There are a wide range of potential risk factors for falling in mid to later life, as such falls are considered to be multifactorial, often being the result of the interplay between a number of intrinsic and extrinsic factors which can include, but are not limited to:
- functional decline, such as muscle weakness, both due to lifestyle factors such as lack of movement or sedentariness (office work) and muscle deterioration which starts to occur during mid-life;
- sensory changes, including visual, and to a lesser extent, hearing loss;
- medical conditions, including multiple long term conditions (and associated pain) and specific medical conditions which make it more likely for a person to fall;
- polypharmacy (multiple medications) and use of certain medications in particular;
- psychological aspects, fear of falling, loss of confidence and self-efficacy;
- diet and nutrition, including low protein diets, malnutrition and lack of vitamin D for those with low levels or during winter months;
- poor balance, which can be caused by ability to integrate sensory information and communicate internally with our musculoskeletal system;
- history of falling, environmental hazards both inside the home (wet floor, poor lighting) and outside in neighbourhoods and cities.
Fear of falling is reported by approximately one in four people over the aged of 65 living in community settings. For those who have already experienced a fall and older people living in the institutional care settings, the prevalence is higher. The potential impacts of fear of falling are many, from increased anxiety, distress and medication use through to reduced and restricted activity, leading to a decline in physical functioning. This lack of movement has a knock-on effect of increasing falls risk and potentially leading to a move from home into institutional care. When considering environmental factors, an older person’s falls risk can vary by residential setting. For those aged 65 and over living in the community, approximately 35% fall over each year, whereas older adults living in long-term care settings have a 50% chance of falling.