Clinical Approach

Falls and fall injuries are one of the most common health problems among older adults. However, since falling is not a single disease, clinicians may not recognize falling as a treatable health problem. The consequences of untreated falls and risk factors can be just as serious as those of other untreated chronic diseases. The risk of falling increases as the number of risk factors an older person has for falling increases.

While some factors that increase risk of falling, such as age and previous falls, cannot be changed, there are a number of important ones that can be - problems walking or moving around, taking 4 or more medications, foot problems or unsafe footwear, blood pressure dropping too much on getting up, problems seeing, and tripping hazards at home. Research has shown that treating and correcting these specific health problems reduces the rate of falling by more than 30%. The table below shows how an older person with fall risk factors can benefit from treatment of those factors.

 Falls Risk Reduction Table

If she has

The chance she will suffer a serious fall in the next year is

Treating risk factors reduces this risk about 1/3 to

Fallen in past year

50% (5 in 10)

30% (3 in 10)

No falls in past year but even minor problems with walking or movements

30% (3 in 10)

20% (2 in 10)

Any 1 of 6 the risk factors below

20% (2 in 10)

10% (1 in 10)

Any 2 of the 6 risk factors below

30% (3 in 10)

20% (2 in 10)

Any 3 of the 6 risk factors below

60% (6 in 10)

40% (4 in 10)

4 or more of the 6 risk factors

80% (8 in 10)

50% (5 in 10)

The known treatable risk factors include:

  1. any problems with walking or movements [see below]
  2. postural hypotension
  3. use of 4 or more medications or any psychoactive medications
  4. unsafe footwear or foot problems
  5. visual problems
  6. environmental hazards

Observe for problems with one or more of these movements:

  1. steady standing on one leg for at least five seconds
  2. steady getting up from a chair
  3. sits down in a chair without plopping

    While walking...
  4. walk path is straight
  5. turns are steady
  6. swing foot always passes the stable foot by at least a foot length (normal step length)
  7. heel of the swing foot always hits the floor first (heel-toe sequencing)