Why Are Falls So Deadly in Older Adults — and What Can Be Done to Prevent Them?

Nov 17

Written By Dr. Jessica Knape

Last Updated: November 2025

Medically Reviewed by Dr Jessica Knape, MD MA

Summary Overview

Falls are the leading cause of injury-related death among adults over 65.
The danger isn’t just the fall itself — it’s what happens next: fractures, brain injury, blood clots, and loss of independence.
Causes include weak muscles, balance issues, medications, vision changes, and chronic disease.
Prevention requires a root-cause, multidisciplinary approach: nutrition, strength, hormones, medication review, and home safety.
The good news: Most falls are preventable with targeted action and early assessment.

The Hidden Cost of a Fall

Falls are common — but in older adults, they’re often life-changing.
According to the CDC, one in four adults over 65 falls each year, and every 20 minutes an older American dies from a fall-related injury.

The danger isn’t just the fall itself — it’s the cascade of complications that follow:

Hip fractures that lead to immobility and blood clots
Head injuries (subdural hematomas) that can cause rapid decline
Loss of independence, leading to isolation, depression, and even early mortality

In fact, research shows that a single fall doubles the risk of falling again, and within a year, one in five older adults who fracture a hip will die — often from complications like infection, blood clots, or cardiovascular stress.

Falls are not just accidents — they are symptoms of deeper issues in the body’s systems of balance, strength, and coordination.

Root Causes: Why Older Adults Fall

Falls rarely have a single cause. In functional and geriatric medicine, we view them as a multi-system failure of balance — involving the brain, inner ear, muscles, vision, and even medications.

Here are the top contributors:

Muscle & Bone Weakness

Underlying Factors: Sarcopenia (muscle loss), osteoporosis
Examples: Weak legs, slower reaction times, fragile bones

Neurologic Changes

Underlying Factors: Slowed reflexes, peripheral neuropathy, cognitive decline
Examples: Shuffling gait, unsteady walking

Medications

Underlying Factors: Sedatives, antihypertensives, pain meds
Examples: Dizziness, orthostatic hypotension, fatigue

Vision & Hearing

Underlying Factors: Cataracts, poor contrast sensitivity, loss of spatial awareness
Examples: Trouble judging depth or obstacles

Metabolic Issues

Underlying Factors: Low blood sugar, dehydration, thyroid or adrenal dysfunction
Examples: Fatigue, dizziness, poor focus

Hormonal Changes

Underlying Factors: Low estrogen, testosterone, or cortisol dysregulation
Examples: Weak muscles, low bone density, low blood pressure

Environmental Hazards

Underlying Factors: Clutter, poor lighting, slippery surfaces
Examples: Preventable home risks

Why Falls Can Be Deadly

1. Fractures

A fall from standing height can cause a hip, wrist, or spine fracture — especially if bone density is low. Hip fractures in particular are devastating:

30% never regain full mobility
20–25% die within one year due to complications
40% require long-term care placement

2. Head Injuries

Even a minor head strike can cause a subdural hematoma (a slow brain bleed).
Because older adults often take blood thinners, these bleeds can progress silently until symptoms — confusion, headache, imbalance — become severe.

3. Immobility and Its Consequences

Prolonged bed rest after a fall causes rapid deconditioning, blood clots, pneumonia, and muscle loss — often starting a vicious cycle that accelerates aging.

4. Psychological Effects

Fear of falling again leads to reduced activity, which weakens muscles further — creating what’s called the “fear–fall–frailty cycle.”

What Doctors Don’t Always Explain

Most falls aren’t random — they’re predictable and preventable.
But standard medicine often treats falls after they happen, focusing on the injury rather than the system breakdown that led to it.

A precision or functional medicine approach identifies why balance and strength declined in the first place — and corrects those root causes.

Functional & Precision Medicine Approach to Fall Prevention

At Healthspan Internal Medicine, we use a systems-based framework to identify the multiple, interacting reasons behind a fall risk.

1. Comprehensive Risk Assessment

We start with:

Gait and balance testing (e.g., Timed Up and Go test)
Strength and mobility evaluation
Cognitive screening (attention, reaction time)
Medication and supplement review
Orthostatic blood pressure checks
Vision, hearing, and vestibular (inner ear) evaluation

2. Functional Lab & Biomarker Analysis

Falls can be linked to subtle physiologic imbalances:

Vitamin D & calcium levels → Bone and muscle strength
Thyroid, cortisol, and sex hormones → Energy and stability
Glucose and insulin patterns → Prevent dizziness and fatigue
Inflammation markers (CRP, homocysteine) → Identify systemic stress
Genomic analysis (e.g., IntellxxDNA) → Detect variants in collagen synthesis, balance, or neuroplasticity pathways

3. Targeted Interventions

We tailor a program to rebuild stability and prevent decline:

Resistance training: 2–3×/week to rebuild muscle and reaction speed
Balance therapy: Yoga, tai chi, or physical therapy
Bone health optimization: Correct low vitamin D, magnesium, or hormone imbalance
Vision & vestibular rehab: Eye alignment and spatial retraining
Medication review: Reduce or replace sedatives, antihypertensives, or polypharmacy culprits

4. Environmental & Lifestyle Modifications

Remove clutter, add grab bars, use contrasting floor colors
Optimize lighting, especially near stairs and bathrooms
Choose stable, supportive footwear
Encourage hydration and small protein-rich meals to prevent orthostatic drops

Preventing Falls Starts at Home

Simple changes can dramatically reduce fall risk:

Install grab bars and non-slip mats in bathrooms.
Add nightlights in hallways and bedrooms.
Remove throw rugs and floor clutter.
Keep a phone or alert device within easy reach.
Have annual eye and hearing exams.

Review all medications at least twice a year with your clinician.

The Role of Exercise and Strength

Exercise is the single best “medicine” for fall prevention.
Programs like Tai Chi, Otago, and balance-based resistance training improve stability and reaction time.

Research from the Journal of the American Geriatrics Society shows that structured strength and balance programs can reduce falls by up to 40% — and increase bone density, confidence, and independence.

When to Seek Medical Help

You should seek immediate evaluation if you or a loved one experiences:

A fall with head impact, confusion, or severe pain
Sudden dizziness or fainting
New weakness, numbness, or visual changes
Signs of dehydration or low blood pressure

Early assessment prevents recurrent falls and helps identify treatable causes such as infection, medication side effects, or heart rhythm issues.

The Healthspan Perspective

At Healthspan Internal Medicine in Boulder, CO, Dr. Jessica Knape integrates root-cause medicine with precision diagnostics to help patients stay active, independent, and cognitively strong as they age.

Our goal isn’t just to prevent falls — it’s to extend functional years through:

Strength and bone optimization
Hormone balance
Cognitive and vestibular health
Environmental safety and confidence training

Because every year of independence is a year of healthspan.

Sources

Medically reviewed by
Dr. Jessica Knape, MD, MA Board Certified in Internal Medicine and Integrative and Holistic Medicine
Healthspan Internal Medicine — serving patients in Boulder, CO

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This content is for educational purposes and does not replace personalized medical advice.

Dr. Jessica Knape https://www.healthspaninternalmedicine.com