Introduction
The World Health Organisation defines fall as “an event which results in a person coming to rest inadvertently on the ground or floor or other lower level.” About 684,000 falls are reported each year worldwide involving all ages1. However, accidental falls are more common in the elderly (over the age of 65 years). An estimated 30% of the elderly population have one or more falls each year, increasing up to 50% in adults over 80 years, worldwide2. By 2050, there are expected to be about 200 crore (2 billion) people over the age of 60 years worldwide. In India, the percentage of elderly people is estimated to be 12.4% of the entire population by the end of 20263. About 10 lakh (1 million) elderly people die in India annually, and almost twice as many are injured due to accidental falls. About 10% of the elderly experience recurrent falls4. This can lead to increased health care costs, especially out-of-pocket expenses. Accidental falls in the elderly are fast becoming a major health concern, leading to mental health issues in them and impacting their quality of life5. Fall prevention in the elderly and management of related injuries is a critical challenge for health care personnel globally.
Who is at Most Risk?
Although anyone can fall anytime, certain groups of people are at a higher risk of experiencing a fall, such as:
- Increasing age, women, more than men of the same age
- People with a previous episode of accidental falls
- People with special socioeconomic factors like poor nutrition or individuals staying alone (single individuals)
- People with certain medical conditions like:
- Parkinson’s disease
- Osteoporosis (women are more prone to osteoporosis)
- Cataracts
- Incontinence of urine
- Joint pain, arthritis, osteoarthritis
- Dementia
- Orthostatic or postural hypotension
- Numbness in the feet (peripheral neuropathy as seen in diabetes
- Stroke
- Diabetes
- Cardiac arrythmias (heart rate disturbances) and other heart conditions
- Dehydration
- Orthostatic hypotension (a condition where there is a sudden fall in blood pressure when you change positions quickly, like sitting to standing)
- Sarcopenia (muscle weakness)
- Labyrinthitis and vestibular dysfunction (ear problems that can lead to poor balance)6,7,8
- People taking certain medications like:
- Antidepressants
- Antiepileptics
- Antipsychotics
- Sedatives like benzodiazepines
- Opioids as pain medication
- Antihistamines for allergies
- Muscle relaxants
- Diuretics
- Antidiabetics
- Blood pressure medications6,7,8
- People who use walking sticks or walkers
- People who smoke and/or consume alcohol5.
Causes of Falls in the Elderly
There is no one specific reason why the elderly fall. However, there are several factors which can increase the risk of falls and injury in the elderly. Some of these include:
1. Extrinsic or environmental factors
- Uneven flooring, stairs, bunched up carpets, wet and slippery floors
- Inadequate lighting, cramped spaces, clutter
2. Intrinsic or personalised factors
- Improper footwear
- Poor vision
- Age-related balance or mobility issues
- People with certain medical conditions that can cause impaired balance, unsteady gait (way of walking), cognitive impairment (forgetfulness, poor thinking and judgment and inability to make decisions), disabilities, joint and muscle problems, hearing disability, and vision problems
- People taking certain medicines (mentioned in the section above)
3. Factors involving special circumstances
- Rushing to the bathroom or to answer the phone or doorbell
- Doing multiple things at a time causes distraction, for example, talking while walking
- Change to unfamiliar surroundings3,9.
Most falls are the result of a combination of one or more factors.
Symptoms of Falls in the Elderly
Symptoms such as dizziness or light-headedness often precede some accidental falls. Many accidental falls may not cause major injuries. However, it is best to watch out for the following symptoms after a fall that may lead to serious complications:
- Dizziness or light-headedness
- Headache
- Vision disturbances
- Pain around the joints and the muscles
- Difficulty in walking, moving, or getting up
- Unconsciousness, strange behaviour
- Bruises and bleeding cuts
- Clear fluid or bleeding coming out of the nose or ears
- Fits or seizures
Contact your doctor immediately if you have any serious symptoms after a fall10,11.
