Clinical Resources - Falls & Mobility

A fall is a sudden and unintentional change in position resulting in an individual landing at a lower level such as on an object, the floor, or the ground, with or without injury. Falls are among the most common and serious problems facing elderly persons. Most falls are predictable and preventable: a fall can cause a loss in confidence which can lead to a decline in health and function and contribute to future falls. (1)

Why is it important?                           

  • 30-50% of seniors experience a fall each year. About a 1/3 of these are serious falls with higher risk of adverse events. 
  • Factors which indicate higher risk are presentation to physician or ER because of fall, fear of falling, multiple frequent falls and abnormal gait (assessed by Timed Up and Go).
  • Falling is associated with increased mortality, morbidity, reduced functioning, and LTCH admissions
  • Increased risk of serious falls in first six weeks after admission to LTC
  • Almost 62% of injury-related hospitalizations for seniors are the result of falls.
  • Fall-related injury rate is 9 times greater among seniors over 65 than those less than 65 years of age.
  • 50% of seniors who fall experience a minor injury: 5% to 25% sustain an injury like a fracture or sprain
  • Falls cause 90% of all hip fractures in seniors: 20% die within a year of the fracture.
  • Often families are unable to provide care: 40% of LTCH admissions occur as a result of falls
  • Fall-related injury coupled with co-morbid diseases (e.g., osteoporosis) and age-related physiological decline (e.g., slower reflexes) make a mild fall dangerous.

Common Causes

The risk of falling dramatically increases as the number of risk factors increases.




Sensory input
   (vision, hearing and

 Nerve conduction

 Number motor neurons

 Fast twitch fibers

 Muscle mass

 Vascular changes -
   prone to postural

  • Lower extremity weakness, balance / gait problems
  • Visual deficits, hearing loss
  • Acute or chronic illness
  • Decreased sensation
  • Depression, cognitive impairment
  • Dizziness / postural hypotension
  • Functional / ADL impairment

Certain medications:

  • Psychotropics/Benzodiazepines; Digoxin, Diuretics
  • Class 1a anti-arrhythmics
  • Polypharmacy (5 or more)


  • History of falls, fear of falling
  • Excessive alcohol use (≥14 /wk)
  • Risk-taking behaviours (lack of insight)
  • Improper use of (or lack of use of)  assistive device
  • Stairs
  • Home hazards (kitchen, bathroom, bedroom)
  • Outdoor hazards
  • Public / community hazards
  • Improper footwear


Primary Care providers can significantly decrease the fall risk of their elderly patients by:

  • Screening for fall risk on admission and annularly.
  • Conducting a comprehensive post falls assessment to identify contributory causes and risk factors
  • Implementing multidisciplinary management strategies that target modifiable risk factor especially environmental factors and footwear
  • Review Beers criteria 2012:
  • Assess for osteoporosis risk and presence of fragility fractures.  Consider use of bisphosphonates and/or equivalent treatments in presence of history of fragility fractures.
  • Consider use of hip protectors


1.  Public Health Agency of Canada, Division of Aging & Seniors.  (2005). Report on Seniors’ Falls in Canada.
Retrieved Feb. 2014 from:

Recommended Readings / Guidelines

1.  Anderson, K.E. &  McKay C.  (2010).  How to manage falls in community dwelling older adults: 

     a review of the evidence. Postgrad Med J. 2010 May; 86 (1015):299-306.  Retrieved March, 2014 from:

2.   Cook, W.L., Donaldson, M.G., Janssen, P.A., Khan, K.M. and Sobolev B.  (2009). Analysis of recurrent events:
      a systematic review of randomised controlled trials of interventions to prevent falls
. Age Ageing. 2009 Mar;
      38(2):151-5. Retrieved March 2014 from:

3.   National Institute for Health and Care Excellence. (2013).  Falls: assessment and prevention of falls in older
: June 2013 NICE. Retrieved March 2014 from:

4.   Registered Nurses’ Association of Ontario. (2002, 2005, 2011).  Prevention of Falls and Fall Injuries in the
      Older Adult
.  Retrieved March 2014 from: