Falls are preventable health problems that can cause moderate to severe injuries & may become primary Etiology of deaths in persons above 65 years of age. High risk of falls in elderly can be attributed to many factors which are broadly categorised into two groups. These are extrinsic/external factors and intrinsic/internal factors.Intrinsic/internal factors are

  • Poor muscle function due to ageing,
  • Reduced co-ordination due to ageing,
  • Medication use (drugs that increase risk of falling are sedatives, tranquilizers, anti-hypertensive drugs, cardiac medicines, hypoglycaemic agents {used in diabetes}, etc.)
  • Impaired vision,
  • Sensory deficits,
  • Alcohol consumption,
  • Poor nutrition,
  • Fall from bed due to disorientation, vertigo, poor balance/muscle power due to chronic illness, etc.
  • Neurological problem such as Stroke, Parkinson’s {balance, gait and postural disturbances}, neuropathy {diabetes}, myopathy {muscle disorders}etc.
  • Loss of consciousness due to epileptic convulsions, cardiac problems, dehydration, vertigo, etc.

Extrinsic/external factors a

re environmental factors such as

  • Slippery floors(waxed or with water),
  • Broken pavements,
  • Slippery rugs/mats,
  • Folded carpet edges,
  • Use of faulty/improper footwear,
  • Use of faulty /improper walking aids,
  • Electrical wires, etc.

Falls may cause moderate to severe injuries. The following are health hazards caused due to falls;

  • Fractures;most commonly seen at hip, spine, ribs, forearm, pelvis, hand, ankle, etc. The bones in elderly are already weakened due to osteoporosis. Any trivial trauma may become a trigger for fracture. This leads to dependence, bed recumbency, reduced activity and mobility, which further leads to enhanced rate of osteoporosis.
  • Head injury; which may vary from a mild concussion to severe injury, may become fatal even.
  • Ligament sprains.
  • Psychological fear leading to dependence, further fear of falling & increased self-restriction of activities.
  • Increased morbidity & bed recumbency.

Prevention of falls

  1. Exercise regularly; ageing process, reduced activity level, morbidity, etc. are few factors which lead to reduced muscle strength, balance & co-ordination. This may pre-dispose to falls. Thus organising camps or group interventions motivates the elderly and also gives them a chance to socialise.
  2. Ergonomics; free active and resistive exercises should be done using thera-tubes, thera-bands, putty, pulleys, balls, etc. 10 repetitions each 2-3 times a week throughout range of motion.
  3. Regular eye check-up; regular eye check-up should be done & update glass power to maximise vision.
  4. Reduce fracture risk; elderly should be regularly screened for osteoporosis through bone density tests, DEXA scan etc. Adequate calcium & vitamin D levels in blood should be maintained through dietary intake and through supplements too. Weight bearing/loading exercises should be regularly followed to strengthen & enhance bone health.
  5. Postural hypotension; regular blood pressure check-up, regular updating of medications. If patient has regular postural hypotension attacks, ask him/her to lie down immediately with foot end of bed elevated. Ask patients to perform ankle pumps.
  6. Medication review; ask doctor to review medication that may cause dizziness/drowsiness. Few drugs that cause drowsiness thereby increasing the risk of fracture are; sedatives, tranquilizers, anti-hypertensive, cardiac medicines, hypo-glycaemic agents, etc.
  7. Home check safety list
    1. Remove throw rugs.
    2. Secure carpet edges on floor & stairs.
    3. Reduce floor & wire clutter.
    4. Install handrails on staircase.
    5. Avoid floor waxes/slippery tiles.
    6. Use anti-skid mats.
    7. Ensure adequate lighting in lobby/walking areas


  1. Install hand rails in shower & bathtubs.
  2. Use anti-skid mats.
  3. Avoid wet surfaces.
  4. Avoid detergent/soap spillage on floor.

Walking aids

  1. Ensure proper balance of walking aids.
  2. Regular check of anti-skid rubbers/buffers of walking aids.
  3. Ensure proper hand grips.


  1. Regular check of footwear wear & tear.
  2. Regular change of footwear grip & comfort.

Regular screening & modifications can prevent falls in elderly thereby improving upon geriatric health, wellness & lifestyle.