Who's at risk for a fall? Unpacking the common risk factors across age groups

According to the Centers for Disease Control and Prevention (CDC), more than one in four Americans age 65 or older falls each year. Knowing who's at risk for a fall is the crucial first step toward prevention, as factors vary significantly depending on age, health status, and environment.

Quick Summary

This article details the many intrinsic and extrinsic factors that contribute to an individual's fall risk, covering different age groups and health conditions. It provides a comprehensive overview of physical, medical, and environmental hazards to help people understand and mitigate their personal risk.

Key Points

• Age is a primary factor: Older adults, especially those over 65, and young children are at the highest risk for falls, although for different reasons.

• Chronic conditions are major contributors: Diseases like Parkinson's, diabetes, arthritis, and heart conditions can impair balance, strength, and reflexes, increasing fall risk.

• Environmental hazards are key culprits: The majority of older adult falls occur at home due to tripping hazards like clutter, poor lighting, and loose rugs.

• Medications can increase risk: Many drugs, including antidepressants, sedatives, and blood pressure medications, can cause dizziness or confusion, especially when multiple medications are taken.

• Children face developmental risks: Falls in young children are often linked to evolving motor skills, natural curiosity, and inadequate supervision, with playgrounds and furniture posing frequent hazards.

• Previous falls and fear compound the issue: Having one fall doubles the risk of another, and the resulting fear can lead to reduced activity that further weakens muscles and balance.

• Sensory deficits are critical factors: Impaired vision and hearing can affect balance and the ability to perceive and avoid hazards, leading to a higher risk of falls.

• Lifestyle matters: Factors like poor nutrition (especially vitamin D deficiency), dehydration, and inadequate footwear contribute significantly to fall risk.

Falls are a major public health concern, but they are not an inevitable part of aging or a sign of clumsiness. For many, falls are the result of a combination of risk factors that are often manageable. By understanding the specific triggers that make someone susceptible to a fall, proactive steps can be taken to reduce the risk. While older adults face the highest risk of serious injury from falls, other populations, including children and adults with certain medical conditions, are also vulnerable.

Intrinsic risk factors (related to the individual)

These are internal factors concerning a person's physical and mental state. As individuals age, a natural decline in strength, balance, and reflexes is expected, but certain health conditions can accelerate this decline.

• Age and previous falls: Simply being over the age of 65 significantly increases fall risk. A history of one fall doubles the risk of falling again. Women, in particular, face a higher risk of fall-related injuries.
• Medical conditions: Chronic illnesses often involve symptoms or treatments that can affect balance and mobility.
  • Neurological disorders: Conditions like Parkinson's disease, dementia, and stroke directly impact coordination and gait.
  • Cardiovascular issues: Arrhythmias, orthostatic hypotension (a drop in blood pressure when standing), and other heart diseases can cause dizziness and fainting.
  • Arthritis and osteoporosis: Arthritis causes joint pain and stiffness that affects mobility, while osteoporosis weakens bones, making fractures more likely in a fall.
  • Diabetes: Nerve damage (neuropathy) from diabetes can cause numbness or pain in the feet, affecting balance.
• Physical impairments:
  • Lower body weakness: This is a primary risk factor, as it impacts the strength needed for walking and standing.
  • Poor balance and gait: Trouble with walking or an unsteady gait makes a person more prone to stumbles and trips.
  • Sensory deficits: Poor vision, especially with conditions like cataracts or glaucoma, makes it hard to see obstacles. Hearing loss can also impair balance.
• Psychological and cognitive factors:
  • Fear of falling: The fear of falling can cause individuals to limit their activity, ironically leading to decreased mobility and an increased risk of a fall.
  • Cognitive impairment: Memory issues and poor judgment can increase risk, especially in unfamiliar environments.

Extrinsic risk factors (related to the environment)

These are external hazards that can cause a fall, regardless of a person's physical condition. The majority of falls for older adults happen in the home.

• Home hazards:
  • Clutter: Piles of papers, cords, and furniture in walking paths are common tripping hazards.
  • Poor lighting: Inadequate lighting, especially on stairs and in hallways, can make it difficult to see obstacles.
  • Slippery surfaces: Wet floors, loose throw rugs, and a lack of non-slip mats in bathrooms create a high risk of slipping.
  • Stairs and bathrooms: Missing or insecure handrails on stairs and a lack of grab bars in bathrooms are significant dangers.
• Outdoor hazards: Uneven sidewalks, icy or wet surfaces, and poorly lit walkways pose threats outside the home.

Lifestyle and behavioral risk factors

Personal habits and choices can also influence fall risk.

• Medications: Many prescription and over-the-counter drugs, including sedatives, antidepressants, blood pressure medications, and some antihistamines, can cause dizziness, drowsiness, or affect balance. The risk increases with polypharmacy, or taking four or more medications.
• Footwear: Ill-fitting shoes, walking in socks on slippery floors, and backless slippers can all contribute to falls.
• Dehydration and poor nutrition: Not drinking enough fluids or having a vitamin D deficiency can cause dizziness, muscle weakness, and fatigue.
• Physical inactivity: A sedentary lifestyle leads to muscle weakness and reduced balance over time, increasing fall risk.

