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Falling is the action of a person or animal losing stability and ending up in a lower position, often on the ground. It is the second-leading cause of
accidental death An accidental death is an unnatural death that is caused by an accident, such as a slip and fall, traffic collision, or accidental poisoning. Accidental deaths are distinguished from death by natural causes, disease, and from intentional hom ...
worldwide and a major cause of
personal injury Personal injury is a legal term for an injury to the body, mind or emotions, as opposed to an injury to property. In common law jurisdictions the term is most commonly used to refer to a type of tort lawsuit in which the person bringing the suit (t ...
, especially for the
elderly Old age refers to ages nearing or surpassing the life expectancy of human beings, and is thus the end of the human life cycle. Terms and euphemisms for people at this age include old people, the elderly (worldwide usage), OAPs (British usage ...
.
Falls in older adults Falls in older adults are a significant cause of morbidity and mortality and are a major class of preventable injuries. Falling is one of the most common accidents that cause a loss in the quality of life for older adults, and is usually precip ...
are a major class of preventable injuries.
Construction worker A construction worker is a worker employed in the physical construction of the built environment and its infrastructure. Definition By some definitions, workers may be engaged in manual labour as unskilled or semi-skilled workers; they may be sk ...
s,
electrician An electrician is a tradesperson specializing in electrical wiring of buildings, transmission lines, stationary machines, and related equipment. Electricians may be employed in the installation of new electrical components or the maintenance ...
s,
miner A miner is a person who extracts ore, coal, chalk, clay, or other minerals from the earth through mining. There are two senses in which the term is used. In its narrowest sense, a miner is someone who works at the rock face; cutting, blasting ...
s, and
painter Painting is the practice of applying paint, pigment, color or other medium to a solid surface (called the "matrix" or "support"). The medium is commonly applied to the base with a brush, but other implements, such as knives, sponges, and ...
s are occupations with high rates of fall injuries. Long-term exercise appears to decrease the rate of falls in older people. About 226 million cases of significant accidental falls occurred in 2015. These resulted in 527,000 deaths.


Causes


Accidents

The most common cause of falls in healthy adults is accidents. It may be by slipping or tripping from stable surfaces or stairs, improper footwear, dark surroundings, uneven ground, or lack of exercise. Studies suggest that women are more prone to falling than men in all age groups.


Age

Older people and particularly older people with
dementia Dementia is a disorder which manifests as a set of related symptoms, which usually surfaces when the brain is damaged by injury or disease. The symptoms involve progressive impairments in memory, thinking, and behavior, which negatively affe ...
are at greater risk than young people to injuries due to falling. Older people are at risk due to accidents, gait disturbances,
balance disorders A balance disorder is a disturbance that causes an individual to feel unsteady, for example when standing or walking. It may be accompanied by feelings of giddiness, or wooziness, or having a sensation of movement, spinning, or floating. Balance ...
, changed reflexes due to visual, sensory, motor and cognitive impairment, medications and alcohol consumption, infections, and dehydration.O'Loughlin, J. L., Robitaille, Y., Boivin, J. F., & Suissa, S. (1993). Incidence of and risk factors for falls and injurious falls among the community-dwelling elderly. American journal of epidemiology, 137(3), 342-354


