Fall Injuries and Prevention in Older Adults

In the United States, falls and fall-related injuries occur frequently [1]. Among the population aged 65 years and older, about 25% of people experience a fall annually [1]. While these falls do not always result in serious injury or fatality, they are still incredibly costly and risky overall [1]. Each year, falls and related injuries account for at least $50 billion in medical costs, 2.8 million visits to emergency departments, and 27,000 deaths [1]. Falls are also a major contributor to hospital readmission rate [2]. Considering that fewer than 25% of fall-related injuries are accurately reported, these numbers are likely an underestimate [3]. Accordingly, it is essential to know the risk factors associated with fall injuries, as well as the ideal prevention techniques necessary to reduce the ubiquity of this occurrence, especially among older adults.

The risk factors for fall injuries are manifold. They include environmental factors, such as uneven floors, missing hand-rails, and poor lighting [4]. Chronic conditions that affect mobility and/or cognition, such as Parkinson’s Disease, stroke, diabetes, and arthritis, can increase an older adult’s likelihood experiencing a fall and subsequent injuries [5]. Additionally, acute illnesses like pneumonia and urinary tract infections augment the likelihood that a person will fall [5]. Physiologically, visual and hearing impairments, sarcopenia, low body mass index, and postural hypertension can also heighten the risk of falling among older adults [5].

Over recent years, further research has revealed more unintuitive risk factors. For instance, Lohman, Fairchild, and Merchant identified a possible association between antidepressant medication use and falls and fall injuries [1]. In their study of 3,565 community-dwelling older adults (aged 65 years or older), antidepressant medication accounted for about 19% and 18% of the association between major depressive disorder and falls and fall injuries respectively [1]. Other psychoactive medications have also been associated with greater fall risk [5].

Fall prevention is an essential element in the care of older adults, particularly those with several risk factors. However, it can be difficult to successfully navigate, with patients, payers, providers, and the overall health care system often impairing the quality of care available to older adults. Furthermore, strategies that appear as though they would be beneficial can fail to reduce fall rates. One such example is multifactorial interventions, such as the one studied by Bhasin in 2020 [6]. Despite providing patients with individualized plans and risk assessments, all administered by specialized nurses, the rate of fall injury did not diminish compared to standard care [6].

This is not to say that all multi-pronged approaches are unsuccessful: Kruschke and Butcher recommended an evidence-based ten-step protocol including fall, gait, and balance screening [4]. Unfortunately, those experimenters did not provide data on the success of their protocol [4]. However, other studies indicate that some multifactorial intervention programs can reduce the rate at which older adults fall [5]. Along with incorporating various screenings and risk factor-specific guidelines, medical practitioners should also advise their patients to regularly engage in physical activities, such as Tai Chi [5]. As seen with antidepressants, doctors should prescribe psychoactive medications with potential effects on fall risk in mind.

Because of the multitude of factors that can influence patients’ likelihood of falling, fall prevention is difficult to navigate. Regardless, analyzing risk factors, adjusting medications, screening appropriately, and promoting regular exercise can help reduce fall risk and rate.


[1] M. C. Lohman, A. J. Fairchild, and A. T. Merchant, “Antidepressant Use Partially Mediates the Association Between Depression and Risk of Falls and Fall Injuries Among Older Adults,” The Journals of Gerontology: Series A, vol. 76, no. 9, p. e171-e178, October 2020. [Online]. Available: https://doi.org/10.1093/gerona/glaa253.  

[2] G. J. Hoffman et al., “Posthospital Fall Injuries and 30-Day Readmissions in Adults 65 Years and Older,” JAMA Network Open, vol. 2, no. 5, p. 1-12, May 2019. [Online]. Available: https://doi.org/10.1001/jamanetworkopen.2019.4276

[3] G. J. Hoffman et al., “Underreporting of Fall Injuries of Older Adults: Implications for Wellness Visit Fall Risk Screening,” Journal of the American Geriatrics Society, vol. 66, no. 6, p. 1195-1200, April 2018. [Online]. Available: https://doi.org/10.1111/jgs.15360

[4] C. Kruschke and H. K. Butcher, “Evidence-Based Practice Guideline: Fall Prevention for Older Adults,” Journal of Gerontological Nursing, vol. 43, no. 11, p. 15-21, October 2017. [Online]. Available: https://doi.org/10.3928/00989134-20171016-01

[5] R. E. Taylor-Piliae and R. Peterson, “Clinical and Community Strategies to Prevent Falls and Fall-Related Injuries Among Community-Dwelling Older Adults,” Nursing Clinics, vol. 52, no. 3, p. 489-497, September 2017. [Online]. Available: https://doi.org/10.1016/j.cnur.2017.04.004

[6] S. Bhasin, “A Randomized Trial of a Multifactorial Strategy to Prevent Serious Fall Injuries,” The New England Journal of Medicine, vol. 383, p. 129-140, July 2020. [Online]. Available: https://doi.org/10.1093/gerona/glaa253.