Understanding Fall Risk Factors for Older Adults

As Spring blooms across South Africa, many older adults begin to spend more time outdoors. Gardening, walking, visiting loved ones, and increased activity brings wonderful benefits. But it also brings the potential for falls, which remain a leading cause of injury, hospitalisation, and loss of independence among people over 60. Recognising and addressing the risk factors for falls is a key role for physiotherapists in helping older community members stay safe and active.

What Makes Someone More Likely to Fall?

Falls rarely happen for just one reason. They’re usually the result of multiple interacting factors: some intrinsic (within the person), some extrinsic (outside, in the environment), and many modifiable with physiotherapy intervention.

Here are common risk factors:

• Muscle weakness, especially in the lower limbs. Reduced strength in legs, hips and ankles can make it difficult to rise from sitting, climb stairs, or recover balance after a slip or trip.

• Gait and balance impairments. Changes in walking speed, stride length, instability, or difficulty turning are major contributors.

• Vision impairment. Poor eyesight, especially in dim light or uneven ground, increases risk.

• Sensory deficits (proprioception, vestibular), joint mobility limitations, or pain from arthritis.

• Medication / polypharmacy. Some medications, or combinations, can cause dizziness, postural hypotension, or sedation.

• Environmental hazards. Poor lighting, slippery / uneven surfaces, loose rugs, obstacles in walkways.
  

Evidence & What Studies Have Found

• In a South African urban community-dwelling older adult study, history of previous falls, poor balance/gait speed, muscle weakness, and use of assistive devices emerged as significant predictors of future falls.

• A large Cochrane-style review of physical activity interventions in people aged 60+ showed that balance and functional exercises, as well as multi-component exercise programmes (including strength + balance + mobility training) reduce fall rate by about 23-28%.

• Health care practitioners in South Africa identify not only the usual risk factors, but also emphasise muscle power (rapid force generation) and joint mobility functions as critical components that are often under-assessed.
  

What Can Physiotherapists Do to Reduce Fall Risk?

1. Screen early and holistically. Use tools and clinical judgement to assess strength, balance, gait, vision, previous fall history, medication review (with prescribing doctors or pharmacists). Pay attention to muscle power and joint mobility, not just strength.

2. Design targeted exercise programmes.

   • Balance training (single-leg stance, tandem walking, stepping reactions)

   • Strength / resistance training for leg muscles, hips

   • Functional task training (stairs, rising from chair, turning)

   • Where possible, mixed interventions that also address mobility and flexibility

3. Home and community environment modifications. Advise older adults to improve lighting, remove tripping hazards, use safe footwear, handrails, non-slip mats.

4. Education & behavioural strategies. Help clients understand their risk, encourage participation in programmes, plan for worst-case scenarios (i.e. safe ways to get up after a fall), ensure regular vision checks, review medications.

5. Seasonally appropriate advice. As days lengthen and outdoors beckons: remind patients to be cautious in early morning or evening dusk (visibility issues), wet/slippery surfaces after rain, uneven garden paths.
   

Relevance for September

With Spring arriving, the days are warmer, plants are coming back, people are more mobile again after winter. This is an ideal time to raise awareness about falls, so older adults can enjoy the season safely. Physiotherapists can play a very timely role in reminding clients about movement, strength, and safety in changing conditions.

Take-Home Message

Falls are not an inevitable part of ageing. Many of the risk factors are modifiable with early assessment, exercise, environmental adjustments, and inter-professional collaboration. This September, let’s help older patients step into Spring with confidence, strength, and safety.

References

Kalula SZ, et al. Risk factors for falls in older adults in a South African Urban community-dwelling population. PMC (2016). PMC

Sherrington C, et al. Evidence on physical activity and falls prevention for people aged 60+: Systematic Review. International Journal of Behavioral Nutrition and Physical Activity (2020) BioMed Central

De Clercq H., Naudé A., Bornman J. The perspectives of healthcare practitioners on fall risk factors in older adults. Health SA Gesondheid (2020)