Comparing fall risk factors: Older adults vs. children

While falls are a serious concern for both groups, the reasons and preventative measures differ significantly.

Factor	Older Adults	Children
Primary Cause	Intrinsic factors (medical conditions, balance issues, aging) combined with environmental hazards	Extrinsic factors (environmental hazards, inadequate supervision) combined with developmental factors (evolving motor skills, curiosity)
Environment	The home is a major source of hazards, including clutter, poor lighting, and loose rugs.	Hazards include playground equipment, furniture, stairs, and windows. The home is a frequent location for falls.
Cognitive Aspect	Cognitive decline (dementia) can affect judgment and awareness of hazards.	Immature motor skills, lack of judgment, and risk-taking behavior are key factors.
Medical Conditions	Chronic conditions like Parkinson's, diabetes, and heart disease are significant risk factors.	Medical issues like seizures, certain medications, and long hospital stays can increase risk.
Medication Risk	Polypharmacy and side effects from various medications are major concerns.	Medication use is a less frequent but still relevant factor, especially in hospital settings.
Supervision	Often self-managed, with interventions potentially requiring family or caregiver assistance.	Inadequate supervision is a key risk factor, particularly for young children.

A case study: The role of chronic conditions

One of the most complex areas of fall risk involves adults with chronic health conditions. A person with arthritis, for example, may experience pain and stiffness that limits their activity. This reduced activity leads to muscle weakness and poorer balance, creating a cycle that increases fall risk. The National Council on Aging highlights that program participants with multiple chronic conditions are at higher risk. Similarly, an individual with diabetes may face nerve damage in their feet, reducing their ability to sense uneven ground, coupled with potential vision loss and issues from blood sugar fluctuations. For people with cardiovascular diseases, medication side effects, such as dizziness from blood pressure medication, or conditions like arrhythmias, pose a constant threat. An effective risk reduction strategy for these individuals must address both the underlying condition and its related side effects, alongside regular exercise and environmental modifications.

Conclusion

Assessing who's at risk for a fall requires a holistic view that considers a wide range of intrinsic and extrinsic factors. For older adults, this often involves managing chronic health conditions, reviewing medications, and modifying the home environment. For children, the focus is on constant supervision and ensuring a safe play and home environment that accounts for their evolving development. While specific risk factors may differ by population, the core principle remains consistent: fall prevention is a multi-faceted effort that combines individual health management with strategic environmental awareness. Engaging in regular physical activity, conducting routine health checks, and maintaining an awareness of personal and environmental hazards are key steps toward mitigating risk and promoting safety for everyone.

Call to action for caregivers

For caregivers of older adults, a home safety checklist is an invaluable tool. Look for and address potential hazards like loose rugs, cluttered walkways, and poor lighting. Ensure your loved one's assistive devices, such as canes or walkers, are in good condition and used correctly. For parents and caregivers of young children, proactive measures are crucial. Anchor heavy furniture, install safety gates at the top and bottom of stairs, and supervise children on playgrounds. Remember that a proactive approach can make a significant difference in preventing falls and ensuring safety.

Note: While some factors like age are non-modifiable, many others, including medication side effects and environmental hazards, can be addressed with appropriate interventions. Consulting with a healthcare provider to create a personalized prevention plan is highly recommended.

Visit the CDC's STEADI initiative for resources on fall prevention

Frequently Asked Questions

What is the single biggest risk factor for falls in older adults?

While multiple factors often contribute to a fall, having a history of falling once is the single biggest predictor of falling again. Other major factors include lower body weakness, poor balance, and certain medications.

How can medication increase a person's fall risk?

Many medications, such as sedatives, antidepressants, and blood pressure drugs, have side effects like dizziness, confusion, or drowsiness that can impair balance. The risk is higher for individuals taking four or more medications (polypharmacy) or when a new medication is started.

What are common environmental hazards that lead to falls?

Common home hazards include cluttered walkways, poor lighting (especially on stairs), loose throw rugs, and slippery surfaces in bathrooms. Outdoors, uneven or wet sidewalks and icy patches also pose a risk.

Are children at risk for falls?

Yes, children are at risk, with their fall risks often linked to their developmental stage, immature motor skills, and curiosity. Common hazards include falls from furniture, stairs, windows, and playground equipment, with inadequate supervision being a significant factor.

How can a fear of falling increase the risk of a fall?

A fear of falling can cause a person to limit their physical activity. This sedentary behavior leads to decreased muscle strength and balance over time, which, paradoxically, increases the likelihood of a fall.

How do chronic conditions, like diabetes and arthritis, impact fall risk?

Chronic conditions can impact fall risk in several ways. For example, arthritis causes painful joints that limit movement, while diabetes can cause nerve damage that affects sensation in the feet. Both can reduce mobility and increase the risk of a fall.

What role does vision play in fall risk?

Poor vision makes it difficult to see obstacles and judge distances accurately. Conditions like cataracts or glaucoma can significantly impair vision, and even outdated glasses prescriptions can increase the risk of a fall.