Many older adults report that they fall due to slips, trips and loss of balance episodes (1,2). This evidence makes it appear that nothing is wrong with the patient, problem is due to extrinsic factors: environmental hazards.

A large review article in a very reputable journal shows that majority, and the most important risk factors for falls in older adults are intrinsic, due to decline in health condition manifested most importantly as gait and balance deficits (3).

How do we reconcile this conflicting evidence?

This question was addressed indirectly by Dr Sri-on’s group questioning the validity of the term “mechanical fall” (4).  The authors show that the term “mechanical fall” used by physician is commonly referred to falls that patients describe as “slip” or “trip” and less commonly due to “passing out.” Yet, there was no difference between mechanical and non-mechanical falls in post-fall emergency department evaluation, re-admissions, recurrent falls, hospitalizations and death rates (4). Dr Sri-on explains that “external factors are seldom the sole cause of an elderly patient’s fall. In almost all cases, patients’ comorbidities and health status are involved: a younger person in the same environment probably would not have fallen“ (4).

It appears that older adult reports of slips and trips, external factors, can perhaps be best seen as a symptom of the underlying intrinsic decline in health condition and needs a thorough biomechanical assessment of balance and gait.

Dr Atanelov, MD. Steady Strides: Fall Prevention and Stroke Rehabilitation Medical Institute

References:

1. Campbell AJ, Borrie MJ, Spears GF, Jackson SL, Brown JS, Fitzgerald JL. Circumstances and consequences of falls experienced by a community population 70 years and over during a prospective study. Age Ageing. 1990 Mar;19(2):136-41. doi: 10.1093/ageing/19.2.136. Erratum in: Age Ageing 1990 Sep;19(5):345-6. PMID: 2337010.

2. Berg WP, Alessio HM, Mills EM, Tong C. Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing. 1997 Jul;26(4):261-8. doi: 10.1093/ageing/26.4.261. PMID: 9271288.

3. Ganz DA, Latham NK. Prevention of Falls in Community-Dwelling Older Adults. N Engl J Med. 2020 Feb 20;382(8):734-743. doi: 10.1056/NEJMcp1903252. PMID: 32074420.

4. Sri-on J, Tirrell GP, Lipsitz LA, Liu SW. Is there such a thing as a mechanical fall? Am J Emerg Med. 2016 Mar;34(3):582-5. doi: 10.1016/j.ajem.2015.12.009. Epub 2015 Dec 12. PMID: 26795891; PMCID: PMC6785031.