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A comprehensive assessment of risk factors for falls in middle-aged adults: co-ordinated analyses of cohort studies in four countries



We identified demographic, health and lifestyle factors associated with falls in adults aged 50–64 years from Australia, The Netherlands, Great Britain and Ireland. Nearly all factors were associated with falls, but there were differences between countries and between men and women. Existing falls prevention programs may also benefit middle-aged adults.


Between ages 40–44 and 60–64 years, the annual prevalence of falls triples suggesting that middle age may be a critical life stage for preventive interventions. We aimed to identify demographic, health and lifestyle factors associated with falls in adults aged 50–64 years.


Harmonised data were used from four population-based cohort studies based in Australia (Australian Longitudinal Study on Women’s Health, n = 10,641, 51–58 years in 2004), Ireland (The Irish Longitudinal Study on Ageing, n = 4663, 40–64 years in 2010), the Netherlands (Longitudinal Ageing Study Amsterdam, n = 862, 55–64 years in 2012–13) and Great Britain (MRC National Survey of Health and Development, n = 2987, 53 years in 1999). Cross-sectional and prospective associations of 42 potential risk factors with self-reported falls in the past year were examined separately by cohort and gender using logistic regression. In the absence of differences between cohorts, estimates were pooled using meta-analysis.


In cross-sectional models, nearly all risk factors were associated with fall risk in at least one cohort. Poor mobility (pooled OR = 1.71, CI = 1.34–2.07) and urinary incontinence (OR range = 1.53–2.09) were consistently associated with falls in all cohorts. Findings from prospective models were consistent. Statistically significant interactions with cohort and sex were found for some of the risk factors.


Risk factors known to be associated with falls in older adults were also associated with falls in middle age. Compared with findings from previous studies of older adults, there is a suggestion that specific risk factors, for example musculoskeletal conditions, may be more important in middle age. These findings suggest that available preventive interventions for falls in older adults may also benefit middle-aged adults, but tailoring by age, sex and country is required.

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Some of the research on which this article is based was conducted as part of the Australian Longitudinal Study on Women’s Health by The University of Newcastle and The University of Queensland. We are grateful to the women who provided the survey data and to the Australian Government Department of Health for funding. The NSHD is funded by the UK Medical Research Council. We are grateful to NSHD study members for their continuing support. NSHD data used in this publication are available to bona fide researchers upon request to the NSHD Data Sharing Committee via a standard application procedure. Further details can be found at doi:; doi: The Longitudinal Ageing Study Amsterdam is supported by a grant from the Netherlands Ministry of Health Welfare and Sports, Directorate of Long-Term Care. The data collection [in 2012–2013 and 2013-2014] was financially supported by the Netherlands Organization for Scientific Research (NWO) in the framework of the project “New Cohorts of young old in the 21st century” (file number 480-10-014). The Irish Longitudinal Study on Ageing (TILDA) is funded by the Irish Government, the Atlantic Philanthropies and Irish Life PLC. We are grateful to all of the TILDA respondents for participating in the study. Researchers interested in using TILDA data may access the data for free from the following sites:


GP was supported by a Global Brain Health Institute Fellowship. RC was supported by the UK Medical Research Council (programme code: MC_UU_12019/4).

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Peeters, G., Cooper, R., Tooth, L. et al. A comprehensive assessment of risk factors for falls in middle-aged adults: co-ordinated analyses of cohort studies in four countries. Osteoporos Int 30, 2099–2117 (2019).

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  • Accidental falls
  • Middle-aged
  • Mobility
  • Population health