Falls are not a normal part of aging, and they are not inevitable. Yet they are the leading cause of both fatal and non-fatal injuries in adults aged 65 and older in the United States. Each year, approximately one in four older adults experiences a fall, and for those who have fallen once, the risk of falling again is significantly elevated. Beyond the physical injury, falls carry a psychological toll: the fear of falling often leads to reduced activity, which weakens the muscles and balance systems that protect against falls, creating a cycle that compounds the original problem.
The good news is that falls are largely preventable with systematic assessment and targeted intervention. At Dr. Maryam Khan’s primary care practice in Lutherville-Timonium, fall risk assessment and prevention is a standard component of geriatric care.
Understanding Fall Risk: It Is Always Multifactorial
No single factor causes most falls. Falls occur at the intersection of multiple risk factors that accumulate over time. Understanding the categories of risk is the foundation of prevention:
Medication-Related Risk Factors
Medications are among the most modifiable and underappreciated fall risk factors. The following medication categories warrant particular attention in older adults:
• Benzodiazepines and sedative-hypnotics (including many ‘sleep aids’): Cause sedation, slowed reaction time, and impaired balance
• Opioids: Cause sedation and impaired coordination
• Antihypertensive medications at higher doses: Can cause orthostatic hypotension (a significant drop in blood pressure upon standing), resulting in dizziness and loss of balance
• Anticholinergic medications (many antihistamines, bladder medications, antidepressants): Cause confusion and impaired coordination, particularly in older adults
• Diuretics: Can cause dehydration and electrolyte imbalances that contribute to dizziness and weakness
| In Dr. Khan’s practice, medication review with specific attention to fall-risk medications is a standard part of every geriatric visit. Patients and families should bring a complete medication list, including all over-the-counter medications, supplements, and vitamins, to each appointment. |
Medical Conditions That Increase Fall Risk
• Orthostatic hypotension: A drop in systolic blood pressure of 20 mmHg or more upon standing. Causes dizziness or lightheadedness, particularly in the morning or after meals.
• Peripheral neuropathy: Reduced sensation in the feet (common in diabetes) impairs the proprioceptive feedback that guides balance.
• Parkinson’s disease: Affects gait, balance, and postural reflexes directly.
• Vision impairment: Reduced visual acuity, depth perception, and contrast sensitivity all increase fall risk. Annual ophthalmology evaluation is important for older adults.
• Cognitive impairment: Impaired judgment about safety, reduced attention, and slowed reaction time increase fall risk substantially.
• Urinary urgency: The rush to reach the bathroom quickly is a common precipitant of falls, particularly at night.
Physical and Functional Factors
• Muscle weakness, particularly in the lower extremities and core
• Impaired gait and balance, assessable with simple clinical tools such as the Timed Up and Go (TUG) test
• Foot problems, bunions, neuropathy, improper footwear
• Inappropriate footwear, loose slippers, high heels, or shoes without adequate grip
Home Safety: The Environment Matters
The majority of falls in older adults occur at home, and many home environments have modifiable hazards. A systematic home safety assessment, either conducted by a professional or self-guided using a checklist, can identify and address these hazards:
| Location | Common Hazards | Modifications |
| Bathroom | Slippery floor, no grab bars, low toilet | Non-slip mat, grab bars by toilet and shower, raised toilet seat |
| Bedroom | Getting up from low bed, clutter, poor lighting | Bed height adjustment, clear pathways, nightlight |
| Stairs | No handrails, poor lighting, loose carpeting | Bilateral handrails, adequate lighting, secure carpet or non-slip strips |
| Kitchen | Reaching overhead, wet floors | Reorganize frequently used items to accessible height, clean spills immediately |
| General | Loose rugs, electrical cords | Remove or secure throw rugs, route cords away from walking paths |
Exercise for Fall Prevention: The Evidence
Exercise is the most consistently effective single intervention for fall prevention. Specifically, programs that include balance training, lower extremity strengthening, and gait training, rather than general aerobic exercise alone, reduce fall rates by 20 to 30 percent in research studies.
Physical therapy is the most structured and individualized pathway to fall prevention exercise. Dr. Khan regularly refers older adults with identified fall risk to physical therapy for formal balance and strengthening programs. The Otago Exercise Programme and Tai Chi have both demonstrated evidence for fall prevention in community-dwelling older adults and may be available through local programs in the Baltimore County area.
Assistive Devices: Using Them Correctly
Canes and walkers are valuable tools when used correctly, and counterproductive when used with the wrong device or improper technique. A cane or walker that is the wrong height, in poor repair, or used inconsistently can itself become a fall hazard. Physical therapists can assess the need for an assistive device, fit it appropriately, and train the patient in its safe use.
| Personal emergency response systems (medical alert devices) are not fall prevention tools, they are response tools for after a fall has occurred. They are valuable for patients who live alone but should not substitute for the fall prevention measures described above. |
Talking to Dr. Khan About Fall Risk
Any fall, regardless of whether injury occurred, should be reported to a physician. A fall is a clinical event with medical significance. At Dr. Khan’s practice, a fall history triggers a systematic evaluation of contributing factors and a review of the preventive interventions that have or have not been implemented.
Families play an important role. If a family member notices that an older adult is moving more cautiously, holding onto furniture for support, or describing near-misses, that information is clinically valuable and should be brought to the primary care visit.
| For a fall risk assessment or geriatric health evaluation in Timonium, MD, contact Dr. Maryam Khan, MD at (443) 577-4010. Located at 1205 York Rd, Suite 11, Lutherville-Timonium, MD 21093. Accepting new patients. |