activity guidelines for older adults )

Read more about preventing falls

Self-refer for help if you've had a fall

If you've had a fall, you might be able to refer yourself directly to services that can help you without seeing a GP.

To find out if there are any services in your area:

• ask the reception staff at your GP surgery
• check your GP surgery's website
• contact your integrated care board (ICB) – find your local ICB
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Being active

As we get older, lots of us may start to feel a bit unsteady on our feet and become worried about falling. The good news is there are lots of things you can do to stay steady on your feet and prevent falls.

What can I do to prevent a fall?

How can i make my home fall-proof, what can i do if i'm worried about a fall.

Take care when you're out and about

With the falling leaves and wet weather during the autumn and winter months, your risk of falling increases. So it's worth having a think about how you can reduce your risk, and take care when you're on the move. 

• Find out more about staying safe when the weather's bad

Although falls become more of a concern as we get older, they aren't inevitable. There's a lot you can do to reduce your chance of having a fall, even if you've had one in the past. 

If you've noticed you're starting to feel unsteady on your feet and it's stopping you doing the things you used to do – whether it's down to your health, your activity levels or your home environment – it's important to reach out and ask for help. You might be reluctant to do this, but admitting that things have changed could help you stay independent for longer.

Stay active

You might think that moving less will help you avoid a fall, but actually, movign more and staying active is the best thing you can do to stay as mobile and independent as possible. Being active can help you maintain your strength, balance and coordination, which can help you prevent falls. This doesn't have to mean doing vigorous exercise. Why not try getting off the bus a stop earlier or doing some simple chair-based exercises?

Find out more about how to get active

It’s important to keep an eye on your appetite and try and make sure you’re eating well. If this is tricky though, it's always better to eat something rather than nothing – even if it's small snacks throughout the day instead of 3 main meals, or a slice of cake. Getting enough energy is important in keeping up your strength and preventing falls.

Find out more about healthy eating

Keep hydrated

As well as eating well, you should make sure you’re drinking lots of fluids – you need 6 to 8 glasses a day. This doesn’t have to be just water. Tea, coffee and low-sugar or sugar-free squash are fine too. When it’s hot, drink a little more to make sure you stay hydrated. If you don’t drink enough it’s likely that you’ll start to feel lightheaded or dizzy and this will increase your risk of a fall. 

Take care of your eyes

Sight problems are common in later life, so it's important you look after your eyes in any way you can. Your vision plays a vital role in keeping you balanced, so having your eyes tested can help reduce your risk of a fall. Get your eyes and glasses prescription checked regularly – at least every 2 years. This is important even if you think your sight is fine, as opticians can detect eye conditions at an early stage.

Find out more about eye health and sight tests

Check for hearing problems

The risk of hearing loss increases as we get older, but people often wait several years after noticing their hearing is getting worse before raising it with their doctor. Our hearing is essential to maintaining balance, so it's important that you look after your ears and check for hearing problems.

Talk to your doctor as soon as soon as you notice your hearing isn't what it used to be. The problem may be something easily treated, such as a build-up of ear wax or an ear infection, or it may be that you need to be referred for a hearing test and prescribed an NHS digital hearing aid in one or both ears. 

Find out more about hearing loss

What if I have combined sight and hearing problems?

Combined sight and hearing problems can have a huge impact on your day-to-day life – so it’s important to seek help if they’re affecting you. Get in touch with your local council's adult social services department to explain how your vision and hearing difficulties are affecting you and ask for an assessment.  Following an assessment, your local council's sensory team will explain what help is available to you. They may also offer mobility training as well as advice on moving around when you’re at home or out and about – plus guidance on how you can stay as fit and active as possible.

Find your local council on GOV.UK

Manage your health conditions and medicines

Low blood pressure and poorly controlled diabetes can make you feel faint or dizzy, as can certain medicines or being on a lot of medication. Let your doctor or pharmacist know if you experience side effects like these – they may need to check the dosage you're on or look consider alternatives.

