What are the common causes of falls in older adults?

Common Causes of Falls in Older Adults

Falls in older adults are primarily caused by gait and balance disorders, medication effects, sensory impairments, environmental hazards, and orthostatic hypotension, with most falls resulting from multiple interacting risk factors rather than a single cause. 1

Key Risk Factors for Falls

Physical and Medical Factors

• History of previous falls: One of the strongest predictors of future falls 2
• Gait and balance impairments:
  • Muscle weakness, especially in hip muscles, quadriceps, and trunk extensors 1
  • Poor balance and coordination 2, 1
  • Slow walking speed (less than 0.8-1 m/s) 3
• Sensory impairments:
  • Visual deficits (poor acuity, depth perception, contrast sensitivity) 1, 4
  • Peripheral neuropathy with reduced lower extremity sensation 5
  • Vestibular disorders affecting balance 1
• Orthostatic hypotension: Blood pressure drops when changing positions 1, 4
• Chronic medical conditions:
  • Neurological disorders (Parkinson's, stroke, dementia) 1
  • Arthritis affecting mobility 1
  • Foot problems and inappropriate footwear 1

Medication-Related Factors

• Psychoactive medications:
  • Benzodiazepines and sedatives 2, 5
  • Antidepressants 1
  • Antipsychotics 1
• Cardiovascular medications:
  • Antihypertensives that may cause orthostatic hypotension 1
  • Diuretics 1
• Polypharmacy: Taking multiple medications increases fall risk 1
• Other high-risk medications: Opioids, antiepileptics, and urological spasmolytics 1

Environmental Hazards

• Home hazards:
  • Poor lighting, especially in stairways and bathrooms 1
  • Loose rugs and mats 1
  • Lack of handrails or grab bars 1
  • Clutter and tripping hazards 1, 6
  • Slippery floors 1
• Public environment hazards:
  • Uneven sidewalks 5
  • Poorly designed curbs and steps 5
  • Inadequate time at pedestrian crossings 1

Behavioral Factors

• Fear of falling: Creates a cycle of reduced activity, deconditioning, and increased fall risk 1
• Risk-taking behaviors: Climbing on unstable surfaces, hurrying 1
• Alcohol consumption: Affects balance and judgment 1

Epidemiology and Impact

• Falls are the leading cause of injury in adults aged 65 years or older 2, 7
• 27.5% of older adults report falling at least once per year 7
• 10.2% report an injury from a fall in the past year 7
• Fall rates increase with age: 27% in adults 65-74 years and 37% in adults 85+ years 2
• In 2018, falls resulted in approximately 3 million emergency department visits, 950,000 hospitalizations, and 32,000 deaths among older adults 7
• More than 90% of hip fractures are caused by falls, with 25% of older adults who sustain a hip fracture dying within 6 months 2

Clinical Implications

The multifactorial nature of falls requires comprehensive assessment and targeted interventions. Most effective fall prevention strategies include:

1. Exercise interventions: Balance training, gait training, and strength exercises can reduce falls by 23% 1, 3
2. Medication review: Discontinuing or reducing doses of high-risk medications 1, 4
3. Home safety assessment and modification: Removing hazards and installing safety features 1, 6
4. Vision correction: Early cataract surgery has been shown to reduce fall rates 3, 4
5. Multifactorial interventions: Systematic assessment and management of multiple risk factors can reduce falls by 23% in high-risk individuals 3

Common Pitfalls in Fall Risk Assessment

• Focusing on a single risk factor when falls are typically multifactorial 6
• Overlooking medication review as a critical component of fall prevention 1
• Failing to assess home environment where many falls occur 1
• Not considering fear of falling which can lead to activity restriction and deconditioning 1
• Missing subtle gait and balance impairments that require specific testing to identify 2, 1

Understanding these common causes of falls allows for targeted assessment and intervention strategies to reduce fall risk and maintain independence in older adults.