Illness

People who have experienced
stroke A stroke is a disease, medical condition in which poor cerebral circulation, blood flow to the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemorr ...
are at risk for falls due to gait disturbances, reduced
muscle tone In physiology, medicine, and anatomy, muscle tone (residual muscle tension or tonus) is the continuous and passive partial contraction of the muscles, or the muscle's resistance to passive stretch during resting state.O’Sullivan, S. B. (2007). ...
and weakness, side effects of drugs to treat MS, low blood sugar, low blood pressure, and loss of vision. People with
Parkinson's disease Parkinson's disease (PD), or simply Parkinson's, is a long-term degenerative disorder of the central nervous system that mainly affects the motor system. The symptoms usually emerge slowly, and as the disease worsens, non-motor symptoms beco ...
are at risk of falling due to gait disturbances, loss of motion control including freezing and jerking, autonomic system disorders such as
orthostatic hypotension Orthostatic hypotension, also known as postural hypotension, is a medical condition wherein a person's blood pressure drops when standing up or sitting down. Primary orthostatic hypertension is also often referred to as neurogenic orthostatic hyp ...
, fainting, and
postural orthostatic tachycardia syndrome Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon standing. Symptoms may include lightheadedness, brain fog, blurred vision, weakness, fatigue, headaches, heart p ...
; neurological and sensory disturbances including muscle weakness of lower limbs, deep sensibility impairment, epileptic seizure, cognitive impairment, visual impairment, balance impairment, and side effects of drugs to treat PD. People with
multiple sclerosis Multiple (cerebral) sclerosis (MS), also known as encephalomyelitis disseminata or disseminated sclerosis, is the most common demyelinating disease, in which the insulating covers of nerve cells in the brain and spinal cord are damaged. This ...
are at risk of falling due to gait disturbances, drop foot,
ataxia Ataxia is a neurological sign consisting of lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in eye movements. Ataxia is a clinical manifestation indicating dysfunction of ...
, reduced
proprioception Proprioception ( ), also referred to as kinaesthesia (or kinesthesia), is the sense of self-movement, force, and body position. It is sometimes described as the "sixth sense". Proprioception is mediated by proprioceptors, mechanosensory neurons ...
, improper or reduced use of assistive devices, reduced vision, cognitive changes, and medications to treat MS.


Workplace

In the occupational setting, falling incidents are commonly referred to as slips, trips, and falls (STFs). Falls are an important topic for
occupational safety and health Occupational safety and health (OSH), also commonly referred to as occupational health and safety (OHS), occupational health, or occupational safety, is a multidisciplinary field concerned with the safety, health, and welfare of people at wo ...
services. Any walking/working surface could be a potential fall hazard. An unprotected side or edge which is or more above a lower level should be protected from falling by the use of a
guard rail Guard rail, guardrails, or protective guarding, in general, are a boundary feature and may be a means to prevent or deter access to dangerous or off-limits areas while allowing light and visibility in a greater way than a fence. Common shapes ...
system,
safety net A safety net is a net to protect people from injury after falling from heights by limiting the distance they fall, and deflecting to dissipate the impact energy. The term also refers to devices for arresting falling or flying objects for the ...
system, or personal fall arrest system. The National Institute for Occupational Safety and Health has compiled certain known risk factors that have been found responsible for STFs in the workplace setting. While falling can occur at any time and by any means in the workplace, these factors have been known to cause same-level falls, which are less likely to occur than falls to a lower level. Workplace factors: spills on walking surfaces, ice, precipitation (snow/sleet/rain), loose mats or rugs, boxes/containers, poor lighting, uneven walking surfaces Work organization factors: fast work pace, work tasks involving liquids or greases Individual factors: age; employee fatigue; failing eyesight / use of bifocals; inappropriate, loose, or poor-fitting footwear Preventive measures: warning signs For certain professions such as
stunt performers A stunt performer, often called a stuntman or stuntwoman and occasionally stuntperson or stunt-person, is a trained professional who performs daring acts, often as a career. Stunt performers usually appear in films or on television, as opposed ...
and
skateboarders Skateboarding is an action sport originating in the United States that involves riding and performing tricks using a skateboard, as well as a recreational activity, an art form, an entertainment industry job, and a method of transportation. S ...
, falling and learning to fall is part of the job.


Intentionally caused falls

Injurious falls can be caused intentionally, as in cases of
defenestration Defenestration (from Modern Latin ) is the act of throwing someone or something out of a window. The term was coined around the time of an incident in Prague Castle in the year 1618 which became the spark that started the Thirty Years' War. ...
or deliberate jumping.


