What Causes Fall?

Elderly are prone to various fall risks
Elderly are prone to various fall risks

What makes you slip, trip, or stumble? To prevent falls we must have a solid understanding of the underlying causes of falling.

Research has identified many conditions which are contributing to the risk of falling. These are called risk factors. Elderly people are prone to fall due to complex interactions of numerous risk factors.

For the purpose of discussion, we will group these risk factors into five categories:


  1. Risk factors associated with ageing

Growing old is accompanied by a gradual decline of physical and mental power, sensory impairment and delayed reflexes. Old age is also associated with chronic illnesses. These changes, in combination with other risk factors, increase the likelihood of falls. And the older a person is the higher the chance that fall may occur unless proper precaution is taken.

Characteristics commonly found in elders are listed here:

  • Muscle weakness of the lower limbs and problems with walking and balance
  • Stiff joints and back which make bending and turning difficult
  • Slow reaction to sudden change of environment
  • Poor eye sight
  • Hearing loss, tinnitus
  • Inactivity of daily living
  • Depression
  • Chronic illnesses such as heart failure, diabetes and COPD
  • Dementia, Alzheimer’s disease


  1. Risk factors associated with personal habits or behaviour

Many risk factors are directly related to personal habits and behaviour. These are potentially modifiable risks because changing the habit or behaviour can reduce the problem significantly.

  • Smoking and excessive alcohol intake cause decreasing bone strength. In addition, alcohol can cause unsteadiness and slow reactions.
  • Poor diet and poor nutrition affects overall health and depletes strength and energy
  • Inappropriate footwear
  • Lack of activity: physically, socially or mentally
  • Using multiple number of drugs (polypharmacy), whether they are prescription or over-the counter-medicines. The use of four or more medications has been strongly associated with an increased risk of falls. The hazard of self-prescription without proper guidance must be taken seriously because of possible interaction between the drugs that you are taking.


  1. Risk Factors relating to medical conditions

Fall most likely happens when there is a sudden dizziness, loss of balance or loss of consciousness. Many diseases can give rise to these symptoms.

The following are some of the common medical conditions found in elderly who fell and sustained serious injuries:

  • Weak musculoskeletal function, gait abnormality and osteoporosis. Osteoporosis is thought to be the deciding factor in fall severity and morbidity.
  • Cardiovascular diseases such as irregular heart rhythms, ischaemic heart disease, carotid sinus sensitivity, syncope, hypotension or hypertension.
  • Arthritis especially of the hips and knees
  • Depression
  • Neurologic conditions such as peripheral neuropathy, epilepsy, stroke, multiple sclerosis, labyrinthitis, vertigo, transient ischemic attack (TIA), dementia, Parkinson’s disease, Alzheimer’s disease
  • Diseases that affect vision and hearing
  • Urinary and bladder dysfunction, incontinence
  • Cancer that affects the bones
  • Diabetes, hypoglycaemia (low blood sugar)
large number of pills
Drugs are potentially dangerous

The actions and side effects of many drugs can cause lightness in the head, disorientation, and drowsiness too. This includes medicines that your doctor has prescribed to treat your medical problems, as well as over-the-counter-medicines that you purchase.

We must be very cautious about certain classes of medicines: tranquilizers, sedatives, antidepressants, antipsychotics, anticonvulsants, and medicines that lower blood pressure or blood sugar. And extra care is due if more than one of these medicines were prescribed.


  1. Risk factors associated with living environment

Environmental hazards, whether at home or at public places, are the leading causes of falls, accounting for about 25 to 45 percent in most studies. In fact, most fractures are the result of falls related to everyday activities such as walking on stairs, going to the bathroom, or working in the kitchen.

Home hazards

  • Poor house plan, for example, location of bathroom and bedroom at different levels
  • Narrow, broken or uneven steps
  • Stairs without handrails
  • Slippery or wet surfaces
  • Throw rugs or mats that can be tripped over
  • Trailing cables on the floor
  • Badly fitting carpets
  • Poor lighting
  • Pathways cluttered with furniture, boxes, bicycles, toys etc.

Public place hazards

  • Poor building design, including uneven steps and poor lighting
  • Slippery or wet floor
  • Cracked or uneven pavements
  • Poor street light and obstacles on the pathway such as rubbish
  • Inconsiderate actions of cyclists, car drivers


  1. Socioeconomic risk factors

The social conditions and economic status of individuals, as well as the community they live in, have great impact on their total wellness. Naturally, it also plays a role in elderly falls and prevention.

WHO has pinpointed factors which may influence the incidence of falls:

  • low income
  • low education
  • inadequate housing or poor housing conditions
  • lack of social interaction
  • limited access to health and social care especially in remote areas
  • lack of community resources


Finally ……

The risk factors we have listed above are not by themselves the cause of falls. Falls are caused by the complex interplay of an individual’s physical conditions and exposure to the surrounding hazards.

For example, weak muscle strength of the legs will lead to imbalance and unsteadiness, which intensifies the risk of falling when stepping on a wet floor; the severity of fall injury is increased by osteoporosis.

Studies have shown that risk of falling increases proportionally with the number of risk factors a person is associated with. With four or more risk factors, our chance of falling is 78 percent.

The strongest independent risk factors for falls are previous falls, muscular weakness, abnormal gait, balance impairments, and use of psychoactive medications.


NICE clinical guideline 161. Falls: Assessment and prevention of falls in older people

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