What is a mechanical fall?

What is a Mechanical Fall?

A mechanical fall is a term that is unclear, inconsistently used, and should be eliminated from clinical practice as it inaccurately implies a benign etiology for an older person's fall. 1

Definition and Problems with the Term

According to the BMJ guidelines, a fall is properly defined as "a sudden, unintentional change in position causing an individual to land at a lower level, on an object, the floor, or the ground, other than as a consequence of sudden onset of paralysis, epileptic seizure, or overwhelming external force." 2

The term "mechanical fall" is problematic because:

• It falsely suggests that falls can be neatly categorized as either "mechanical" (caused by external/environmental factors) or "non-mechanical" (caused by intrinsic medical conditions) 1
• It often leads clinicians to conduct less thorough evaluations by prematurely attributing falls to environmental factors 1
• Research shows there is little difference in associated conditions between falls labeled as "mechanical" versus "non-mechanical," except that those labeled "mechanical" had more environmental causes but fewer syncope causes 1

Why the Term Should Be Abandoned

The 2016 study in the American Journal of Emergency Medicine found that:

• More than a quarter of falls labeled as "non-mechanical" still had associated environmental factors 1
• There was little difference in fall evaluation, ED revisit rates, recurrent falls, subsequent hospitalizations, and mortality between falls labeled as "mechanical" versus "non-mechanical" 1
• The term does not predict outcomes and may lead to inadequate clinical assessment 1

The Reality of Falls in Older Adults

Falls in older adults are typically multifactorial with both intrinsic and extrinsic components:

• One-third of older persons living at home (65+) fall annually 2
• Falls are the leading cause of injury-related death among persons aged 65 and over in the USA 2
• 90% of fractures in older adults are caused by falls from standing height or lower 3

Proper Approach to Fall Assessment

Instead of using the term "mechanical fall," clinicians should:

1. Recognize that falls are complex events with multiple contributing factors
2. Conduct a thorough assessment of both intrinsic and extrinsic risk factors
3. Consider that a person older than 65 years is at risk of falling if they:
   • Present with a fall
   • Report at least one injurious fall or two or more non-injurious falls
   • Report or display unsteady gait or balance 2

Key Risk Factors to Assess

• Intrinsic factors: Balance impairments, gait abnormalities, muscle weakness, medication effects (especially psychoactive medications), vision problems, cognitive impairment, and chronic conditions 4
• Extrinsic factors: Home hazards, improper footwear, inadequate lighting, and unstable furniture 4

Conclusion

The term "mechanical fall" should be eliminated from clinical practice as it creates a false dichotomy between intrinsic and extrinsic causes of falls, potentially leading to inadequate assessment and missed opportunities for intervention. All falls in older adults warrant a comprehensive evaluation of both intrinsic and environmental factors to properly address fall risk and prevent future falls.