Diagnosis
There are no specific mandatory tests to be performed after a fall. However, doctors follow standard guidelines and may advise testing depending on the suspected cause of the fall, the type of injuries and your physical condition. These may include:
- A thorough physical examination to evaluate the risk and assess the cause of the fall. Blood pressure measurement (to rule out orthostatic hypotension), vision and hearing assessment, and an electrocardiogram.
- Doctors may perform one or more of the following tests to assess the balance and determine overall cognitive status in their clinics:
- Comprehensive Geriatric Assessment (CGA), involving 5 domains of health, when combined, also assesses the risk of falls
- Timed Up-and-Go Test for checking the gait
- 30-second Chair Stand test to check balance and strength
- 4-stage balance test for balance while standing in 4 different positions
- Berg balance test involving 14 tasks with scores allocated to each task (the lower the score, the higher the risk)
- Falls Efficacy Scale does not assess the risk of falls directly. It involves 16 activities with scores allocated to each activity on how concerned/fearful they are about falling (the higher the score, the greater the fear of falling)9,12.
- Blood tests for measuring blood glucose levels, electrolytes, haemoglobin, vitamin D levels, etc, to determine the cause of the fall.
- Imaging tests like X-rays, Ultrasound, CT scans, and/or MRIs to assess the damage, like broken bones, brain bleeds, etc., depending on your condition9,11.
Treatment of Falls in the Elderly
Treatment of falls in the elderly depends on the cause of the fall, the injuries caused by the fall and the physical condition. Broadly, they can be categorised as:
- Treatment of injuries, like casting for fractures, physiotherapy for sprains, dressing and care for cuts and wounds. Only pain medication may be given for minor injuries, while surgical management may be needed for major ones. Treatment for some injuries requires a specialised setting (especially head and neck injuries, and fractures). For instance, in case of head injuries, neuroimaging and monitoring for intracranial bleeding are done, and neurosurgical care may be needed.
- Treatment of the cause, like a change in medications, treatment of heart disease or muscle weakness, etc
- Prevention of recurrence with exercises for improving balance and muscle strength
Every treatment should be tailored to each case, specifically involving multiple specialists like doctors, nurses, physiotherapists, social and community workers, etc. It is best to discuss the treatment options with your doctor13,14.
How to Prevent Falls in the Elderly?
Although it may not be realistically possible to prevent falls completely, steps may be taken to reduce the chances of falling and fall-related injury in elderly. Fall prevention in the elderly requires a multidimensional approach, for example:
- Lifestyle changes and exercise programs
- Medical or clinical interventions
- Environmental or home modifications13,14.
Besides medical or clinical interventions, lifestyle changes and exercise programs should be incorporated in routine. Environmental or home modifications may be required to make the surroundings safer13,15.
Let’s have a look at these in detail in the next section.
Lifestyle and Environmental Changes
Making the elderly feel safe and building their confidence is of prime importance. Adopting certain lifestyle changes and following some safety guidelines can help reduce the risk of accidental falls, such as:
- Installing grab bars wherever necessary, especially in the bathroom and toilets
- Making things accessible easily, like light switches, telephones, cupboards, and cabinets
- Maintaining good and adequate lighting, and installing night lights wherever possible
- Removing clutter and making the furniture stable by removing wheels and rickety legs
- Using non-slip mats under the carpets, in the bathtubs or showers, on the stairs, in areas where it can be wet and slippery
- Keeping corridors and passageways clear of wires, cables, and cords
- Removing crumpled or folded carpets, floor rugs and such from the floors and hallways
- Replacing locks that can be opened from both sides to have access to a family member or medical team in case of an emergency.