Alcohol can increase your risk of falls in and of itself – but it’s worth knowing that it can also interact with some medicines in a way that affects your balance. Check the leaflet that comes with your medicine for possible side effects.

Find out more about getting the most out of your medicines

Support your bone health

Stronger bones don't just make a fall less likely, they reduce the risk of more severe effects if you do fall. Keep your bones strong by doing regular exercise, such as walking, bowls or tennis. You also need calcium and vitamin D to maintain strong bones, both of which can be found in certain foods. For calcium, make sure you include dairy products, fortified soya products or canned fish in your diet, as well as fortified breakfast cereals, pulses and nuts. For vitamin D, make sure you're trying to include oily fish, eggs or fortified spreads in your diet.

However, it's difficult to get enough vitamin D from diet alone – sunshine is actually the best source. You might want to consider a daily vitamin D supplement in autumn and winter, when the sun is weaker, or all year round if you spend most of the day indoors, have darker skin or cover your skin for cultural or health reasons. 

Think about your foot health and footwear

Problems with your feet can affect your balance and increase your risk of tripping or falling. Report any problems with your feet, such as pain or decreased sensation, to your doctor or practice nurse. It's also a good idea to keep your toenails short. 

It's also important to make sure you're wearing appropriate footwear. For example, you should avoid wearing high heels. Instead, wear high-sided shoes with low heels, thin soles and good grip. And to avoid slips around the house, don't walk around with bare feet, socks or tights. 

Find out more about how to keep your feet healthy

Sometimes even familiar environments can become difficult to navigate as we get older. But there are some simple things you can do to feel safer and more comfortable at home. Here are some of our top tips:

• If you think you could benefit from adaptations to your home, get in touch with the adult social services department of your local council. They can give you more information about your options and may offer you a free care needs assessment. 
• Keep things tidied out of the way of stairs and hallways, and move rugs and mats away from the top or bottom of the stairs. Also, make sure that floors are clear of trailing wires and wrinkled or fraying rugs and carpets.
• Think about installing fitted handrails in helpful places, like by the bath and in the garden. Non-slip mats can also be helpful to stop you slipping when you're at home. 
• If you wake up during the night, consider installing a night light near the bed to make sure you can see where you're going. You could install a motion-activated light that comes on as needed. 
• If you have a pet, think about getting it a collar with a bell attached to it. Pets can get under your feet, so it's good to be aware of where they are when they're moving around. 

Find out more about home adaptations

You might be nervous because you’ve had a fall before or because you’ve noticed you’re starting to feel unsteady on your feet. You might have noticed changes to your health, or just feel like you’re slowing down a little.

Whatever the reason, it isn’t unusual to become cautious and lose confidence, and this can stop you doing the things you used to do and make you feel more isolated. The good news is that making some adjustments and getting the right help can make you feel more confident again.

Talk to your doctor

If you've had a fall or you've started to feel unsteady, tell your doctor – even if you feel fine otherwise. Your doctor can check your balance and the way you walk to see if improvements can be made. They may be able to refer you for a falls risk assessment or to the falls prevention service. If you have a falls risk assessment, an action plan will then be designed to meet your individual needs and reduce your risk of falls.

Get a home safety check

Contact your local council to find out if it offers home safety checks or a handyperson scheme. Some local Age UKs also offer handyperson schemes to assist with small repairs and carry out home-safety checks – why not get in touch with yours to see whether any support is available?

Find out more about local handyperson services

Consider getting some telecare

If you’re worried about what might happen if you fall, simple technology known as ‘telecare’ can help put your mind at ease. For example, a bed or chair sensor can detect if you’ve got up but haven’t returned within a set time – it can automatically send an alert to a carer or call centre in case you’ve fallen.

Personal alarms

Personal alarms allow you to call for help if you need it – for example, if you’re unwell or you have a fall and can’t reach a telephone. By pressing a button on a pendant or wristband, you can contact a 24-hour response centre. Staff at the emergency response centre will then call either your chosen contact – a neighbour, relative or friend – or, if the situation is more urgent, the emergency services

Want more information?

