Falls Are a Major Risk for Adults Aged 65 and over

By Wayne Persky

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10%–15% of all deaths among adults aged 65+ can be directly or indirectly associated with falls.

This includes:

• ​Direct causes, such as severe head trauma, internal bleeding, complications from fractures (especially hip fractures).
• Indirect causes, such as infections (for example, pneumonia), immobility complications, surgical complications, or long-term decline in function after a fall.

According to the CDC, WHO, and NIH:

• Falls are the leading cause of injury-related death in adults over age 65.
  
• Over 30% of adults aged 65+ fall each year, and the rate increases with age.
  
• Among those who suffer a hip fracture, up to 30% die within 1 year.
  
• A serious fall often leads to permanent loss of independence, setting off a cascade toward institutionalization and mortality.

25 to 30% of disabilities in senior citizens are initiated by falls.

The CDC reports that one in four Americans age 65 and older falls each year, and falls are the leading cause of injury -related disability in older adults. Studies show that falls account for roughly 1/3 of all disability cases among the elderly, especially in those with previously good mobility. Falls commonly result in:

• Hip fractures
• Traumatic brain injuries
• Long term functional decline
• Increased risk of nursing home admission​

Why are falls so dangerous for seniors?

• Frailty and comorbidities mean slower recovery and higher risk of complications.
• Post-fall fear and immobility can lead to rapid physical and cognitive decline.
• Hospitalization itself increases risk of delirium, infection, and further functional loss.​

The most frequent contributors to falls are:

• Impaired balance and gait
  
• Decreased muscle strength, slower reflexes, and vestibular (inner ear) issues
  
• Common conditions such as sarcopenia (age-related muscle loss) and neuropathy
  
• Drugs that affect the central nervous system, such as antidepressants, sedatives, antipsychotics, and antihypertensives that can cause dizziness, drowsiness, and orthostatic hypotension (drop in blood pressure)
  
• Vision impairment, such as cataracts, glaucoma, and age-related macular degeneration (which reduce depth perception and hazard awareness)
  
• Foot problems and improper footwear, such as painful feet, deformities, or wearing slippery, loose, or overly soft shoes that can destabilize walking
  
• Underlying medical conditions such as stroke, Parkinson’s, arthritis, diabetes, and cognitive decline (for example, dementia), all of which can impair movement, judgment, or strength
  
• Environmental hazards such as slippery floors, poor lighting, loose rugs, and clutter are frequent causes of trips and stumbles at home or in care facilities
  
• Alcohol use
  
• Cannabis use

While the most direct cause of a fall is often loss of balance, it usually stems from a multifactorial mix of aging physiology, chronic disease, and medication side effects. It's important to note that:

Medications are often a primary cause of loss of balance.

A recent online Medical Xpress article discussed the seriousness of this medication issue (Macquarie University, 2025, April 13).1 Research conducted at Macquarie University and the Australian Institute of Health Innovation illustrated the growing concern surrounding psychotropic medication use in aged care homes, particularly its link to serious fall injuries among older adults. Published in BMJ Open, the findings raise urgent questions about how mental health is managed in residential aged care facilities, and the need to re-evaluate the long-term use of medications like antidepressants, antipsychotics, and sedatives (Batool, Raban, Seaman, Westbrook, and Wabe, 2025).2​

Do such medications do more harm than good?

The study analyzed data from 3064 residents across 23 aged care homes in Sydney over a two-year period (2020–2021), focusing on potentially inappropriate psychotropic medications, especially those affecting the central nervous system (CNS). These drugs, which include common antidepressants and sleep aids, are widely used to manage depression, anxiety, and insomnia in older adults.

The data paint a troubling picture:

• 40% of residents used at least one CNS-potentially inappropriate psychotropic medication.
• Among those, 70% experienced at least one fall, and 30% required hospitalization due to the fall.
• Residents on CNS-potentially inappropriate psychotropic medications had significantly higher fall rates:​

Those patients experienced:

• 16.2 falls per 1,000 resident-days, compared to 10.8 in non-users.
  
• ​5.68 injurious falls and 1.77 hospitalizations per 1,000 days, versus 3.65 and 1.26, respectively, in non-users.

In short, those taking CNS-potentially inappropriate psychotropic medications are more likely to fall, get injured, and be hospitalized.

So why are these medications still being so widely used?