- Using a cane or a walker of optimal height for support
- Using a personal alarm, emergency telephone or medical alert button, like a necklace or bracelet, with you always so that you can reach out for help in an emergency
- Wearing comfortable footwear with anti-slip soles
- Being mindful of your movements and surroundings. Get up or stand up slowly, taking enough time to adjust to the new position
- Switching to comfortable, functional, and adaptive clothing. Sit down and dress. Keep your ankles clear of fabrics to avoid tripping over them
- Resistance and/or strength training to improve balance and muscle strength
- Endurance training, like treadmills, bicycles
- Doing specific exercises focused on flexibility, functionality, and gait improvement, including Yoga and Tai Chi
- Being regular with general checkups, eye exams, and hearing tests
- Discussing with your doctor and being aware of the side effects of your medications, especially sleep medications like benzodiazepines (drowsiness), blood pressure medication (orthostatic hypotension), and medications used to treat mental health conditions like psychotropic medications Your doctor may prescribe safer combinations of medications or reduce the dosage of existing medications whenever possible to reduce your fall risk.
- Carrying a list of emergency contacts with you if someone else needs to contact your loved ones or caregivers
- Eating a balanced, nutritious diet and getting enough sleep
- Avoiding smoking and alcohol
- Supplementation with vitamin D and calcium (if advised), under medical supervision16, 17,18
Emergency Response and Follow-up
If you are attending to someone who has had a fall, call for an ambulance or emergency services if:
- The person is unconscious
- Is bleeding from cuts or through the ears or nose
- Has problems with moving, speaking, or understanding instructions or advice
- Is having seizures or fits10,11.
When to Seek Medical Help?
Many falls may cause only a slight injury or discomfort. However, if you do not recover from the mild symptoms within a couple of weeks, you should consult your doctor5,10. If you or someone around you is not feeling well or is uncomfortable after a fall, contact your doctor immediately. Seek medical help if you experience worsening of symptoms or developing new serious symptoms like:
- Vomiting
- Headaches
- Dizziness, sleepiness, or drowsiness
- Problems with vision, speech, orientation (like places and people), and balance
- Seizures or fits
- Clear fluid or blood from the nose or ears or worsening of bleeding
- Weakness in the limbs, unsteady walking or losing balance.
Conclusion
Falls in elderly are common and can be dangerous. A single fall can lead to a domino effect of health issues ranging from minor injuries to prolonged hospitalisations, immobility, and loss of independence. Fortunately, avoiding a fall or reducing the chances of a fall is frequently possible with the certain proactive measures. Fall prevention in the elderly is achievable by adopting a multidimensional approach of early recognition and reduction of the risk factors, regular health check-ups, and making optimal lifestyle changes. The responsibility of fall prevention is shared by health care professionals, family members, caregivers, the elderly themselves, and the wider community. Together, with a multidisciplinary, holistic approach, our elderly can not only avoid falls, but also enjoy a life of dignity, independence, and vitality that they deserve in their golden years.
Frequently Asked Questions (FAQs)
How can I know my risk of falling? Doctors can assess your risk of falling with the help of STEADI (Stopping Elderly Accidents, Deaths, and Injuries) protocol, which is developed by the Centres for Disease Control and Prevention in three stages:
-Screening: A detailed history of previous falls, medical conditions, and problems with movement, like unsteadiness, imbalance, etc
–Assessment: Your doctor can perform a series of tests to assess your fall risk. Ask your doctor if you want to know more about them.
–Intervention: By helping you to make decisions on your health and implement strategies to reduce fall risk19.
What types of injuries are common with falls in the elderly? Depending on the force of the fall and how you fall, different parts of the body may be involved, such as bones, joints, muscles, nerves, ligaments, tendons, and blood vessels. A fall can cause fractures of the bones or inside the joints, dislocations, sprains, muscle pulls, nerve damage, cuts, and bruises3,15.
How long does it take to recover from a fall? The recovery process is slow in the elderly. The recovery time depends on the nature of the fall, injuries caused and the physical condition of an individual. Minor injuries may take a few days to heal. Major injuries like fractures, brain injuries, etc, may take a few months to more than a year. Ask your doctor about the recovery plan and how long it might take in your specific case20.
What is Tai Chi? How does it help reduce the risk of falls?? Tai Chi is a type of exercise routine used in China. It involves several `poses´ that use body weight and gravity to improve balance and strength. Movements like twisting of the torso, shifting of weight, squatting, and controlling the posture help with cognitive improvement. Tai Chi exercises may reduce the risk of falls by improving balance and strength21,22.
