Knowledge Exchange

The Low Down on Falls

How common are falls:

  • 30-50% of seniors experience a fall each year
  • 50% of injury-related hospitalizations were due to falls: 30% of these are serious falls
  • 90% of all hip fractures were due to falls
  • Most falls occur in the home: often in bedroom, bathroom and on the stairs
  • Between 2005 and 2013, the rate of fall-related injuries among Canadian seniors aged 65 years or older increased from 5 to almost 6 per 100 individuals
  • Fall-related injuries are more common in women and in older age groups.
  • Fractures accounted for 37% of all injuries due to falls, highlighting the importance of bone health
  • A significant increase in the rate of fall-related injury between 2005 and 2013 was observed in women and in those aged less than 75 years

Injury sustained

pie chart illustrating percentage of body parts injured in fall

Activity undertaken when fall occurred

pie chart illustrating percentage of scenarios when fall occurs

Some contributing factors

  • falls can be due to decreased sight, hearing, posture changes  (tendency to be stooped over) and slower reaction speed
    • arthritis, pain, cataracts, hip surgery, previous strokes and conditions such as Parkinson’s disease affect how individuals walk, and increase the risk of tripping and falling
    • balance can also be affected by chronic conditions such diabetes and heart disease.
  • the more medications someone takes the more likely the effects may contribute to falls
    • effects from  sedatives (sleeping or medications to reduce anxiety), analgesia (pain medication) and some heart medications can increase risk
  • fear of falling can contribute to falling and actually increase the risk of falls.

Falls Prevention is the goal

The overarching recommendation for fall prevention of older adults is to assess individuals for fall risk and tailor prevention efforts to their individual risk profile.

Use a Multifactorial Approach

Approaches that target multiple risk factors are more effective than addressing a single factor. Reduce environmental hazards In the home and in residential settings. Fall risk can be reduced by identifying hazards and taking steps to remove them. Some of the following can be attempted:

  • Create a safer home environment that can help reduce the risk of falls. Identify hazards and taking steps to remove them. This is particularly effective for individuals at high risk of falling. 
    • remove loose rugs and creat clear pathways for movement
    • consider adequate lighting and non-glare, non-slip and energy absorbing flooring
    • physiotherapist or occupational therapist home assessment can be invaluable

  • Appropriate exercise can reduce fall risk. It is important to build strength and balance.  
    • An effective training program (for groups or individuals) should be affordable, accessible, enjoyable and  tailored to individual capacity
    • focus on training to help improve balance, gait, muscle strength, flexibility, endurance and coordination

  • Remember to encourage older individuals to:
    • eat well:  missing meals can cause weakness and dizziness. Eating regular, balanced, healthy meals will help keep up strength.
    • keep fit:in order toprevent a decline in mobility, strength, balance and flexibility, keep muscles toned by accumulating at least 30 minutes of moderate physical activity most days. If possible, to walk every day, even if it's only around the house and engage in activities or an exercise class that will improve strength and balance.
    • monitor sight and hearing: those who cannot see or hear properly are at greater risk of falling and should wear appropriate glasses (wearing reading glasses while walking is dangerous!). Impaired hearing increases the risk. Eyesight and hearing should be tested regularly.
    • know medications: medications can cause dizziness and weakness, affecting perception and balance, especially if not taken as prescribed or if not suitable. Be aware of the potential hazards and interactions of the medications.
    • practice moderation:the negative effects of too much alcohol on sight, hearing, balance and judgement about personal safety are very clear. Whether used alone or combined with medication, alcohol use can result in dangerous falls, especially for older people.

Gail Hawley Knowles, RN BA MHs
Manager, Centre for Studies in Aging & Health

More information developed for older individuals can be found at the following sites

  1. Health Promotion and Chronic Disease Prevention in Canada: Research, Policy and Practice Volume 35 · Number 7 · September 2015
  2. Fall-related Head Injuries in Adults 65 and over,  Ontario Injury Compass Issue 10 September 2015 retrieved Oct 29, 2015
  3. Veterans Affairs Canada retrieved Oct 29, 2015