Current Trauma Reports

, Volume 3, Issue 2, pp 118–123 | Cite as

Older Adult Falls: Effective Approaches to Prevention

  • Ann DellingerEmail author
Injury Prevention (T Raybould, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Injury Prevention



The issue of older adult falls combines a problem with high incidence and high injury susceptibility with an increasing population at risk. A firm understanding of both fall risk factors and effective strategies is required to reduce risk and prevent these injuries.

Recent Findings

Each year, 28.7% of older adults aged ≥65 sustain a fall. At the national level, this represents 29 million falls resulting in 27,000 deaths and 7 million injuries requiring medical treatment or restricted activity for at least 1 day. There are several strategies that have been shown to effectively reduce the risk or the incidence of falls.


More than 90% of older adults see a medical provider at least once a year providing an opportunity to identify and address fall risk factors. Comprehensive fall prevention in the primary care setting is both feasible and practical.


Senior falls Fall prevention Effective fall prevention Clinician role fall prevention 


Compliance with Ethical Standards

Conflict of Interest

Dr. Dellinger declares no conflicts of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the author.


The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Pew Research Center. Available at:
  2. 2.
    Centers for Disease Control and Prevention. Older adult falls. Available at:
  3. 3.
    • Bergen G, Stevens MR, Burns ER. Falls and fall injuries among adults aged >65 years—United States, 2014. MMWR. 2016;65(37):993–8. This article provides national estimates of the self-reported incidence of older adult falls and the proportion injured by state. Google Scholar
  4. 4.
    • Burns ER, Stevens JA, Lee R. The direct costs of fatal and non-fatal falls among older adults—United States. J Saf Res. 2016; doi: 10.1016/j.jsr.2016.05.001. This article provides national estimates of direct medical costs for older adult falls in hospital, emergency department, and outpatient settings.
  5. 5.
    Stockdale H, Guillory K. In American Cancer Society Cancer Action Network (Ed.), Why cancer patients depend on Medicare for critical coverage Available at:
  6. 6.
    • Dieleman JL, Baral R, Birger M, Bui AL, Bulchis A, Chapin A, et al. US spending on personal health care and public health, 1996–2013. JAMA. 2016;316(24):2627–46. doi: 10.1001/jama.2016.16885. This article provides estimates of US healthcare spending for 155 conditions.
  7. 7.
    Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based injury statistics query and reporting system (WISQARS) [online]. (2005). Available at:
  8. 8.
    McMahon S, Talley KM, Wyman JF. Practice development section paper 1 older people’s perspectives on fall risk and fall prevention programs: a literature review. Int J Older People Nursing. 2011;6(4):289–98. doi: 10.1111/j.1748-3743.2011.00299.x. Scholar
  9. 9.
    Yardley L, Donovan-Hall M, Francis K, Todd C. Older people’s views of advice about falls prevention: a qualitative study. Health Educ Res. 2006;21(4):508–17.CrossRefPubMedGoogle Scholar
  10. 10.
    Berlin Hallrup L, Albertsson D, Bengtsson Tops A, Dahlberg K, Grahn B. Elderly women’s experiences of living with fall risk in a fragile body: a reflective lifeworld approach. Health Soc Care Community. 2009;17(4):379–87.CrossRefPubMedGoogle Scholar
  11. 11.
    Boyd R, Stevens JA. Falls and fear of falling: burden, beliefs and behaviours. Age Ageing. 2009;38(4):423–8.CrossRefPubMedGoogle Scholar
  12. 12.
    Sterling DA, O’Connor JA, Bonadies J. Geriatric falls: injury severity is high and disproportionate to mechanism. J Trauma Injury Infect Crit Care. 2001;50(1):116–9.CrossRefGoogle Scholar
  13. 13.
    Ambrose AF, Hausdorff PG. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013;75:51–61.CrossRefPubMedGoogle Scholar