Staying steady information guide (PDF, 4 MB)

Find out more about getting and staying active as you get older

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One Senior Place: Take steps to make sure you don't fall at home. Here's some advice

Q: How can I prevent falls as I age?

A: During a recent check-up, my doctor asked me if I had fallen in the last three months.

What? Is 55 the magic age for asking about falls?

Does missing the bottom step count?

ALL people fall.

My 3-year-old granddaughter falls almost daily.

The truth is, some adults navigate a mine field of furniture, pets, throw rugs and more.

Medications can cause dizziness. The sidewalk can jump up and grab you out of nowhere.

Previous One Senior Place columns:

You're not alone: PTSD can affect seniors who have health issues, have lost loved ones

Future planning: Social Security should be part of your future financial planning

Don't run out: Setting up your finances can help stave off worry of running out of money

Falling is a big deal

According to the Centers for Disease Control (CDC), over 14 million (one in four) people 65 and older fall each year — although less than half tell their doctor.

It's important to come clean about your fall history, since the risk of death or serious injury from falls increases with age.

Falls are the leading cause of fatal and nonfatal injuries among older adults.

And falling once doubles your chance of falling again.

Limiting your activity is NOT the answer, as weakness increases the risk of a second fall!

Fall risk management

For people 65 and older, a “fall risk assessment” can be helpful.

Usually conducted by a health care professional, it includes medical history, medication review, fall history and a test of your strength, balance and gait.

• Timed up-and-go  (gait). You'll start in a chair, stand up, and then walk about 10 feet at your regular pace and sit down again.
• 30-second chair stand  (strength and balance). You'll sit in a chair with your arms crossed over your chest. Then, you'll stand up and sit down again — repeatedly. Your provider will count how many times you can do this in 30 seconds.
• 4-stage balance (maintaining balance). If you can't hold various positions for the prescribed number of seconds or you can't stand on one leg for 5 seconds, you may be at higher risk for a fall.

Help prevent falls with a healthy diet that protects your bones and muscles and an exercise regimen to improve your strength and balance!

See your physician annually and have your vision checked every two years after age 65.

Declutter your home.

Working with a Certified Care Manager? Clients receive an in-home safety assessment to identify anything that could precipitate a fall.

Even inappropriate footwear is a risk! Luckily, many shoe stores will do a comprehensive analysis of your feet and recommend a safe style of shoe.

For more tips, join us for an expert panel event on fall prevention June 20 in Viera. RSVP online at OneSeniorPlace.com or by calling 321-751-6771.

One Senior Place is a marketplace for resources and provider of information, advice, care and on-site services for seniors and their families. Questions for this column are answered by professionals in nursing, social work, care management and in-home care. Send questions to [email protected], call 321-751-6771 or visit One Senior Place, The Experts in Aging.

Brenda Lyle is a Certified Care Manager and Certified Dementia Practitioner with One Senior Place, Greater Orlando.

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Recommended by the Advisory Committee on Immunization Practices ( ACIP ) and approved by the Centers for Disease Control and Prevention ( CDC) , American Academy of Pediatrics ( AAP ), American Academy of Family Physicians ( AAFP ), American College of Obstetricians and Gynecologists ( ACOG ), American College of Nurse-Midwives ( ACNM ), American Academy of Physician Associates ( AAPA ), and National Association of Pediatric Nurse Practitioners ( NAPNAP ).

The comprehensive summary of the ACIP recommended changes made to the child and adolescent immunization schedule can be found in the January 11, 2024  MMWR .

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Dnc will foot part of $345k bill for jill biden’s pricey back-and-forth delaware-france flights, taxpayers on the hook for rest .

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The Democratic National Committee indicated Monday that it will cover some of the costs incurred by the federal government for first lady Jill Biden’s recent back-and-forth flights from Delaware to France — but taxpayers will be on the hook for the rest.

