Why Falls Happen More Often as We Age: Causes of Instability in Older Adults

Falls are a leading cause of injury and hospitalisation in older Australians. In fact, one in three people over 65 will experience a fall each year, and the risk increases significantly with age. While many people think of falls as accidents, they’re often the result of underlying medical, physical, or environmental factors that can be identified and addressed.

In this article, we explore the common causes of falls and instability in seniors and what can be done to reduce the risk and promote independence.

1. Changes in Balance and Gait

As we age, the systems that help us maintain balance, including the inner ear (vestibular system), vision, and proprioception (our sense of body position), often become less reliable. This can result in unsteadiness while walking, difficulty turning, and a higher chance of tripping or falling.



Gait changes, such as shorter stride length, slower walking speed, or shuffling, are common and can be early warning signs of fall risk.

2. Muscle Weakness and Loss of Strength

Aging is naturally accompanied by sarcopenia, the gradual loss of muscle mass and strength, especially in the legs and core. This makes it harder to:

• Rise from a chair
  
• Climb stairs
  
• Regain balance after a slip or stumble
  
  

Regular physical activity and resistance exercises can significantly reduce fall risk by improving strength and stability.

3. Vision Impairments

Reduced visual acuity, depth perception, and contrast sensitivity are common with age. Eye conditions in seniors such as cataracts, glaucoma, and macular degeneration, can make it difficult to spot obstacles, judge distances, or see in low light — all of which increase the risk of tripping or misstepping.



4. Medication Side Effects

Many older adults take multiple medications — a situation known as polypharmacy. Some medications can cause:

• Dizziness or drowsiness
  
• Drop in blood pressure upon standing (orthostatic hypotension)
  
• Impaired alertness or coordination
  
  

Common culprits include sedatives, blood pressure medications, antidepressants, and medications for diabetes or Parkinson’s.

5. Chronic Health Conditions

Several health conditions common in older adults can contribute to instability, including:

• Arthritis, which limits joint mobility and causes pain
  
• Neurological disorders such as Parkinson’s disease, stroke, or peripheral neuropathy
  
• Heart conditions that affect circulation or oxygen delivery
  
• Cognitive decline or dementia, which can impair judgement, navigation, or the ability to recognise hazards
  
  

These conditions can subtly — or suddenly — affect mobility and balance, making falls more likely without warning.

6. Fatigue and Poor Sleep

Sleep disturbances become more common with age, and poor sleep in seniors can lead to daytime fatigue, delayed reaction times, and reduced coordination. Fatigue also affects concentration and alertness, increasing the risk of falls during everyday activities.



7. Environmental Hazards at Home

Many falls occur in and around the home, often due to avoidable hazards such as:

• Loose rugs or clutter
  
• Poor lighting
  
• Slippery floors
  
• Inaccessible items requiring reaching or climbing
  
  

Simple changes to the home environment can significantly reduce fall risks.

8. Foot Problems and Poor Footwear

Foot pain, bunions, or poor circulation can affect gait and balance. Footwear that doesn’t provide proper support — such as backless slippers, high heels, or overly worn shoes — increases fall risk.



Older adults should wear well-fitting, non-slip shoes with good arch support and consider seeing a podiatrist for persistent foot issues.

9. Lack of Physical Activity

Physical inactivity leads to weaker muscles, stiffer joints, and slower reflexes, all of which contribute to instability. Regular movement — even light walking, tai chi, or water-based exercise — can help maintain balance, flexibility, and confidence.



10. Cognitive Changes

Mild cognitive impairment or dementia can affect:

• Awareness of surroundings
  
• Ability to recognise or respond to hazards
  
• Memory of safety instructions (e.g., using a walker)

This may lead to wandering, poor judgement, or missteps, especially in unfamiliar environments.

How to Reduce Fall Risk

• Stay active with exercises focused on strength, balance, and flexibility
  
  
• Have regular eye and hearing tests
  
  
• Review medications with a GP or pharmacist
  
  
• Ensure the home is safe, clutter-free, and well-lit
  
  
• Use assistive devices when needed (e.g. walking sticks, handrails)
  
  
• Consider professional fall risk assessments
  
  
• Monitor health data (e.g., gait, heart rate, blood pressure) through smart technology

Staying Safe with Smart Fall Detection and Panic Alarms