  14. 14.
    Rubenstein LZ, Josephson KR. The epidemiology of falls and syncope. Clin Geriatr Med. 2002;18(2):141–58.CrossRefPubMedGoogle Scholar
  15. 15.
    Goldacre MJ, Roberts SE, Yeates D. Mortality after admission to hospital with fractured neck of femur: database study. BMJ. 2002;325(7369):868–9.CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, Marra CA. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169(21):1952–60.CrossRefPubMedGoogle Scholar
  17. 17.
    Muir SW, Berg K, Chesworth B, Klar N, Speechley M. Quantifying the magnitude of risk for balance impairment on falls in community-dwelling older adults: a systematic review and meta-analysis. J Clin Epidemiol. 2010; doi: 10.1016/j.jclinepi.2009.06.010.PubMedGoogle Scholar
  18. 18.
    Verghese J, Ambrose AF, Lipton RB, Wang C. Neurological gait abnormalities and risk of falls in older adults. J Neurol. 2010;257(3):392–8. doi: 10.1007/s00415-009-5332-y.CrossRefPubMedGoogle Scholar
  19. 19.
    Agrawal Y, Carey JP, Della Santina C, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults. Arch Intern Med. 2009;169(10):938–44.CrossRefPubMedGoogle Scholar
  20. 20.
    Moreland JD, Richardson JA, Goldsmith CH, Clase CM. Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc. 2004;52:1121–9.CrossRefPubMedGoogle Scholar
  21. 21.
    Stevens JA, Baldwin GT, Ballesteros MF, Noonan RK, Sleet DA. An older adult falls research agenda from a public health perspective. Clin Geriatr Med. 2010;26(4):767–79.CrossRefPubMedGoogle Scholar
  22. 22.
    American Geriatrics Society, British Geriatrics Society, American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. Special series: clinical practices. J Am Geriatr Soc. 2001;49:664–72.Google Scholar
  23. 23.
    •• Panel on Prevention of Falls in Older Persons, American Geriatrics Society, British Geriatrics Society. Summary of the updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons. J Am Geriatr Soc. 2011;59:148–57. This is an updated summary of the practice guideline for older adult fall prevention that provides graded recommendations for care. Google Scholar
  24. 24.
    Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. New Engl J Med. 1988;319(26):1701–7.CrossRefPubMedGoogle Scholar
  25. 25.
    Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, et al. Interventions for preventing falls in older people living in the community (review). Cochrane Database Syst Rev. 2012; doi: 10.1002/14651858.CD007146.pub3.Google Scholar
  26. 26.
    Stubbs B, Brefka S, Denkinger MD. What works to prevent falls in community-dwelling older adults? Umbrella review of meta-analyses of randomized controlled trials. Phys Ther. 2015;95(8):1–16.CrossRefGoogle Scholar
  27. 27.
    Michael YL, Whitlock EP, Lin JS, Fu R, O’Connor EA, Gold R. Primary care-relevant interventions to prevent falling in older adults: a systematic evidence review for the U.S. Preventive Services Task Force. Ann Intern Med. 2010;153:815–25.CrossRefPubMedGoogle Scholar
  28. 28.
    Thomas S, Mackintosh S, Halbert J. Does the Otago exercise programme reduce mortality and falls in older adults?: a systematic review and meta-analysis. Age Ageing. 2010;39(6):681–687. doi: 10.1093/ageing/afq102.
  29. 29.
    Rimland JM, Abraha I, Dell’Aquila G, Cruz-Jentoft A, Soiza R, Gudmusson A, et al. Effectiveness of non-pharmacological interventions to prevent falls in older people: a systematic overview. PLOS ONE: The SENATOR project ONTOP series; 2016. doi: 10.1371/journal.pone.0161579.Google Scholar
  30. 30.
    Barnett A, Smith B, Lord SR, Williams M, Baumand A. Community-based group exercise improves balance and reduces falls in at-risk older people: a randomized controlled trial. Age Ageing. 2003;32(4):407–14.CrossRefPubMedGoogle Scholar
  31. 31.
