Fall Risk Factors Among Older Adults

I have been practicing physical therapy in Arizona for over 30 years and I have noticed many common risk factors that may indicate a ground level fall in a patient’s future. I would like to make you aware of some of these so that you can help yourself or your loved ones continue to live a functional, happy, healthy life.

Click here for some more information and statistics on common fall risks.

Every year, millions of older adults experience a ground-level fall. Falling can cause moderate to severe injuries, such as fractures and head traumas, Injuries sustained in a fall can increase the risk of early death. Fortunately, the problems caused by falling are largely preventable; fall prevention is one of the most important benefits of physical therapy for seniors.

Falls are the most common cause of traumatic brain injuries. Most fractures among older adults are caused by ground-level falls. The most common negative result of experiencing a ground-level fall is fractures of the spine, hip, forearm, leg, ankle, pelvis, upper arm, and hand. Many people who fall, even if they are not injured, develop a fear of falling. This fear may cause them to limit their activities, which leads to reduced mobility and loss of physical fitness, and in turn, increases their actual risk of falling. These risk factors rarely occur in isolation and many of them may be present at the same time.

A List of the Most Common Fall Risk Factors

A Previous fall:

As a physical therapist working with patients for 34 years, I have often heard the expression that “everyone falls now and then” as a way of dismissing the true danger of falling. Though there may be some truth the fact is as a normally active adult, engaged in activities of daily living, one should not be falling to the ground. If you have experienced a fall it is important to do an accident assessment. Was it carelessness, did you trip, slip, or get dizzy? It is important to do an objective accident “post-mortem” to be sure to mitigate factors that may contribute to a future fall. In fact, if you have fallen more than once in the past year, you should get checked out by your medical provider.

Lower extremity weakness:

It is a fact that as we age (and often become sedentary) we become weaker. Weakness in the hip, knee, and ankle muscles can contribute to falling. There are a couple of easy ways to assess your own lower extremity strength. 1. Can you slowly step up and down a curb or step without the use of a handrail? Try this with each side, be sure to have someone with you. 2. Do you need to use your hands to stand from a seated position? If yes, the true cause may be due to weakness.

Gait deficit (use of an assistive device to walk):

This may seem obvious to some but not others. If you have had some difficulty walking for any reason and have had to rely upon a cane, walker, or crutches to get around and walk, your risk of falling increases. If you or a loved one is dependent upon an assistive aid to walk you may want to get checked out to ensure proper and safe use.

Balance deficit:

This risk factor is often difficult to see in oneself. It is often easier to do in others. To assess your own balance, first do not dismiss feedback from loved ones. Second, if you find yourself holding onto furniture or the walls to steady yourself (“wall surfing”), you may have a balance deficit. Finally, to assess balance, stand at the kitchen counter and see how long you can stand on one foot. Use a light touch on the counter only for safety. Assess both sides. If you cannot stand on one foot for 20 seconds you may have a balance deficit. If you can not stand on one foot for ten seconds you do have a deficit and you should get checked out by your medical provider.

Vision deficit:

If you are visually impaired or wear corrective lenses your chance of falling is increased. Be sure your prescription is up to date and you are wearing your corrective lenses properly. Even in individuals with normal vision, keeping your home free of clutter and well-lighted is also important to mitigate the risk of falling due to vision deficit.


 Lower extremity joint pain from arthritis or other causes can often lead to an abnormal gait pattern or some other compensation to avoid pain. Pain can also contribute to a loss of joint awareness contributing to a risk of falling.


Clinical depression is classified as a mental illness and is much more than simply feeling sad or having the blues. Clinical depression encompasses many of the body’s systems, including the musculoskeletal system. Depression can lead to inactivity and resulting weakness. One’s cognitive functioning may also be impacted making it difficult to concentrate and assess the relative safety of a situation. Each of these factors contributes to one’s risk of falling. Exercise is an excellent and natural way to help manage depression and improve safety when up and around.

Difficulty performing your normal activities of daily living:

The normal activities associated with your daily routine may be a window to your relative risk of falling. If: getting on and off the toilet, getting in and out of a chair, taking out the garbage can, or standing at the sink to do dishes are more difficult for you these may be signs of a balance deficit and it is a good idea to see your medical provider for an assessment.


a sensation of whirling and/or loss of balance, associated particularly with looking down from a great height, may be caused by disease affecting the inner ear or the vestibular system. If you have had episodes of feeling like the room is spinning, or like the floor is unstable, you may have an inner ear issue that can be addressed by your medical provider. This condition places you at risk of falling and should be evaluated promptly.

Cognitive deficit:

A deficit in cognition can be the result of many issues, including dementia, Alzheimer’s disease, a previous head injury, and dehydration/electrolyte imbalance just to name a few. If you know a loved one who has a clear cognitive deficit be aware that this person is at a higher risk of falling causing other serious medical complications.

80(+) years old:

With aging comes a host of other issues, many of them previously mentioned. The sad fact is that individuals in the eighth decade of life are at a must higher risk of falling. Tragically, the consequences of suffering a ground-level fall at this age are far more significant. It is not an overstatement to say that a ground-level fall in individuals 80 years and older can be life-threatening and easily life-altering. Please take advantage of the opportunity to be screened by a qualified medical professional to assess the risks and learn mitigation strategies, particularly if there are other risk factors present.

How to mitigate risks and prevent falls:

Older adults can stay independent and reduce their chances of falling by:

  • Exercising regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Talk to your Physical Therapist to get specific recommendations.
  • Ask your doctor or pharmacist to review your medicines—both prescription and over-the-counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness.
  • Have your eyes checked by an eye doctor at least once a year and update your eyeglasses to maximize your vision.  Consider getting a pair with single vision distance lenses for some activities such as walking outside.
  • Make your homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways, and improving the lighting in your home.
  • Get checked by your doctor or physical therapist if you experience persistent dizziness or “vertigo.”

You are welcome to call our office for a phone or in-person consult – free of charge. If you are out of town, please find a licensed physical therapist in your area to assess you. It’s worth it!

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