The Impact of Falls on Our Elders

Authored by: Carla Hu

Art by: Ariana Desai

Falls at a young age are often dismissed as minor accidents, yet for older adults, they can be a turning point that reshapes their independence, confidence, and quality of life. More than one in four adults over age 65 fall each year, making falls one of the most common and serious threats to healthy aging [1]. Even more concerning, falls are the leading cause of injury-related deaths for older adults, and mortality rates due to falls have steadily increased over time 41% from 2012 to 2021 [2]. In 2021, the mortality rate from falls was 78 out of every 100,000 older adults [2]. Despite these concerning statistics, falls are not an inevitable part of aging, and many are preventable. Understanding why they occur and how our healthcare system addresses falls reveals a complex public health challenge that goes beyond simple accident prevention.

Healthcare providers play a central role in reducing falls by performing clinical screenings that allow professionals to evaluate mobility, balance, and bone density before an accident occurs. Interventions for falls often include strength and balance training, medications, and home safety modifications such as installing grab bars or improving lighting [3]. These preventative approaches highlight that falls can result from multiple causes, including physiological decline, medication side effects, and environmental hazards. One important yet often overlooked contributor to falls is osteoporosis, a medical condition that does not cause falls directly but can greatly amplify their consequences.

Osteoporosis is a widespread bone disease characterized by weakened bone tissue, reduced bone structure, where the formation of new bone cannot keep up with the loss of old bone [4]. This often makes fractures far more likely to occur even in low-impact falls [4]. Among all adults, osteoporosis prevalence is higher in women than in men, and in 2017-2018, 55.7% of adults aged 50 and older had osteoporosis or low bone mass [4]. For these older adults, a fracture could mean hospitalization, loss of independence, or permanent disability. Thus, bone health can determine whether falls become a temporary setback or a life-altering event. This often leads to healthcare providers frequently prescribing medications to strengthen bones and reduce fracture risk. Bisphosphonates, one of the most common drugs for osteoporosis, have been shown to improve bone density and reduce fracture risk, improving long-term outcomes after a fall [5]. These preventative medications allow older adults to recover from falls without sustaining fractures that could significantly impact their quality of life, illustrating how medical intervention is key to protecting healthy aging.

However, medications are not without trade-offs. Researchers have found that osteoporosis medications may be associated with increased rates of depression and anxiety, suggesting potential unintended psychological side effects [5]. In one analysis, depressive adverse drug reactions were more than 14-fold higher in patients under age 65 taking alendronate and more than fourfold higher in patients over 65 than in controls [5]. These findings complicate a straightforward clinical decision. Physicians and patients must consider not only the risks for fractures, but also mental health and overall well-being. This dilemma highlights a broader issue in geriatric medicine, where interventions designed to solve one problem may unintentionally create another, making careful risk evaluations and individualized care essential.

Osteoporosis medications can reduce fracture risk, but they may also carry important side effects that physicians must weigh carefully. Some drugs have been associated with psychological adverse effects such as depression and anxiety, while newer medications raise other safety concerns. Romosozumab, a treatment option for severe osteoporosis, takes a unique approach by increasing bone formation to reduce fracture risk and is a major advancement in treating osteoporosis [6]. However, emerging research found that Romosozumab is also associated with increased risk for cardiovascular events like heart attacks and atrial fibrillation [6]. This reflects the delicate balance in clinical decision-making where medications can prevent debilitating fractures but may simultaneously increase cardiovascular risk. Therefore, physicians making decisions for fall prevention must also consider their patients’ other medical conditions and the risks and benefits of prescribing newer osteoporosis treatments.

These trade-offs reveal that preventing falls cannot solely rely on medication. Thus, physicians may instruct older adults with cardiovascular conditions to take a non-pharmacological approach, such as environmental modifications and physical therapy programs that build muscle strength and improve balance. This strategy may be safer than being exposed to the risk of medication side-effects. Yet for individuals with severe osteoporosis or very high fracture risk, medication remains essential in addition to lifestyle and environmental changes.

Ultimately, falls in older adults are more than isolated incidents. They reveal how well the healthcare system supports an aging population through prevention and individualized care rather than standard treatment alone. Successfully addressing falls in this population requires holistic preventative measures and close collaboration between healthcare providers and older adults to ensure quality care later in life.

References

1. Centers for Disease Control and Prevention. National Center for Health Statistics. National Vital Statistics System, Mortality 1999–2021 on CDC WONDER Online Database. Accessed January 24, 2023. https://wonder.cdc.gov/ucd-icd10.html 

2. Kakara RS, Lee R, Eckstrom EN. Cause-Specific Mortality Among Adults Aged ≥65 Years in the United States, 1999 Through 2020. Public Health Reports. 2023 March;139(1):54–58. DOI: 10.1177/00333549231155869.

3. Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years—United States, 2012–2018. MMWR Morbidity and Mortality Weekly Report. 2020 July 10;69(27):875–881. DOI: 10.15585/mmwr.mm6927a5.

4. Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017–2018. NCHS Data Brief, no 405. Hyattsville, MD: National Center for Health Statistics. 2021. DOI: https://dx.doi.org/10.15620/cdc:103477external icon.

5. Keshishi, D., Makunts, T. & Abagyan, R. Common osteoporosis drug associated with increased rates of depression and anxiety. Sci Rep 11, 23956 (2021). https://doi.org/10.1038/s41598-021-03214-x

6. Stolcpart R, Higgs E, Bartelt K, Longo J. Some Bone Density Treatments Linked to Increased Likelihood of Heart Attack and Atrial Fibrillation. Epic Research. https://epicresearch.org/articles/some-bone-density-treatments-linked-to-increased-likelihood-of-heart-attack-and-atrial-fibrillation. Accessed on January 22, 2026.