Fall risk factors in older adults: what raises the risk and what lowers it

Why falls matter after 65

Each year, millions of adults ages 65 and older fall. More than one out of four older people falls each year, but less than half tell their doctor, and falling once doubles your chances of falling again (CDC). The USPSTF calls falls the leading cause of injury-related illness and death among older adults in the US. In 2018, 27.5% of adults 65 or older living in the community reported at least 1 fall in the past year, and 10.2% reported a fall-related injury (USPSTF 2024).

Older adults are also more likely to break a bone when they fall, especially if they have osteoporosis, and a broken hip may lead to disability and a loss of independence (MedlinePlus). Falls caused 83% of hip fracture deaths, and they are the most common cause of traumatic brain injuries in older adults (CDC).

Risk factors that raise the risk

The CDC says many fall risk factors can be changed. Most falls are caused by a combination of them, and the more risk factors a person has, the greater their chances of falling (CDC).

• A past fall. Falling once doubles your chances of falling again (CDC). Studies reviewed by the USPSTF most often used a history of falls to find people at increased risk (USPSTF 2024).
• Lower body weakness. Weak legs make it harder to get up from a chair or keep your balance when walking on an uneven surface (CDC) (MedlinePlus).
• Problems with walking and balance, and slow reflexes that make it hard to keep your balance or move out of the way of a hazard (CDC) (MedlinePlus).
• Medicines. Tranquilizers, sedatives and antidepressants, and even some over-the-counter medicines, can affect balance and how steady you are on your feet (CDC). Some medicines can make you feel dizzy, confused or slow (MedlinePlus).
• Vision problems (CDC) (MedlinePlus).
• Vitamin D deficiency, meaning not enough vitamin D in your body (CDC).
• Foot pain or poor footwear (CDC).
• Home hazards, such as broken or uneven steps, and throw rugs or clutter that can be tripped over (CDC).
• Alcohol, which can affect your balance and reflexes (MedlinePlus).
• Certain illnesses, such as low blood pressure, diabetes and neuropathy (MedlinePlus).
• Fear of falling. Many people who fall, even if they are not hurt, become afraid of falling and cut down on everyday activities. Being less active makes them weaker, which raises their chances of falling (CDC).

Which ones you can change

MedlinePlus says regular exercise may lower your risk of falls by strengthening your muscles, improving your balance and keeping your bones strong. It also advises regular eye exams, getting rid of tripping hazards at home, and rails on the stairs and in the bath. To lower the chance of breaking a bone if you do fall, get enough calcium and vitamin D (MedlinePlus).

What the USPSTF says helps

For adults 65 or older living in the community who are at increased risk for falls, the USPSTF recommends exercise to prevent falls (grade B) (USPSTF 2024). The exercise most often studied was gait, balance and functional training, followed by strength and resistance training, flexibility and endurance training. Most studies used group exercise classes; some used supervised individual physical therapy, and a smaller number used group dance or tai chi (USPSTF 2024).

For a fuller program that starts with an assessment of balance, gait, vision, blood pressure on standing, medicines, the home, memory and mood, followed by a plan for each problem found, the USPSTF says the decision should be made person by person, because the overall benefit is small (grade C) (USPSTF 2024). The current USPSTF falls statement does not address vitamin D to prevent falls; that is being reviewed separately (USPSTF 2024). The vitamin D and calcium check covers what the USPSTF says about supplements and fractures.

After a fall

About 37% of older adults who fall report an injury that needed medical treatment or limited their activity for at least a day (CDC). An older person who falls and hits their head should see their doctor right away to make sure they do not have a brain injury, especially if they take medicines such as blood thinners (CDC). Even a fall without injury is worth telling your provider about, since one fall doubles the chance of another (CDC).

Check your own risk

The fall risk check uses the CDC STEADI Stay Independent questions, 12 yes or no items about past falls, steadiness, strength, medicines and mood (CDC STEADI). The FRAIL scale is a 5-question frailty screen.

Common questions

I fell once but was not hurt. Should I mention it?

Yes. Falling once doubles your chances of falling again, and less than half of older people who fall tell their doctor (CDC).

What kind of exercise helps most?

The USPSTF found it hard to name a single most effective component. Gait, balance and functional training were studied most, followed by strength training (USPSTF 2024). Ask your provider which class or program fits you.

Can my medicines make me fall?

Some can. The CDC names tranquilizers, sedatives and antidepressants, and notes that even some over-the-counter medicines can affect balance (CDC). Do not stop a medicine on your own; ask your provider or pharmacist to review them.