Four Risk Factors for Falls in Older Adults

Falls are the leading cause of injury for adults aged 65 years and older.¹ Recognizing risk factors for falls can empower healthcare providers to take proactive steps in fall prevention and promote safety for their patients.

While some factors, like age and gender, are beyond our control, others are modifiable, allowing for targeted strategies to help reduce fall risk. Below are four key risk factors for falls to monitor and address for better patient outcomes.

1. Unsafe environments

An unsafe environment poses a substantial risk factor for falls. Common hazards, such as poor lighting, lack of handrails on stairs, absence of grab bars in bathrooms, and tripping risks like rugs, can significantly increase the likelihood of a fall.

Falls often occur when an older adult tries to navigate their home with compromised vision or limited mobility. As a healthcare provider, you should assess your patient’s home environment and suggest modifications that promote fall prevention at home. This includes addressing potential hazards and educating patients on setting up safe spaces both indoors and outdoors to reduce fall risks.

2. Poor vision

Decreased contrast sensitivity, depth perception, and overall visual acuity are common with age and are notable risk factors for falls. Poor vision contributes significantly to fall risk in older adults, as changes in visual clarity and depth perception make it difficult to navigate safely.

One study on visual impairments and fall among older adults found that those with low vision are twice as likely to experience falls, repeated falls, and fall-related fractures.² Patients with these vision challenges may struggle with navigating steps or uneven surfaces, increasing their risk.

To help reduce this risk factor for falls, you can:

• Optimize lighting: Install automatic sensor lights for stairways or outdoor steps to improve visibility in areas that may be dim or shadowed.
• Mark steps: Use contrasting colors or create tactile grooves on handrails at the top and bottom steps, helping patients feel their location more securely.
• Remove tripping hazards: Ensure that cords, rugs, and other items are removed or secured in high-traffic areas where patients walk frequently.
• Encourage clear pathways: Advise patients to maintain clear, obstacle-free walking areas within the home, especially in commonly used rooms and hallways.
• Suggest visual aids: For those with low vision, suggest the use of magnifying glasses or other visual aids to help read signs, labels, or other items they may need to see clearly.

3. Polypharmacy

For older adults, taking four or more medications significantly raises the risk of falls. This increased risk often stems from side effects, such as dizziness, fatigue, and confusion, which can impair balance and coordination. Certain types of medications—especially sedatives, blood pressure medications, and antidepressants—are known to heighten fall risk because they affect both physical stability and cognitive clarity.

To manage this risk factor for falls, conducting regular medication reviews is essential. Ideally, these reviews should happen annually and whenever a medication is added, discontinued, or changed. Working closely with pharmacists to optimize dosages, reduce unnecessary medications, and simplify the regimen can help lower fall risk. For patients with visual impairments, requesting large-font labels and verifying their understanding of dosage instructions are additional steps that support both safety and medication adherence.

These proactive measures can make a substantial difference in reducing fall risks associated with polypharmacy and improve overall patient safety.

4. Balance and gait deficits

Balance and gait deficits significantly contribute to risk factors for falls, especially when older adults struggle to coordinate movements or maintain stability while walking. Imagine a patient attempting to carry groceries while moving across a cluttered floor; this multitasking can overwhelm their balance abilities and elevate their risk of falling.

Can your patient simultaneously walk and perform an activity? If not, targeted balance and mobility programs can be beneficial. Collaboration with physical therapists to incorporate activities like Tai Chi or balance training classes may be beneficial for improving strength and stability.

The dynamic gait index and functional gait assessment are valuable tools for evaluating gait stability and identifying balance deficits that may lead to falls. These assessments provide detailed insights into a patient’s ability to safely navigate various environments, allowing for tailored interventions that specifically address identified weaknesses.

What tools can help you address fall risk factors?

Fall prevention requires collaborative efforts from healthcare providers, patients, and their families. For older adults, managing risk factors for falls often involves both direct intervention and regular assessment. Below are some key tools to help evaluate and manage fall risks:

• Falls Efficacy Scale-International: This tool helps assess a patient’s fear of falling, which can lead to avoidance of necessary therapy activities, particularly those that involve standing or walking. Understanding the psychological impact of fall fear allows you to support patients in addressing it directly.
• Geriatric Depression Scale-Short Form and GAD-7: Depression and anxiety often co-occur in older adults facing fall risk factors, impacting their engagement in activities that could improve balance. Research shows that, among hospitalized older adults with moderate to severe fear of falling, nearly 40% meet criteria for a depressive disorder.³ Using these tools provides insights into patients’ mood, enabling you to guide interventions that encourage both physical activity and mental well-being.

Because activity engagement and functional performance are essential to fall prevention, identifying each patient’s specific fall risks and history can aid in developing personalized, effective intervention strategies. By addressing these risks, you can improve patient safety and independence, while helping reduce the likelihood of rehospitalization and emergency department visits due to fall-related injuries.

Supporting safe and independent living for older adults

Preventing falls involves more than addressing immediate hazards; it’s about empowering older adults to live safely and independently. By assessing and managing key risk factors for falls, you play an essential role in helping your patients lead full, confident lives. Working with patients to implement these proactive strategies can not only reduce their risk of falling but also enhance their quality of life by fostering stability and independence.

By integrating these insights and tools into your practice, you can create an impactful fall prevention plan that is comprehensive, empathetic, and tailored to each patient’s needs.

References

1. Centers for Disease Control and Prevention. (2024, May 9). Older adult falls data. U.S. Department of Health and Human Services. https://www.cdc.gov/falls/data-research/index.html
2. Singh, R. R., & Maurya, P. (2022). Visual impairment and falls among older adults and elderly: evidence from longitudinal study of ageing in India. BMC public health, 22(1), 2324. https://doi.org/10.1186/s12889-022-14697-2
3. Iaboni, A., & Flint, A. J. (2013). The complex interplay of depression and falls in older adults: a clinical review. The American journal of geriatric psychiatry : official journal of the American Association for Geriatric Psychiatry, 21(5), 484–492.