The first lady juggled attending first son Hunter Biden’s Wilmington, Del., gun trial as well as D-Day remembrances in Normandy and a state dinner in Paris last week by traveling separately from the president, multiple times, at an estimated $345,400 cost to taxpayers, the Daily Mail reported on Monday. 

“In accordance with relevant regulations utilized across administrations, the government is reimbursed the value of a first-class fare for these flights to Wilmington and back to Paris,” Jill Biden’s office told the outlet . 

A DNC spokeswoman said Monday that the national Democratic Party intends to pay “for the first class travel of the first lady,” according to CBS News . 

Jill Biden’s whirlwind travel week saw her log a full day’s worth of time in the air. 

She first flew from Joint Base Andrews in Maryland to Wilmington on Tuesday evening so she could attend courtroom proceedings Hunter’s criminal trial on Wednesday morning. 

The first lady then boarded a government plane to France that evening and spent Thursday in Normandy with President Biden commemorating the 80th anniversary of the allied invasion of Nazi-occipied Europe.

While her husband remained in France, Jill Biden flew back to Wilmington to spend Friday in court with Hunter before flying back to Paris that evening for a full day of Saturday events culminating in a state dinner at the Élysée Palace.  

She returned to the US on Sunday with the president, flying aboard Air Force One.

The National Taxpayers Union Foundation, a government watchdog group, noted that the government plane likely used by Jill Biden for her trips without the president was a Boeing C-32, which has a reimbursable rate of  $13,816 per hour, according to the Daily Mail. 

The math for each of her three fights between France and Delaware adds up to $110,528 per leg. 

When the first lady’s one-hour flight from Joint Base Andrews to Wilmington is included, her total bill comes out to $345,400 – far more than the combined total of four first-class tickets to and from each destination. 

Security concerns prevent first ladies from having the option to fly commercial.

The DNC did not say exactly how much it plans to reimburse the federal government and did not respond to The Post’s request for comment. 

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The risk of falls among the aging population: A systematic review and meta-analysis

Associated data.

The original contributions presented in the study are included in the article/ Supplementary material , further inquiries can be directed to the corresponding authors.

This study aims to clarify the risk factors for falls to prevent severe consequences in older adults.

We searched the PubMed, Web of Science, Embase, and Google Scholar databases using the terms “risk factors” OR “predicting factors” OR “predictor” AND “fall” OR “drop” to identify all relevant studies and compare their results. The study participants were divided into two groups, the “fall group” and the “control group”, and differences in demographic characteristics, lifestyles, and comorbidities were compared.

We included 34 articles in the analysis and analyzed 22 factors. Older age, lower education level, polypharmacy, malnutrition, living alone, living in an urban area, smoking, and alcohol consumption increased the risk of falls in the aging population. Additionally, comorbidities such as cardiac disease, hypertension, diabetes, stroke, frailty, previous history of falls, depression, Parkinson's disease, and pain increased the risk of falls.

Demographic characteristics, comorbidities, and lifestyle factors can influence the risk of falls and should be taken into consideration.

Introduction

By 2050, people older than 65 years are estimated to account for 16% of the population ( 1 ). Falls are a major public health problem, as approximately 28–35% of individuals aged ≥ 65 years experience falls each year. As the aging population increases, more individuals will be at risk of falling ( 2 ).Among older people, physical falls are events that adversely affect health and lead to disability and mortality ( 3 , 4 ). Moreover, fall-associated economic burdens are substantial and continue to increase worldwide ( 4 , 5 ). Even non-injury falls are associated with negative impacts, such as anxiety, depression, and decreased mobility, which greatly affect the quality of life (QOL) and aging trajectory. The most harmful consequences of injurious falls are hip fracture and brain damage ( 4 ). Research on the risk of falling has become increasingly important to maintain the health of older individuals ( 2 ).Early screening for the risk of fall that takes risk factors into account is needed. Many retrospective, cross-sectional, and longitudinal studies have examined fall prevalence, fall-related consequences, and risk factors for falls in older individuals. However, even though some reviews have addressed these topics ( 6 , 7 ), a high-quality systematic review has yet to be conducted. Therefore, in this study, we aimed to investigate the association between lifestyle factors and fall risk in aging adults to promote the development of effective fall prevention strategies.