Which yoga exercises can help reduce my risk of falls? Work under the supervision of a certified yoga teacher to learn `asanas´ or poses that improve balance and strength. Follow a simple yoga routine that is tailored to your fitness level and health conditions. To begin with, start with slow and simple exercises, gradually increasing in complexity to achieve the optimal benefits of yoga, and to reduce the risk of falls. Some such poses are:
Tree pose
Dancer pose
Crescent warrior pose
Warrior III pose
Side plank
Figure 4 pose
Upward and downward facing dog poses23,24.
References
- World Health Organization: WHO. Falls [Internet]. 2021. [Cited 2025 Aug 25]. Available from: https://www.who.int/news-room/fact-sheets/detail/falls
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- Amaljith A, Marzo RR, Lekamwasam S, Kisa A, Behera A, S P, Saravanan PB, Shah PB, Mahapatra SS, Gopi K, P V, Swathika R, Baddar NU, John DM, Rajagopal V, Prevalence of fall and its associated factors among elderly population in India: Evidence from the Longitudinal Aging Study of India (LASI). The Evi. 2024:2(2):1-. DOI:10.61505/evidence.2024.2.1.47 [Cited 2025 Aug 15].
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- Lee AK, Juraschek SP, Windham BG, Lee CJ, Sharrett AR, Coresh J, Selvin E. Severe Hypoglycemia and Risk of Falls in Type 2 Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study. Diabetes Care. 2020 Sep;43(9):2060-2065. doi: 10.2337/dc20-0316. Epub 2020 Jul 1. PMID: 32611607; PMCID: PMC7440903. Available from: https://pubmed.ncbi.nlm.nih.gov/32611607/
- Appeadu MK, Bordoni B. Falls and Fall Prevention in Older Adults. [Updated 2023 Jun 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan- [Cited 2025 Aug 15]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560761/
- Falls Prevention Health Network. Health advice following a fall [Internet]. 2015. [Cited 2025 Aug 15]. Available from: https://www.health.wa.gov.au/~/media/Files/Corporate/general-documents/falls/PDF/12653-health-advice-following-a-fall-web-accessible.pdf
- Stefanacci RG, Wilkinson JR. Falls in older adults [Internet]. MSD Manual Consumer Version. 2025. [Cited 2025 Aug 15]. Available from: https://www.msdmanuals.com/home/older-people-s-health-issues/falls-in-older-adults/falls-in-older-adults#Symptoms_v836662
- The National Falls Prevention Resource Center and Resources Available | ACL Administration for Community Living [Internet]. Available from: https://acl.gov/programs/falls-prevention/national-falls-prevention-resource-center-and-resources-available
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- Chen W, Li M, Li H, Lin Y, Feng Z. Tai Chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials. Front Public Health. 2023 Sep 1;11:1236050. doi: 10.3389/fpubh.2023.1236050. PMID: 37736087; PMCID: PMC10509476. [Cited 2025 Aug 20]. Available from: https://pubmed.ncbi.nlm.nih.gov/37736087/
- Tai Chi: What you need to know [Internet]. NCCIH. .[Cited 2025 Aug 20]. Available from: https://www.nccih.nih.gov/health/tai-chi-what-you-need-to-know
- Yazzie MK, Salt River Pima-Maricopa Indian Community. Yoga for elder fall Prevention: Pilot study of a 10-Week program for older adults in the Salt River Pima-Maricopa Indian community [Internet]. https://www.ihs.gov/sites/injuryprevention/themes/responsive2017/display_objects/documents/general-injury-prevention/Yoga_for_elder_fall_prevention_Pilot_study_of_a_10_week_program_for_older_adults.pdf
- Harvard Health. Yoga balance workout [Internet]. Harvard Health. 2015. [Cited 2025 Aug 20].Available from: https://www.health.harvard.edu/exercise-and-fitness/yoga-balance-workout
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