    • Stevens JA, Burns ER. A CDC compendium of effective fall interventions: what works for community-dwelling older adults. 3rd ed. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, 2015. This report showcases effective single and multifactorial interventions in the areas of exercise, home modification, and clinical strategies that include vitamin D supplementation, medication modification, vision correction, podiatry, and pacemaker surgery. Google Scholar
  32. 32.
    Carande-Kulis V, Stevens JA, Florence CS, Beattie BL, Arias I. A cost-benefit analysis of three older adult fall prevention interventions. J Saf Res. 2015;52:65–70.CrossRefGoogle Scholar
  33. 33.
    Clemson L, Cumming RG, Kendig H, Swann M, Heard R, Taylor K. The effectiveness of a community-based program for reducing the incidence of falls in the elderly: a randomized trial. J Am Geriatr Soc. 2004;52:1487–94.CrossRefPubMedGoogle Scholar
  34. 34.
    Li F, Harmer P, Fisher KJ, McAuley E, Chaumeton N, Eckstrom, et al. Tai Chi and fall reductions in older adults: a randomized controlled trial. J Gerontology. 2005;60A(2):187–94.Google Scholar
  35. 35.
    Bischoff-Ferrari HA, Dawson-Hughes B, Staehelin HB, Orav JE, Stuck AE, Theiler R, et al. Fall prevention with supplemental and active forms of vitamin D: a meta-analysis of randomized controlled trials. BMJ. 2009;339:b3692. doi: 10.1136/bmj.b3692.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Murad MH, Elamin KB, Abu Elnour NO, Elamin MB, Alkatib AA, Fatourechi MM, et al. The effect of vitamin D on falls: a systematic review and meta-analysis. J Clin Edocrinol Metab. 2011;96(10):2997–3006.CrossRefGoogle Scholar
  37. 37.
    Bolland MJ, Grey A, Gamble GD, Reid IR. Vitamin D supplementation and falls: a trial sequential meta-analysis. Lancet Diabetes Endocrinol. 2014;2(7):573–80. doi: 10.1016/S2213-8587(14)70068-3.CrossRefPubMedGoogle Scholar
  38. 38.
    Institute of Medicine, Committee to Review Dietary Reference Intakes for Vitamin D and Calcium, Dietary intakes; calcium and vitamin D, 2011. Available at:
  39. 39.
    Dawson-Hughes B. Serum 25-hydroxyvitamin D and functional outcomes in the elderly. Am J Clin Nutr. 2008;88(suppl):537S–40S.PubMedGoogle Scholar
  40. 40.
    Looker AC, Johnson CL, Lacher DA, Pfeiffer CM, Schleicher RL, Sempos T. Vitamin D status: United States, 2001–2006. National Center for Health Statistics Data Brief No 59. 2011. Available at:
  41. 41.
    American Geriatrics Society Workgroup on Vitamin D Supplementation for Older Adults. Recommendations abstracted from the American Geriatrics Society consensus statement on vitamin D for prevention of falls and their consequences. J Am Geriatr Soc. 2013;62(1):147–52.CrossRefGoogle Scholar
  42. 42.
    Spink MJ, Menz HB, Fotoohabadi MR, Wee E, Landorf KB, Hill KD, et al. Effectiveness of a multifaceted podiatry intervention to prevent falls in community dwelling older people with disabling foot pain: randomized controlled trial. BMJ. 2011;342:d3411. doi: 10.1136/bmj.d3411.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Karlsson MK, Magnusson H, von Schewelov T, Rosengren BE. Prevention of falls in the elderly—a review. Osteoporos Int. 2013;24:747–62. doi: 10.1007/s00198-012-2256-7.CrossRefPubMedGoogle Scholar
  44. 44.
    Menant JC, Steele JR, Menz HB, Munro BJ, Lord SR. Optimizing footwear for older people at risk of falls. J Rehabil Res Dev. 2008;45(8):1167–81.CrossRefPubMedGoogle Scholar
  45. 45.
    Cumming RG, Ivers R, Clemson L, Gullen J, Hayes MF, Tanzer M, et al. Improving vision to prevent falls in frail older people: a randomized trial. J Am Geriatr Soc. 2007;55:175–81. doi: 10.1111/j.1532-5415.2007.0146.x.CrossRefPubMedGoogle Scholar
  46. 46.
    Day L, Fildes B, Gordon I, Fitzharris M, Flamer H, Lord S. Randomized factorial trial of falls prevention among older people living in their own homes. BMJ. 2002;325:128–33.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Harwood RH, Foss AJE, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following first eye cataract surgery: a randomized controlled trial. Br J Opthalmol. 2005;89:53–9. doi: 10.1136/bjo.2004.049478.CrossRefGoogle Scholar