Guidelines and ethical review

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in this systematic review. As this study was a review, no ethical approval was necessary.

Search strategy and data extraction

We hypothesized that demographic characteristics, lifestyle factors, and comorbidities would influence the risk of falls in the aging population. We chose these risk factors on the basis of records in the literature. After searching and carefully reading the literature, we found that the above factors had the most related studies and received the most attention. Therefore, we compared these factors between fall and non-fall groups. We searched for potentially relevant articles published in English before January 2022 during the initial search process. The terms searched in the PubMed, Web of Science, Embase, and Google Scholar databases were as follows: “risk factors” OR “predicting factors” OR “predictor” AND “fall” OR “drop”. Since Boolean operators do not work on Google Scholar, we used search terms like “risk factors for fall” and “predicting factors for fall” on Google Scholar. Two authors independently screened all the abstracts and citations of all studies identified with the search strategy to determine eligible studies. Data were independently extracted by two of the authors using a standardized Excel file. Studies were considered eligible if they included two groups and aging individuals (≥65 years old) with or without falls, and presented data on the baseline lifestyle characteristics and comorbidities of the participants. The exclusion criteria were as follows: duplicate publications, reviews, studies on unrelated topics, studies with different variables, and studies with different group criteria. The search process consisted of 2 steps, the initial search with short keywords and then detailed search with detailed search strategy (present in Supplementary File 1 ). The description of the detailed search strategy for each part of the PICO research question is provided in Supplementary File 1 , which is amended for other databases using database-specific subject headings, where available, and keywords in both titles and abstracts. The extracted data included baseline characteristics, lifestyle habits, comorbidities, and occurrence of falls. All the included data were subsequently entered in RevMan 5.1.4.

Comparisons

In our meta-analysis, we compared 22 factors between the two groups (the fall group and the control [no falls] group). The factors included age, body mass index (BMI), education level, polypharmacy, sex, relationship status (living alone), residential location (rural), (mal)nutrition, smoking status, alcohol consumption, and comorbidities including cardiac disease, hypertension, diabetes, stroke, depression, Parkinson's disease, pain, vision impairment, frailty, previous history of falls, and cognitive impairment.

Quality assessment

The quality of the included studies was assessed by two authors according to the Cochrane Collaboration Reviewer's Handbook and the Quality of Reporting of Meta-analysis guidelines ( 40 , 41 ).

Data analysis

The data were analyzed using RevMan 5.1.4. Continuous outcomes are presented as weighted mean differences (MDs) with 95% confidence intervals (CIs). Dichotomous data are presented as relative risks (RRs) with 95% CIs. A meta-analysis was performed using fixed-effect or random-effects models as appropriate. Specifically, the fixed-effects models were used when no significant heterogeneity was present, and the random-effects models were used when heterogeneity was present. Statistical heterogeneity among the trials was evaluated by the I 2 test, with significance set at P < 0.05.

Description of the included studies

A total of 14,144 reports were initially identified from the databases. After screening for duplicate publications, reviews, and irrelevant records based on the titles and abstracts, 13,139 reports were excluded from the study. After screening the full texts, 422 articles with different baseline data, 432 articles with different results criteria, and 117 articles with different group classifications were excluded. Thus, we eventually included 34 articles in the final analysis ( 8 – 32 , 34 – 39 , 42 – 44 ). The conditions of these studies and the clinical details of the participants are presented in Table 1 . A flow chart of the literature search is shown in Figure 1 .

Details of included papers.

RCT, Randomized controlled trial.

Flowchart of the literature review process and exclusion criteria.

