Falls and their consequences are the leading cause of death in people 65 years and older. For people 85 and older, it’s estimated that one in five falls results in death.

The accident myth Until recently, most falls have been blamed on a single cause—precipitated by either a medical event or an “accident” related to the environment. Today, researchers know that falls are rarely the result of an isolated event. Rather, falls are complex events caused by the interaction of both internal and external factors.

Most falls represent the end result of a series of independent and often small risks. Individually, such risks pose no harm. Young and able-bodied people can manage avoiding many daily mishaps so naturally, they never even realize it. Eventually though, age, disability or compromised health not only creates its own risks, it can make it impossible to deal with even the simplest environmental risks. Often, a fall “happens” (meaning, factors set it in motion) long before the victim encounters the event. As relatives and caregivers, it becomes our responsibility to recognize and correct those factors—both physiological and environmental— and break the chain of risk, before a fall occurs. Prevention is no accident.

Internal risk factors

A number of physiological and medical factors play a role in causing falls. Understanding these can help you reduce the risks from these and other factors.

Here are a few major ones.

Changes in muscles and bones. Changes in muscles and joints not only make movement more difficult, they also make it harder to correct for a sudden loss of balance. Loss of strength in the legs or upper arms limits the ability to transfer in and out of bed or a chair. Orthopedist prescribed orthotics, like knee braces, can do wonders for improving stability and balance.

Vision changes. As people get older it becomes harder for the eyes to adjust to varying levels of lightness and darkness. We become more sensitive to glare. Decreased depth perception also makes it hard to distinguish high-contrast patterns from actual elevation changes.

Balance problems. Aging naturally diminishes the body’s natural automatic reflexes that enable people to properly interpret and re-orient their center of gravity as they move or walk. Changes in gait (such as walking with a narrower or wider stance than usual) increase the risk of catching a foot on an obstruction.

Cardiovascular difficulties. Numbness in the limbs affects the ability to sense the ground or command their limbs to adjust to it. Cardiovascular problems can also cause sudden loss of blood to the brain, resulting in fainting.

Medications. Many drugs (including alcohol) affect judgment and coordination. Tranquilizers can slow reflexes. Others increase the risk of fainting.

Chronic or acute diseases. Falls may often be the initial symptom of a disease.

Degenerative disorders only compound the risk of falls. Depression, stress or lack of sleep. Such issues can make people preoccupied and less alert to the dangers around them.

External risk factors

People’s environment (both indoors or outdoors) plays a major role in exposing them to falls. Falls in the bedroom bathroom, and dinning areas are the most common places where falls happen—reflecting the amount of time spent in those areas.

Relocation—such as moving between a home and a nursing facility, hospital, or even a relative’s home—can greatly increase the risk of falls, particularly in frail older people. Lack of familiarity to floor surfaces and distance is only aggravated by a lack of expected visual clues for depth perception. Stress only makes it worse. Within these areas, here are some major items to consider and things you can do to limit the risk these environmental factors play.

Lighting. Is there plenty of light in every room and along hallways and in stairways? Is there emergency lighting or a flashlight within easy reach?

Bathroom and kitchen. Are there grab bars in the tub or shower and by the toilet? Are there non-slip bath strips or mats in the tub or shower? A bath bench and a raised toilet seat are valuable additions. In kitchens, countertops should be glare-free. Often used items should be kept within easy reach.

Flooring. Are all rugs (including bathroom rugs) tacked down or secured with nonskid pads? All carpeting should be low pile. Only no-wax cleaners should be used on floors—and shine should be eliminated as much as possible to reduce glare.

Stairways. Hand rails are a necessity on both sides of stairways and outside steps. Care must be taken to ensure these hand rails are secure, so they do not wobble and induce a loss of balance. Steps should also have non-skid treads. Marking the edge of the first and the last step with a color strip provides a helpful visual clue.

Furniture and living areas. Arrange furniture so it doesn’t block walking areas. Make sure all electrical cords are out of the way. Special care should be taken to ensure that the floor is kept clear of all toys, games and even pet items.

What you can do to lessen the risks

While specific internal and external factors themselves seldom cause falls independently,  the more you can do to manage, reduce or eliminate each risk will help prevent these factors from overlapping and causing a fall. Here are just a few ways you can help the elderly to defend themselves from situations that lead to falls.

Evidence suggests that falls can be reduced by 50% when an individual’s risks of falling are assessed and action taken to reduce them.

—British Medical Journal, January, 2008

Engage in regular physical activity. Helping elderly people remain physically active improves their balance, flexibility and strength, alleviates stress and depression, increases alertness and strengthens the heart and circulatory system. Even simple exercises such as stretching while in bed can improve the ability to stand, walk and even improve the reflexes needed to arrest impending falls. 

Manage a healthy diet. While seniors tend to eat less than younger people, it’s important not to skip foods. Limit alcohol consumption, too, since it can adversely affect alertness and coordination.

Monitor medications. Use a log to keep track of the medications being taken by the person you’re caring for. Learn their side effects, especially if they affect alertness or balance, as tranquilizers do. It’s best to limit or avoid physical activities when under the effects of such medications.

Schedule regular checkups. Even if your loved one is feeling fine, it’s important to have regular physical, vision and hearing exams. Eyeglasses and hearing aids should be worn as instructed and have the most up-to-date prescription.

Dress for success. Safety starts with sturdy shoes. Nonskid soles, flat bottoms and good support are essential. Walking around in socks or smooth soled slippers can be dangerous. Sunglasses and a broad brimmed hat are also important to reduce glare.

Provide proper equipment. A doctor, physical therapist or a medical equipment supplier can help you choose the best cane, walker, or wheelchair. A power assisted seat-lift chair may be a wise furniture investment. You may also want to provide a personal emergency response device that a senior can activate, or hire a monitoring service that will call often and will send help if no one responds.

Learn more, and share the knowledge

Be sure to speak with your family and helpful neighbors, as well as the person you’re caring for. Discuss the risks and how to prevent falls.

Call Home Care Assistance now toll-free at

1-877-254-4860 to receive a free pamphlet,

Preventing Slips and Falls in the Home.

We can also recommend other books about falls:

Perkins-Carpenter, Betty. How to Prevent Falls. New York: Senior Fitness Productions, 2006. Tideiksaar, Rein. Falls in Older People: Prevention & Management. Baltimore: Health Professionals Press, 2002.