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Understanding Falls

Posted by Deborah Lee on


One of the most common problems older adults face is the risk of falling. An estimate shows that more than a third of those aged over 65 worldwide experience a fall in within the year. In Singapore, this prevalence is around 17.2%.

Those who have fallen before also face the risk of falling again, with the risk of falls increasing with age. From 17.2%, elderly persons aged 80 and above have 50% more likelihood of falling.


There are both physical and mental consequences of falling. Physical consequences range from minor bruising, major bruising, hip fractures and even premature death. About 1% of older adults are likely to sustain a hip injury after falling. With hip injuries, mortality rate is increased by 20-30%.

A serious mental consequence of falling is fear. Fear of falling creates a phobia which restricts the overall independence of the elderly. Even if they suffered only minor injuries, the elderly person may be too afraid to be as mobile as before and wish to prolong staying at home. This leads to depression, anxiety, increased dependence on others and reduced body functions. The risk of developing this fear is higher in prevalent falls. Decreased mobility has an exponentially adverse effect on the health of an elderly person.


What causes falling? There are 2 categories of factors: Intrinsic and extrinsic.

Intrinsic factors refer to health related issues such as balance disorders, arthritis, depression, side effects of medication, dizziness and visual impairment. Balance disorders affect 20–50% of elderly over the age of 65 (Rubenstein, 2002).  Depression also increases the risk of falls two-fold as it may bring about risky behavior or limited awareness of surrounding hazards. Additonally, elderly persons who have difficulty carrying out activities of daily living face twice the risk of falling.

Extrinsic factors are environmental hazards (slippery floors, clutter, uneven platforms) that cause accidental falls. This is why it is important for caregivers and the community to ensure that our environment is elderly-friendly. Accidental falls are the most common of falls, accounting for 25 to 40% of falls (Lim, 2010), yet they can easily be prevented.


There is no one-size-fits-all way to prevent elderly persons from falling. It takes education, regular exercise, environment modification and where applicable, review of medication. Vitamin D supplementation has been shown to reduce falling risks by more than 20% among mobile elderly living in institutionalised homes, possibly due to better neurological function (Bischoff, 2004). 

A multi-dimensional approach to fall prevention is the key to effectiveness, by understanding the causes of falls and mitigating the risks early, so that our elderly can live more safely and independently.



Bischoff, H. F. (2004). Effect of Vitamin D on falls: a meta-analysis. JAMA.

Lim, S. C. (2010). Elderly Fallers What do we need to do. Singapore: Department of Geriatric Medicine, Singapore General Hospital.

Rubenstein, L. (2002). The Epidemiology of falls and syncope. Clinic Geriatr Med.

Tinetti, M. (1988). Risk Factors for falls among elderly persons. England.



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