Height and severity

The severity of injury increases with the height of the fall but also depends on body and surface features and the manner of the body's impacts against the surface. The chance of surviving increases if landing on a highly deformable surface (a surface that is easily bent, compressed, or displaced) such as snow or water. Injuries caused by falls from buildings vary depending on the building's height and the age of the person. Falls from a building's second floor/story (American English) or first floor/storey (British English and equivalent idioms in continental European languages) usually cause injuries but are not fatal. Overall, the height at which 50% of children die from a fall is between four and five
storey A storey (British English) or story (American English) is any level part of a building with a floor that could be used by people (for living, work, storage, recreation, etc.). Plurals for the word are ''storeys'' (UK) and ''stories'' (US). T ...
heights (around ) above the ground.


Prevention

Long-term exercise appears to decrease the rate of falls in older people. Rates of falls in hospital can be reduced with a number of interventions together by 0.72 from baseline in the elderly. In nursing homes, fall prevention programs that involve a number of interventions prevent recurrent falls.


Surviving falls

A falling person at low altitude typically reaches
terminal velocity Terminal velocity is the maximum velocity (speed) attainable by an object as it falls through a fluid ( air is the most common example). It occurs when the sum of the drag force (''Fd'') and the buoyancy is equal to the downward force of grav ...
of after about 12 seconds, falling some 450 m (1,500 ft) in that time. Without alterations to their aerodynamic profile, the person maintains this speed without falling any faster. Terminal velocity at higher altitudes is greater due to the thinner atmosphere and consequent lower air resistance. JAT stewardess
Vesna Vulović Vesna Vulović ( sr-Cyrl, Весна Вуловић, ; 3 January 1950 23 December 2016) was a Serbian flight attendant who holds the Guinness world record for surviving the highest fall without a parachute: . She was the sole survivor after a ...
survived a fall of on January 26, 1972, pinned within the broken fuselage of the DC-9 of
JAT Flight 367 JAT Yugoslav Airlines Flight 367 was a McDonnell Douglas DC-9-32 aircraft (registration YU-AHT) which exploded shortly after overflying NDB Hermsdorf (located in or around Hinterhermsdorf, in the present-day municipality of Sebnitz), East G ...
. The plane was brought down by explosives over
Srbská Kamenice Srbská Kamenice (german: Windisch Kamnitz) is a municipality and village in Děčín District in the Ústí nad Labem Region of the Czech Republic. It has about 300 inhabitants. History The first written mention of Srbská Kamenice is from 1352. ...
in the former
Czechoslovakia , rue, Чеськословеньско, , yi, טשעכאסלאוואקיי, , common_name = Czechoslovakia , life_span = 1918–19391945–1992 , p1 = Austria-Hungary , image_p1 ...
(now the
Czech Republic The Czech Republic, or simply Czechia, is a landlocked country in Central Europe. Historically known as Bohemia, it is bordered by Austria to the south, Germany to the west, Poland to the northeast, and Slovakia to the southeast. The ...
). The
Serbia Serbia (, ; Serbian: , , ), officially the Republic of Serbia ( Serbian: , , ), is a landlocked country in Southeastern and Central Europe, situated at the crossroads of the Pannonian Basin and the Balkans. It shares land borders with Hu ...
n stewardess suffered a broken skull, three broken vertebrae (one crushed completely), and was in a coma for 27 days. In an interview, she commented that, according to the man who found her, "…I was in the middle part of the plane. I was found with my head down and my colleague on top of me. One part of my body with my leg was in the plane and my head was out of the plane. A catering trolley was pinned against my spine and kept me in the plane. The man who found me, says I was very lucky. He was in the German Army as a medic during World War Two. He knew how to treat me at the site of the accident." In World War II there were several reports of
military A military, also known collectively as armed forces, is a heavily armed, highly organized force primarily intended for warfare. It is typically authorized and maintained by a sovereign state, with its members identifiable by their distinct ...
aircrew Aircrew, also called flight crew, are personnel who operate an aircraft while in flight. The composition of a flight's crew depends on the type of aircraft, plus the flight's duration and purpose. Commercial aviation Flight deck positions ...
surviving long falls from severely damaged aircraft: Flight Sergeant