Characteristics and lifestyles of people with/without falls

First, we compared aging adults in terms of age, BMI, education level, polypharmacy, malnutrition, sex (female), living alone, living in a rural area, smoking status, and alcohol consumption ( Figures 2A – L ). Older age (MD 1.87; 95% CI 1.14–2.6; p < 0.00001, Figure 2A ), number of drugs used (MD.36; 95% CI.19–0.52; p < 0.0001, Figure 2E ), and polypharmacy (RR 1.06; 95% CI 1.03–1.09; p = 0.0002, Figure 2F ) were associated with increased incidence of falls. Malnutrition (RR 1.4; 95% CI 1.19–1.64; p < 0.0001, Figure 2G ), living alone (RR 1.39; 95% CI 1.29–1.5; p < 0.00001, Figure 2I ), living in a rural area (RR 1.09; 95% CI 1.02–1.16; p = 0.006, Figure 2J ), smoking (RR 1.17; 95% CI 1.05–1.3; p = 0.004, Figure 2K ), and alcohol consumption (RR 1.18; 95% CI 1.09–1.28; p < 0.001, Figure 2L ) were risk factors for falls. Education level (MD −0.29; 95% CI −0.73–0.16; p = 0.21, Figure 2C ) had no impact on risk of falls, but completion of the mandatory level of education (RR 0.93; 95% CI 0.89–0.97; p = 0.006, Figure 2D ) decreased the risk of falls. BMI (MD −0.22; 95% CI −0.48–0.05; p = 0.11, Figure 2B ) and sex (RR 1.02; 95% CI 1–1.04; p = 0.13, Figure 2H ) did not affect risk of falls.

(A–L) Forest plots of the impacts of patient characteristics and lifestyle factors on the risk of falls.

Comorbidities in people with or without falls

Eleven comorbidities were compared between people with and without falls: cardiac disease, hypertension, diabetes, stroke, vision dysfunction, frailty, fall history, cognitive impairment, depression, Parkinson's disease, and pain ( Figures 3A – L ). Even though these comorbidities may alter the rate of frailty among elderly individuals (RR 1.1; 95% CI 1.05–1.15; p < 0.0001, Figure 3A ), not all of the comorbidities mentioned above necessarily influence falls. For instance, diabetes (RR 1.08; 95% CI 0.87–1.34; p = 0.49, Figure 3D ), stroke (RR 1.55; 95% CI 0.72–3.35; p = 0.26, Figure 3E ), vision dysfunction (RR 1.24; 95% CI 0.91–1.69; p = 0.17, Figure 3F ), and cognitive impairment (RR 1.11; 95% CI 0.88–1.39; p =0.37, Figure 3I ) did not significantly differ between the two groups. In contrast, heart disease (RR 1.14; 95% CI 1.09–1.19; p < 0.00001, Figure 3B ), hypertension (RR 1.08; 95% CI 1.03–1.12; p = 0.0004, Figure 3C , frailty (RR 1.35; 95% CI 1.25–1.45; p < 0.00001, Figure 3G ), fall history (RR 1.53; 95% CI 1.44–1.62; p < 0.00001, Figure 3H ), depression (RR 4.34; 95% CI 4.02–4.68; p < 0.00001, Figure 3K ), Parkinson's disease (RR 3.05; 95% CI 1.84–5.05; p < 0.0001, Figure 3K ), and pain (RR 1.22; 95% CI 1.11–1.34; p < 0.0001, Figure 3L ) were associated with increased risk of falls among the aging population.

(A–L) Forest plots of the impacts of comorbidities on the risk of falls.

