The Impact of Falling Down and How to Prevent Falls

In 1973, Erica Jong’s ground-breaking novel Fear of Flying, which documented a 29-year-old woman’s journey of self-discovery, became a national bestseller. Fast-forward to the present day, and a likelier concern for the book’s aging heroine might be her fear of falling.

The Physical and Psychological Impact of Falls

Falls come at a significant cost to the individual and society. According to the United States Centers for Disease Control and Prevention (CDC), falls are the number one cause of injuries and injury-related mortality among older men and women. One out of four people aged 65 and over in the US fall every year, and 2.8 million older individuals are treated each year in emergency facilities for fall-related injuries.

Approximately 800,000 of these falls result in hospitalization. Traumatic brain injury, which is most commonly the result of falling, is a major cause of disability among older individuals.

In addition to their physical impact, falls can have significant psychological effects. Many people who have experienced a fall develop a strong fear of falling again. This can lead to reduced activity levels and can cause people to hesitate to venture from their homes. Less activity leads to less strength and worsened balance, which increase the risk of another fall. By seeking to reduce their risk of falling by limiting their activities, fall victims can actually bring about the event they fear, resulting in a vicious cycle of diminished activity levels and additional falls.

Populations at Risk of Falling

Advanced age, decreased physical strength, having fallen during the previous year, and pain were associated with a fear of falling in a study of individuals aged 60 to 92 years.1 In this study, 26.9% of the men and 43.3% of the women reported a fear of falling. As the authors report, the prevalence of being afraid of falling among community dwellers is 29% in the USA, ~58% in Japan, and ~77% in Korea. The authors also note that a fear of falling is associated with comorbidities such as cardiovascular diseases, diabetes mellitus, stroke, and chronic obstructive pulmonary disease.

Why do older people fall more often than younger adults? According to the CDC, muscle weakness (sarcopenia), impaired balance, challenges with walking, poor vision, home hazards, prescription and over-the-counter medication side effects, foot disorders and poor footwear, decreased vitamin D levels, and other factors can all increase the risk of falls. Osteoporosis has been linked to falling, when fracture of a weak, brittle bone is the cause, rather than the effect of a fall.

While many medications are essential for the treatment of a variety of conditions, a number of prescription drugs have been associated with the risk of falls. Opioids, sedatives, hypnotics, tricyclic antidepressants, selective serotonin reuptake inhibitors, and serotonin norepinephrine reuptake inhibitors have been associated with an increased risk of falls. There is evidence that drugs used to treat high blood pressure, including calcium channel blockers, beta-blockers, and angiotensin system blockers may also increase the risk of falls. If these drugs are deemed necessary, care should be taken to minimize other fall risks.

Reducing the Risk of Falling

Supplementation with a protein-enriched diet, calcium, and vitamin D was associated with less than half the risk of falling in comparison with usual care in a study that included a group of malnourished older adults.2 Consuming an optimal amount of protein on a daily basis is critical for the maintenance of muscles that strengthen and stabilize the body.

A review and meta-analysis published in the Journal of the American Medical Association concluded that calcium and vitamin D supplementation combined with clinic-level quality improvement strategies and multifactorial assessment and treatment was associated with an 88% lower risk of injurious falls compared with usual care.3 Combined osteoporosis treatment, which included bisphosphonate, calcium supplementation, and vitamin D supplementation, was associated with a 78% lower risk of fractures.

How Vitamin D Protects Against Falls

In a review of vitamin D’s effects on strength, frailty, and falls, M. Halfon and colleagues observe that vitamin D supplementation is associated with improved muscle strength and gait and that, despite the interpretation of some meta-analyses, a lower risk of falls has been attributed to supplementing with vitamin D due to direct effects on muscle cells.4 They add that insufficient vitamin D levels have also been associated with frailty, which increases fall risk. Vitamin D supplementation has also been associated with improved postural balance.5 It has additionally been suggested that vitamin D’s protection against falling could also be the result of a cognitive benefit associated with the vitamin. People who are cognitively impaired can experience impaired foresight, planning, and reactions, which may lead to falls.

Due to the high level of vitamin D deficiency among older individuals, routine treatment with vitamin D supplements has been recommended to prevent falls and associated disability and mortality. A consensus statement from the American Geriatrics Society concluded, based on clinical trials of older community-dwelling and institutionalized persons and meta-analyses, that a serum 25 hydroxyvitamin D (25(OH)D) concentration of 30 ng/mL (75 nmol/L) should be a minimum goal to achieve in older adults, particularly in frail adults, who are at higher risk of falls, injuries, and fractures. The workgroup concluded that the goal to reduce fall injuries related to low vitamin D status could be achieved safely, and would not require practitioners to measure serum 25(OH)D concentrations in older adults in the absence of underlying conditions that increase the risk of hypercalcemia, such as advanced renal disease, certain malignancies, or sarcoidosis.

“Vitamin D supplementation is emerging as an easy, safe and well-tolerated fall reduction/prevention strategy due to the beneficial effects on the musculoskeletal system with improvements in strength, function and navigational abilities,” write F. D. Shuler and colleagues. The authors conclude that, based on data from meta-analyses, a maximal fall reduction benefit in seniors could be achieved when correcting vitamin D deficiencies and when performing calcium supplementation.6

The Bottom Line

Exercise remains one of the most important therapies for fall prevention, as well as protection against a number of other diseases and age-related conditions. However, some individuals are unable or unwilling to devote the time and energy to this important facet of health. Supplementation with proteins, calcium, and vitamin D is a simple and inexpensive way for older men and women to maintain optimal health and help conquer their fear of falling.


  1. Tomita Y et al. Medicine (Baltimore). 2018 Jan;97(4):e9721.
  2. Neelemaat F et al. J Am Geriatr Soc. 2012 Apr;60(4):691-9.
  3. Tricco AC et al. JAMA. 2017 Nov 7;318(17):1687-1699.
  4. Halfon M et al. Biomed Res Int. 2015;2015:953241.
  5. Cangussu LM et al. Menopause. 2016 Mar;23(3):267-74.
  6. Shuler FD et al. W V Med J. 2014 May-Jun;110(3):10-2.


Anonymous said...

I have a parent who is presently 93. After a severe fall & hip fracture 15 years ago, she developed a true fear of falling that made her significantly less willing to get out & about. Today she is still mentally agile & not fallen in a decade.
I think the following may have helped:
She supplements with adequate vitamin D, & on her last diagnostics was at the very upper end of the recommended range.
She works out every day of the week, including 3 resistance training programs. Perhaps most significantly she practices walking backwards & forwards & side to side for range of motion & balance. Note she always has nearby chairs so she cannot fall whilst extending herself.
I also draw her attention to some Life Extension content, so thank you all.

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