  48. 48.
    Foss AJE, Harwood RH, Osborn F, Gregson RM, Zaman A, Masud T. Falls and health status in elderly women following second eye cataract surgery: a randomized controlled trial. Age Ageing. 2006;35:66–71. doi: 10.1093/ageing/afj005.CrossRefPubMedGoogle Scholar
  49. 49.
    Cumming RG, Thomas M, Szonyi G, Salkeld G, O’Neill E, Westbury C, Frampton G. Home visits by an occupational therapist for assessment and modification of environmental hazards: a randomized trial of falls prevention. J Am Geriatr Soc. 1999;47(12):1397–402.CrossRefPubMedGoogle Scholar
  50. 50.
    Voigt-Radloff S, Ruf G, Vogel A, van Nes F, Hüll M. Occupational therapy for elderly: evidence mapping of randomized controlled trials from 2004-2012. Z Gerontol Geriatr. 2015;48(1):52–72. doi: 10.1007/s00391-013-0540-6.CrossRefPubMedGoogle Scholar
  51. 51.
    O’Hara B, Caswell K. Health Status, health insurance, and medical services utilization: 2010. P70-133RV, Current Population Reports, U.S. Census Bureau, Washington, DC, 2013.Google Scholar
  52. 52.
    Stevens JA, Ballesteros MF, Mack KA, Rudd RA, DeCaro E, Adler G. Gender differences in seeking care for falls in the aged Medicare population. Am J Prev Med. 2012;43(1):59–62.CrossRefPubMedGoogle Scholar
  53. 53.
    Stevens JA, Noonan RK, Rubenstien LZ. Older adult fall prevention: perceptions, beliefs, and behaviors. Am J Lifestyle Med. 2010;4(1):16–20. doi: 10.1177/1559827609348350.CrossRefGoogle Scholar
  54. 54.
    Dickinson A, Horton K, Machen I, et al. The role of health professionals in promoting the uptake of fall prevention interventions: a qualitative study of older people’s views. Age Ageing. 2011;40(6):724–30.CrossRefPubMedGoogle Scholar
  55. 55.
    de Groot GC, Fagerström L. Older adults’ motivating factors and barriers to exercise to prevent falls. Scand J Occup Ther. 2011;18(2):153–60.CrossRefPubMedGoogle Scholar
  56. 56.
    Chou WC, Tinetti ME, King MB, Irwin K, Fortinsky RH. Perceptions of physicians on the barriers and facilitators to integrating fall risk evaluation into practice. J Gen Intern Med. 2006;21:117–22.CrossRefPubMedPubMedCentralGoogle Scholar
  57. 57.
    Fortinsky RH, Iannuzzi-Sucich M, Baker DI, Gottschalk M, King MB, Brown CJ, et al. Fall-risk assessment and management in clinical practice: views from healthcare providers. J Am Geriatr Soc. 2004;52(9):1152–6.CrossRefGoogle Scholar
  58. 58.
    Phelan EA, Aerts S, Dowler D, Eckstrom E, Casey CM. Adoption of evidence-based fall prevention practices in primary care for older adults with a history of falls. Front Public Health. 2016;4:190. doi: 10.3389/fpubh.2016.00190.
  59. 59.
    Stevens JA, Phelan EA. Development of STEADI: a fall prevention resource for health care providers. Health Promot Pract. 2013;14(5):706–14.CrossRefPubMedGoogle Scholar
  60. 60.
    Parker E, Lee R, Floyd F, Roma A, Talbut B, Moss H, et al. Making older adult fall prevention part of routine care in a large health system in New York state. Gerontologist. 2015;55(Suppl_2):320. doi: 10.1093/geront/gnv620.02.Google Scholar
  61. 61.
    • Casey CM, Parker EM, Winkler G, Liu X, Lambert GH, Eckstrom E. (2016) Lessons learned from implementing CDC’s STEADI falls prevention algorithm in primary care. Gerontologist. doi: 10.1093/geront/gnw074. This article provides a real-world example of how to incorporate older adult fall prevention into a fast-paced primary care setting.

Copyright information

© Springer International Publishing AG (outside the USA) 2017

Authors and Affiliations

  1. 1.Division of Unintentional Injury Prevention, National Center for Injury Prevention and ControlCenters for Disease Control and PreventionAtlantaUSA

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