What is a Mechanical Fall?
A mechanical fall is not a clinically valid concept and should be eliminated from clinical terminology as it inaccurately implies a benign etiology for an older person's fall. 1
Definition and Misconceptions
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 commonly used in clinical settings but lacks a standardized definition and clinical implications, often incorrectly attributing falls solely to extrinsic environmental factors while ignoring potential intrinsic causes. 1
Research shows there is little difference in associated conditions, fall evaluation, ED revisit rates, recurrent falls, subsequent hospitalizations, and mortality between falls labeled as "mechanical" versus "nonmechanical." 1
The Problem with the Term "Mechanical Fall"
Using the term "mechanical fall" may lead clinicians to conduct less thorough assessments of potential underlying intrinsic causes of falls. 1
Studies have found that even falls labeled as "nonmechanical" frequently have associated environmental factors (more than 25%), demonstrating the inconsistent application of this terminology. 1
The term creates a false dichotomy that doesn't reflect the multifactorial nature of falls in older adults, where both intrinsic and extrinsic factors typically interact. 1, 2
Actual Fall Mechanisms
Falls can be categorized more accurately based on biomechanical causes:
- Unrecoverable limb collapse (59.8% of falls in one study)
- Anteroposterior instability (32.0%)
- Mediolateral instability (8.2%) 3
Most recurring falls (86.4%) happen due to the same biomechanical cause, suggesting that identifying the true mechanism is important for prevention. 3
Risk Factors for Falls
Falls generally result from an interaction of multiple risk factors that can be classified as:
- Intrinsic factors: lower extremity weakness, poor grip strength, balance disorders, functional and cognitive impairment, visual deficits 2
- Extrinsic factors: polypharmacy (four or more prescription medications), environmental hazards such as poor lighting, loose carpets, lack of bathroom safety equipment 2
The risk of falling increases dramatically as the number of risk factors increases, demonstrating the synergistic effect of multiple factors. 2
Proper Fall Assessment Approach
Instead of labeling falls as "mechanical," a comprehensive fall risk assessment should be conducted, including:
- Evaluation of gait and balance disorders
- Assessment for postural hypotension
- Medication review, especially those that increase fall risk
- Evaluation of sensory impairments
- Assessment of environmental hazards 4
Multifactorial interventions should be tailored to the individual's specific risk factors identified during assessment. 4, 2
Conclusion
The term "mechanical fall" should be eliminated from clinical use as it is unclear, inconsistently applied, and does not predict outcomes or guide appropriate evaluation. 1
Falls should be recognized as complex events resulting from the interaction of multiple intrinsic and extrinsic factors that require thorough assessment and targeted interventions. 2, 4