Am I at Risk for Falls?

January 26, 2022

nurse assisting senior to prevent a fall

Have you ever said, “I never had good balance”, “I am accident prone”, “I have fallen and/or tripped”? Are you a human living on planet earth or any other planet with gravity/gravitation forces? Are you human? If you answered yes to any or all these questions, this article is for you.

Facts About Falls

Falls can have a physical and financial toll, especially falls in the elderly. Falls are the leading cause of fatal and nonfatal injuries for older Americans and can threaten seniors’ safety and independence generating large economic and personal costs.

According to the U.S. Centers for Disease Control (CDC):

  • In 2018, about 28% of older adults (about 1 in 4) reported a fall in the USA and in Maryland about 20% reported a fall.
  • In 2018, there were 68 deaths related to falls out of every 100,000 people; in Maryland, there were 54 deaths out of every 100,000.
  • Each year, about 3 million older adults are treated in emergency departments for a fall injury.
  • Each year at least 300,000 older people are hospitalized for hip fractures.
  • More than 95% of hip fractures are caused by falling.

Internal Risk Factors for Falls

Understanding your internal risk factors for falls is key in reducing or addressing these risks. The more risk factors you have the higher the risk you have of falling.

Improper Balance

Balance consists of three different and complex systems, often compared to a “three-legged stool”:

  1. your eyes (vision)
  2. vestibular system (inner ears)
  3. proprioception (perception or awareness of the position and movement of the body)

If there is a problem and/or deficit in one or more of these systems, you are no longer working with a balanced three-legged stool.

Impaired Vision

Having visual impairments changes how you see the world; pun not intended. Some visual impairments are macular degeneration, glaucoma, field cuts, double vision, blurry vision, blindness, etc.

In terms of fall prevention, if there is not a clear picture of where you are moving and of any potential obstacles that may be present, how can you avoid it? Getting your eyes checked regularly and/or the use of a white cane for those with severe visual impairments, can help you prevent falls.

Lower Body Weakness

Lower body weakness contributes to a fall by impairing your body’s ability to sense movement, action, and location. This is called proprioception. Foot pain and wearing improper shoes can also be contributing factors.

There are different types of proprioceptors, but for now, three will be addressed:

  1. In the muscle there are muscle spindles which detect how much that muscle is being stretched.
  2. In the tendon, which attaches muscle to bone, are Golgi tendon organs. They detect and give information on the strength of a muscle contraction and the tension in the muscle.
  3. Finally, joint kinesthetic receptors, which are in the joint, detect angles of the joint, as well as movement.

All these signals and information that are being sent ultimately makes it to the central nervous system: brain, brain stem, and spinal cord.  Not having enough strength to support the body, to fight gravity, not detecting movement quickly and by not having enough reaction time to counteract the potential fall can all lead to tripping and falling.

Physical therapy is a great place to start to work on strength and balance. Physical therapists are movement specialists. If you are having foot problems or pain, bring this up with your therapist; it is not normal to have pain and changing how the body moves can lead to further pains and injury.


Some people think, well if there is a chance of falling, then not moving will help decrease that risk. This is incorrect and actually leads to higher risk of falling. When you become afraid of falling, immobility (lack of movement) increases. This lack of movement causes increased weakness and decreased reaction time, which equals a hard time holding yourself up from the ground and takes longer to respond to losing your balance

If this seems redundant, it is because it is. Movement is crucial in so many aspects, including prevention of falls.

Vestibular System Dysfunction

Have you ever felt lightheaded/unsteady/dizzy? Have you ever seen a child spin around in circles for several turns and then stumble around/or spun around yourself? If so, your vestibular system is being affected.

The vestibular system is a structure located in the inner ears behind the ear drums, one on the left and one on the right. It tells the brain about spatial orientation (ability to identify position/direction in relation to external objects), movement, and head position.

There are several different conditions that can cause vestibular dysfunction, not including roller coasters or spinning around in circles.


Vertigo is a particularly common problem where a crystal in your inner ear is not in the right canal, and you physically see the room spin. Many people fall because of this. You are in fact not spinning, but your eyes are moving in such a way that it feels like it. This can easily be treated with physical therapy and not medication. The crystals can get back to where they need to be, and you can go about your everyday life without spinning and feeling like you are going to be sick.

Asymptomatic Vestibular Problem

80% of the elderly population have an asymptomatic vestibular problem, meaning they do not feel dizzy/lightheaded/unsteady; they might not realize that they are swaying back and forth while standing and/or veering left/right while walking. This can lead to tripping and falling.

If you feel dizzy, even if for a few moments, bring this up to your health care provider. Physical therapy and seeing your health care provider are ways to check to see if there is anything wrong with your vestibular system.


Some medicines, even over-the-counter medicines and herbal supplements, can increase your fall risk. As you get older, the way medicines work in your body can change and some medicines, or combinations of them, can make you sleepy or dizzy and cause you to fall.

Make sure your provider and pharmacist are aware of all medication, prescribed and over-the-counter medications (including vitamins and minerals) that you are taking.

External Risk Factors for Falls

External risk factors are things in your environment like stairs, ramps, flooring and lighting that could cause you to take a spill. These hazards in your home and/or community can be identified and corrected. If you do not know how, your health care team is here for you.

  • Area rugs or unsecured floor coverings
  • Cords/wires/chargers on the ground
  • Low visibility / not enough light to see
  • Uneven steps
  • Improper use of canes/walkers/crutches
  • Pets
  • Frequent use items kept high in shelves that require use of stool/ladder/excessive reaching over head
  • Fallen leaves (they become really slick), ice, snow, rain

Removing things you can trip over, avoiding step stools, installing safety measures like grab bars, railings and non-slip mats and improving the lighting in your home are a few ways you can make your home safer and prevent falls from happening.

Fall Prevention: What Can I do?

Talk openly with your healthcare provider about fall risks and prevention. While it might be common, it is not normal to fall.

  • Have your eyes checked regularly
  • Work on strength and balance with your physical therapist
  • Don’t be afraid to stay active
  • Talk to your healthcare provider if you feel unsteady or dizzy
  • Have your provider or pharmacist review all the medicines you take
  • Make your home safer

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