Risk for Elderly - Falling

Old people fall more often than young and middle-aged adults, and this is a concern because older people are also more susceptible to injury. Preventing falls can stop many cases of bone fracture from happening among the elderly. In addition to having more brittle bones than young people, older people tend to have worse senses of balance. Both muscle weakness, especially in the legs (quadriceps), and unstable postures contribute to a propensity to falls.

Falls are a serious health problem and kill the person or, more likely, can trigger a downward cycle leading to the person entering a nursing home. It is estimated that 30 percent of seniors (past age 65) fall over the course of a year (US numbers). The CDC says unintentional injury is the sixth leading cause of death among old people, and that category includes falls. Indeed, within the category of death from injury, falls are number one.


People sometimes pooh-pooh the idea that balance is a skill, but we all know that children learning to ride bikes must develop this skill. Even younger children develop the skill to maintain balance while walking upright. It should not be surprising that the elderly have to relearn this skill in the face of declining bodily functions. Balancing a body is complex. In normal function it employs your bones (including joints), nervous system, inner ear, vision, and muscles. You might learn to adapt when one of these systems declines or fails, but it is not a “walk in the park.”

Specific things that can throw a person’s balance off include loss or blur of vision, delirium, dizziness, and syncope or presyncope. Strokes affect the central nervous system and people who have suffered strokes are more likely to experience a fall.

Doctors have methods of assessing a person’s ability to maintain balance and ways to assess and classify gait. If the person has not fallen recently, the medical team may overlook this risk but some nurses and doctors are cognizant of the benefits of screening

Researchers found that very small vibrations applied to the soles of the feet can help people maintain their balance. This technology has yet to become widespread, but it could be good news.

Related to balance is the sense we have called Proprioception. This allows us to figure out where we are in space and how our body is configured, and it is part of how we live in the world. When a toddler learns to walk, he or she is running developing proprioception. The sense relies on receptors in the body that send information to the brain. Some of these receptors are in the ears which is why people with ear problems often love their sense of balance. As we age these receptors fail or cannot transmit information as readily. This is why older people have greater problems maintaining their balance.

Evaluating Balance Risk

The Tinetti Balance and Gait test evaluates mobility and assesses a patient's fall risk. Developed by Mary Tinetti in the 1980s, it has found widespread use.

Boston University’s website published a worksheet to evaluate gait and balance (the Tinetti Evaluation). BU Worksheet (PDF). A physician is not required to administer this test, which should take no more than a half hour.

Another worksheet (PDF)

Another very simple test is the Get Up and Go test. The subject sits in a chair about 10 ft from a door. The tester uses a stopwatch to keep time. When the tester says "go" the subject stands up and walks to the door. The subject then walks back to the chair and sits down. The tester measures time from “go” until the subject is sitting in the chair. If this time is greater than 12 seconds, the subject is considered to be at risk of falling or having trouble walking.

Risk Factors

Just as medical diseases have risk factors, so do falls. Risk factors are not causes; they are events or conditions that statistically correlate with the incidence of falls. Age is the biggest risk factor as it is for most geriatric syndromes.

Medical risk factors: sarcopenia, kyphosis, orthostatic hypotension, poor vision, arrhythmia, and use of medications that induce drowsiness.

Environmental risk factors: slippery walkways, loose rungs, bad lighting, bathroom equipment without te right equipment.

Alcohol and Medicines

Older people tend to take more medicines than younger ones, and that can increase the risk of losing one’s balance. The National Institute on Aging says alcohol is a factor in 60 percent of falls.


Most falls happen at home. The National Institute on Aging has advice about fall-proofing your home: https://www.nia.nih.gov/health/fall-proofing-your-home. Measures to stop falls can focus on the person’s body, his or her behavior, and his or her environment (living space).

The Census Bureau reports that one in four Americans past age 65 fall in a given year with direct medical costs of $50 billion. 10 percent of homes are aging-ready. A quarter of older households have trouble with some feature of the home.

Benefits of exercise: a study shows that activity is linked to better proprioceptive capacity and reduce the risk of falls.

Living area

The patient, his or her caretakers, or children can help reduce the hazards posed by falls by taking common-sense measures.

You want to avoid

  • Bad lighting
  • Loose rugs and carpets
  • Slippery floors and walkways
  • Placement of shower/bathtub/toilet in a place that is difficult to get to

Measures to reduce the risk of falls include

  • Brighter lights
  • Handrails on staircases
  • Handrails in bathrooms

See also section on wheelchairs.