From the Guidelines
Falls are caused by both intrinsic and extrinsic factors that often interact to increase risk, including age-related physiological changes, chronic medical conditions, medication effects, and functional impairments, as well as environmental hazards and external circumstances that create unsafe conditions. Intrinsic causes originate within the individual and include age-related physiological changes, chronic medical conditions, medication effects, and functional impairments. Common intrinsic factors include:
- Muscle weakness
- Balance disorders
- Visual impairment
- Cognitive decline
- Orthostatic hypotension
- Certain medications like sedatives, antihypertensives, and psychotropics Specific medications that increase fall risk include benzodiazepines (lorazepam, diazepam), antipsychotics (risperidone, quetiapine), and some blood pressure medications (lisinopril, metoprolol) that can cause dizziness. Extrinsic causes are environmental hazards and external circumstances that create unsafe conditions, including:
- Poor lighting
- Uneven walking surfaces
- Loose rugs
- Cluttered pathways
- Lack of grab bars in bathrooms
- Inappropriate footwear
- Inadequate assistive devices Prevention requires addressing both types of factors through medication reviews, strength and balance training, vision correction, home safety modifications, and proper footwear, as supported by recent studies such as 1 and 1. Understanding these causes is essential because falls rarely result from a single factor but typically involve multiple intrinsic vulnerabilities combined with environmental challenges.
From the Research
Intrinsic Causes of Falls
- Intrinsic causes can be divided into age-related physiological changes and pathological predisposing conditions 2
- Age-related physiological changes include:
- Sight disorders
- Hearing disorders
- Alterations in the Central Nervous System
- Balance deficits
- Musculoskeletal alterations
- Pathological conditions can be:
- Neurological
- Cardiovascular
- Endocrine
- Psychiatric
- Iatrogenic
- Intrinsic factors such as lower extremity weakness, gait disorders, effects of medications, or acute illness can contribute to falls 3
- Intrinsic reasons for falls can occur mainly during rest or sleep hours, and are often associated with moderate or severe disturbances in attention and concentration 4
Extrinsic Causes of Falls
- Extrinsic causes of falls include environmental factors such as:
- Obstacles
- Inadequate footwear
- Slippery floors
- Uneven and unfamiliar environments
- Extrinsic factors can contribute to falls in people with Parkinson's disease, particularly when combined with behavioral and intrinsic factors 5
- Extrinsic reasons for falls can occur at all hours of the day and night, mainly in people who are alone and wearing shoes or sandals at the time of the fall 4
- Accidents and extrinsic causes can account for approximately half of falls in the elderly 3