Falls are defined as events in which a person unintentionally comes to rest on the ground, floor, or other lower level. Fall-related injuries can be fatal or non-fatal, though most are non-fatal. For instance, in China, for every death due to a fall, four children suffer permanent disability, thirteen are hospitalized for over ten days, twenty-four are hospitalized for one to nine days, and six hundred and ninety seek medical care or miss school or work due to fall-related injuries.
Globally, falls represent a significant public health problem. An estimated 684,000 fatal falls occur annually, making falls the second leading cause of unintentional injury deaths, after road traffic injuries. Over 80% of fall-related fatalities occur in low- and middle-income countries, with the Western Pacific and Southeast Asia regions accounting for 60% of these deaths. Death rates are highest among adults aged 60 and above across all regions.
Although not always fatal, approximately 37.3 million falls severe enough to require medical attention occur every year. Falls are responsible for over 38 million Disability-Adjusted Life Years (DALYs) lost annually, resulting in more years lived with disability than transport injuries, drowning, burns, and poisoning combined.
While nearly 40% of DALYs lost to falls worldwide occur in children, this measure may not accurately reflect the impact of fall-related disabilities among older adults, who have fewer life years to lose. Moreover, older individuals who fall and suffer disability are at major risk for subsequent long-term care and institutionalization.
The financial costs of fall-related injuries are substantial. In Finland and Australia, the average healthcare cost per fall injury for those aged 65 years or older is US$ 3,611 and US$ 1,049, respectively. Evidence from Canada suggests that effective fall prevention strategies that reduce fall incidence by 20% among children under 10 could save over US$ 120 million annually in healthcare costs.
While anyone who falls is at risk of injury, age, gender, and health status influence the type and severity of the injury.
Age is one of the key risk factors for falls. Older individuals face the highest risk of death or serious injury from a fall, and the risk increases with age. For example, in the United States, 20-30% of older adults who fall experience moderate to severe injuries, such as bruises, hip fractures, or head trauma. This elevated risk may be due to the physical, sensory, and cognitive changes associated with aging, combined with environments that are not adapted for an aging population.
Another high-risk group is children. Childhood falls typically occur due to developmental changes, an innate curiosity about their surroundings, and increasing levels of independence that often involve "risk-taking" behaviors. Inadequate adult supervision is a commonly cited risk factor, but the circumstances are often more complex, influenced by factors such as poverty, single-parenthood, and hazardous environments.
Gender also plays a role in fall-related risks. Both males and females are at risk of falling, but in some countries, males are more likely to die from falls, while females tend to suffer more non-fatal falls. Older women and young children, in particular, are at higher risk of falling and experiencing more severe injuries. Males consistently suffer higher death rates and DALYs lost globally. Possible explanations for the greater burden seen among males include higher levels of risk-taking behaviors and hazardous working conditions.
Other contributing risk factors include:
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Occupations involving elevated heights or other hazardous working conditions.
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Alcohol or substance use.
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Socioeconomic factors such as poverty, overcrowded housing, single-parent households, and young maternal age.
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Underlying medical conditions such as neurological, cardiac, or other disabling conditions.
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Side effects of medication, physical inactivity, and loss of balance, particularly among older individuals.
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Poor mobility, cognition, and vision, particularly in institutional settings such as nursing homes or long-term care facilities.
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Unsafe environments, especially for individuals with poor balance or limited vision.
A variety of interventions exist to prevent falls across the life course. These include, but are not limited to:
For children and adolescents:
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Parenting programs for low-income and marginalized families.
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Providing parents with information about child fall risks and supporting them in reducing these risks at home.
For workers:
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Enforcing stricter workplace safety regulations in high-risk occupations, such as the construction industry.
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Multicomponent workplace safety programs.
For older adults:
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Gait, balance, and functional training.
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Tai Chi programs.
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Home assessment and modifications.
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Reduction or withdrawal of psychotropic medications.
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Multifactorial interventions (individual fall-risk assessments followed by tailored interventions and referrals).
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Vitamin D supplementation for those who are Vitamin D deficient.
In addition to these evidence-based interventions, there are other measures considered prudent, despite the lack of high-quality research backing. This is because such interventions are unlikely to undergo rigorous research due to challenges in conducting the necessary studies or because their effectiveness is so fundamental that research is not deemed necessary. Examples of such interventions include:
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Fencing off or restricting access to dangerous areas.
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Promoting playground safety standards, such as requiring soft play surfaces and restricting fall heights.
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Functioning occupational health and safety systems.
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Harnesses, restraint systems, fall arrest systems, and safe scaffolding for workers at heights.
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Requiring landlords to make necessary home modifications and enforcing building standards.
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Improving the accessibility of neighborhoods and public spaces (e.g., pavements).
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Ensuring adequate staff-to-resident ratios in residential care facilities.
Whether through individual health management or improvements to the broader social and environmental infrastructure, raising public awareness about the risks of falls and implementing comprehensive prevention measures will help reduce the harm caused by falls. This will be especially beneficial for older adults, significantly improving their quality of life.