In older adults, falls impose major health, economic, and societal burdens ( 16 ). Falls are the leading cause of injury in the elderly population ( 36 ). A serious fall could result in decreased independence and reduced QOL ( 36 ). Hip fracture, in particular, is a serious and devastating consequence of falling in older individuals ( 36 ). Moreover, Makino et al. reported that fall history is the most influential predictor of future falls ( 25 ). According to recent research, fall history increases the current risk of falls. Some research has also proposed that fear of falling is significantly associated with falls. Usually, fear of falling arises from a fall history ( 45 ). Patil R et al. suggested that fear of falling may increase even after a non-injurious fall. Subsequently, older adults may enter into a negative cycle in which they reduce their activity, leading to reduction in functionality ( 45 ). To avoid this negative cycle, we recommend early prevention of falls in elderly adults. Fear of falling was also independently associated with presence of knee pain, with a significant relationship observed between fear of falling and moderate to severe knee pain but not mild knee pain ( 14 ). Pain is a frequently mentioned factor, but only a few studies have prospectively collected data on fall occurrence in relation to knee pain or the lack of association between knee pain and fall occurrence during long-term follow-up. Furthermore, fear of falling may exacerbate depression. Our present results demonstrated that depression can also impact the risk of falls. As most falls result from loss of balance while walking and poor balance is the leading risk factor for falls, people tend to focus on the importance of mobility in the risk of falls ( 46 ). This explains the lack of sufficient predictive factors in older adults at risk of one or more falls. Additionally, social factors can increase the psychological burden on elderly individuals and reduce self-care capability, a factor with strong influences ( 47 ) on the risk of falls as well as the incidence rates of many diseases. Thus, the identification of risk factors for falls will provide important guidance for the care of elderly individuals.

Older age, polypharmacy, malnutrition, frailty, smoking, and alcohol consumption significantly increased the risk of falls; these factors also reflect decline in physical condition. Moreover, chronic illnesses are very common in older adults, and cardiac disease, hypertension, diabetes, stroke, and Parkinson's disease are associated with falls. Older adults residing in urban areas had a higher risk of falling than those residing in rural areas ( 27 ). This difference may be explained by traffic, which can impede medical treatment. Residency in suburban areas has certain advantages; for instance, it is easier to engage in physical exercises, such as walking, in suburban and rural areas than in urban areas. Physical exercise helps to reduce the risk of falls in adults and improves lower limb strength in older people ( 27 , 47 ). Moreover, living in a rural area is associated with less pollution exposure; this factor is particularly important in developing countries because pollution may cause comorbidities. However, only a few articles have focused on this topic. We plan to explore this topic further in the future once a larger number of relevant reports have been published. Sex has been identified as a risk factor for falls among older adults ( 37 ), but in our study, women did not have a higher risk of falling than men. While women experience a higher rate of frailty than men ( 37 ), men are more likely to exhibit harmful lifestyle habits, such as smoking and consuming alcohol; therefore, sex differences in the risk of falling merit further study. Another risk factor in our study is living alone, which increases the risk of depressive symptoms and the impacts of falls.

A major strength of this study is that we analyzed data from several large-scale, well-characterized cohorts and systematically summarized the risk factors for falls in the elderly population. These findings can inform healthcare in the elderly population. Biswas et al. explored the risk factors for falls among older adults in India ( 6 ); however, their study focused on only the Indian population and thus exhibited geographic and ethnic limitations. Xie et al. examined risk factors for the development of fear of falling, but fear of falling was only one of the risk factors for falls; we suggest that it is more meaningful to identify the risk factors for falls. Our meta-analysis also has some limitations. For example, we did not categorize the participants according to whether they lived in the community or in nursing homes, which is a major factor associated with the risk of falls.

We demonstrated that (1) older age, polypharmacy, malnutrition, single status, living in a rural area, smoking, and alcohol consumption significantly increased the risk of falls in elderly adults. In contrast, higher education level was protective against falls. Additionally, we found that (2) individuals with cardiac disease, hypertension, frailty, previous history of falls, depression, Parkinson's disease, and pain had a higher risk of falls than individuals without such comorbidities.

Data availability statement

Author contributions.

Data acquisition and drafting of the manuscript: QX, XO, and JL. Conception and design of the study: JL. Analysis and/or interpretation of data: QX and XO. All authors contributed to the article and approved the submitted version.

Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2022.902599/full#supplementary-material

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