Psychotropic medications are often prescribed as quick solutions for mood and behavior-related challenges in older adults, especially those with dementia or complex emotional needs. However, as lead author Narjis Batool notes, many residents remain on these drugs for far longer than medically recommended, with limited re-evaluation of necessity or dosage.
​
Unlike earlier studies, this research uniquely focused on actual medication administration, not just prescriptions, giving a more accurate picture of real-world risks.

This is an easily preventable risk to older adults.

Falls are one of the leading causes of serious injury, hospitalization, and even death in aged care settings. The researchers found that inappropriate medication use is a modifiable risk factor, meaning that fall risk could be substantially reduced with better oversight.
Dr. Nasir Wabe, senior author, emphasized that preventing falls is not just a safety issue, it’s a matter of preserving independence and quality of life. "Targeted interventions, including medication reviews, could significantly reduce injury and hospital admissions," he said.

Then there are risks that are not so easily preventable— falls caused by pets.

Pets have minds of their own, and sometimes they get excited and overactive. Falls associated with pets are more common than many people realize, often leading to serious injuries, including fractures and head trauma.
According to the CDC, an estimated 86,000 fall injuries each year in the U.S. are related to pets or pet related activities. Nearly 88% of those falls occur at home, and over 30% involve adults aged 65 and older. Older adults are especially vulnerable to hip and wrist fractures as a result of pet associated falls.

Common accidents include:

• Tripping over pets, especially smaller or quiet pets that are frequently underfoot
• Being pulled by a lease, as frequently happens with larger dogs
• Falls while feeding, bathing, or playing with pets
• Slipping on pet toys, water bowls, or waste

Older adults are at higher risk:

• Slower reflexes, weaker bones, and reduced balance increase the risk of a severe fall
• Many older adults have already developed osteoporosis, making fractures more likely
• Vision or hearing problems can make sudden movements from pets more difficult to anticipate

Older adults can significantly reduce the risk of disabling or fatal falls through a combination of home safety improvements, physical conditioning, medical management, and lifestyle adjustments.

Improve strength and balance: by exercising regularly, focusing on:

• Leg strength (for example, chair squats, resistance band training
• Balance (for example, Tai Chi, standing on one leg, heel to toe walk
• Flexibility and posture (for example, stretching, yoga​

Make your home safer by:

• Removing trip hazards such as clutter, cords, throw rugs
  
• Installing grab bars in bathrooms and near stairs
  
• Using nonslip mats in bathtubs, showers, and kitchens
  
• Improving lighting by adding nightlights and bright bumps throughout the house
  
• Make sure there are sturdy handrails on both sides of staircases
  
• Avoid the use of step stools — use reach tools or ask for help

Manage medications and health conditions.

• Review medications with a doctor or pharmacist
  
• Note that antidepressants, sleep aids, sedatives, and blood pressure drugs can cause balance problems
  
• Correct vision and hearing problems — sensory loss increases fall risk
  
• Address foot pain or deformities by using proper footwear with good grip and support

Prevent falls by taking precautions.

• Use assistive devices if you need them, such as walkers, canes, or walking poles
  
• Install raised toilet seats or shower chairs to avoid awkward movements
  
• Stay hydrated and eat regularly to avoid dizziness or low blood sugar
  
• Be cautious with multitasking while walking
  
• Avoid turning quickly, especially when carrying heavy loads

Reduce the risk of pet -related falls by:

• Training pets to stay out from underfoot
  
• Keeping pet items such as toys and food bowls out of walkways
  
• Using leash harnesses that offer better control when walking dogs

Remember:

Although falls are the leading cause of fatal and disabling injuries in older adults, most are preventable. Enroll in fall prevention classes. Many classes are free through community or senior centers. And always carry a phone with you in case you fall and need help. ​

References

​1. Macquarie University. (2025, April 13). Falls prevention: Call for review of antidepressant medication use in aged care homes. Medical Xpress, Retrieved from https://medicalxpress.com/news/2025-04-falls-antidepressant-medication-aged-homes.html?utm_source=nwletter&utm_medium=email&utm_campaign=daily-nwletter#google_vignette

2. Batool, N., Raban, M. Z., Seaman, K., Westbrook, J., and Wabe, N. (2025). Impact of potentially inappropriate psychotropic medicines on falls among older adults in 23 residential aged care facilities in Australia: a retrospective longitudinal cohort study. BMJ Open, 15:e096187. Retrieved from https://bmjopen.bmj.com/content/15/4/e096187