Nicholas Alkemade Nicholas Stephen Alkemade (10 December 1922 – 22 June 1987) was a British tail gunner in the Royal Air Force during World War II who survived a freefall of without a parachute after abandoning his out-of-control, burning Avro Lancaster ...
jumped at without a parachute and survived as he hit pine trees and soft snow. He suffered a sprained leg. Staff Sergeant
Alan Magee Alan Eugene Magee (January 13, 1919 – December 20, 2003) was an American airman during World War II who survived a 22,000-foot (6,700 m) fall from his damaged B-17 Flying Fortress. He was featured in the 1981 ''Smithsonian Magazine'' as on ...
exited his aircraft at without a parachute and survived as he landed on the glass roof of a
train station A train station, railway station, railroad station or depot is a railway facility where trains stop to load or unload passengers, freight or both. It generally consists of at least one platform, one track and a station building providing ...
. Lieutenant
Ivan Chisov Ivan Mikhailovich Chisov (russian: Иван Михайлович Чисов, uk, Іван Михайлович Чиссов; 1916–1986) was a Soviet Air Force lieutenant who survived a fall of approximately 7,000 meters (23,000 feet). Biograph ...
bailed out at . While he had a parachute, his plan was to delay opening it as he had been in the midst of an air-battle and was concerned about getting shot while hanging below the parachute. He lost consciousness due to lack of oxygen and hit a snow-covered slope while still unconscious. While he suffered severe injuries, he was able to fly again in three months. It was reported that two of the victims of the Lockerbie bombing survived for a brief period after hitting the ground (with the forward nose section
fuselage The fuselage (; from the French ''fuselé'' "spindle-shaped") is an aircraft's main body section. It holds crew, passengers, or cargo. In single-engine aircraft, it will usually contain an engine as well, although in some amphibious aircraft t ...
in freefall mode), but died from their injuries before help arrived.
Juliane Koepcke Juliane Koepcke (born 10 October 1954), also known by her married name Juliane Diller, is a German-Peruvian mammalogist and biologist. In 1971, when she was 17 years old, Koepcke survived the LANSA Flight 508 plane crash. After falling while ...
survived a long free fall resulting from the December 24, 1971, crash of LANSA Flight 508 (a LANSA
Lockheed Electra Lockheed Electra refers to two distinct aircraft designs: * Lockheed Model 10 Electra, a ten-passenger piston engine aircraft of the 1930s, which had two immediate variants: ** Lockheed Model 12 Electra Junior, a six-passenger scaled-down version o ...
OB-R-941 commercial airliner) in the
Peruvian rainforest Peruvian Amazonia ( es, Amazonía del Perú) is the area of the Amazon rainforest included within the country of Peru, from east of the Andes to the borders with Ecuador, Colombia, Brazil and Bolivia. This region comprises 60% of the country ...
. The airplane was struck by
lightning Lightning is a naturally occurring electrostatic discharge during which two electrically charged regions, both in the atmosphere or with one on the ground, temporarily neutralize themselves, causing the instantaneous release of an average ...
during a severe
thunderstorm A thunderstorm, also known as an electrical storm or a lightning storm, is a storm characterized by the presence of lightning and its acoustic effect on the Earth's atmosphere, known as thunder. Relatively weak thunderstorms are some ...
and exploded in mid air, disintegrating up. Köpcke, who was 17 years old at the time, fell to earth still strapped into her seat. The German Peruvian teenager survived the fall with only a broken collarbone, a gash to her right arm, and her right eye swollen shut. As an example of "freefall survival" that was not as extreme as sometimes reported in the press, a skydiver from Staffordshire was said to have plunged without a parachute in Russia and survived. James Boole said that he was supposed to have been given a signal by another skydiver to open his parachute, but it came two seconds too late. Boole, who was filming the other skydiver for a television documentary, landed on snow-covered rocks and suffered a broken back and rib. While he was lucky to survive, this was not a case of true freefall survival, because he was flying a wingsuit, greatly decreasing his vertical speed. This was over descending terrain with deep snow cover, and he impacted while his parachute was beginning to deploy. Over the years, other skydivers have survived accidents where the press has reported that no parachute was open, yet they were actually being slowed by a small area of tangled parachute. They might still be very lucky to survive, but an impact at is much less severe than the that might occur in normal freefall. Parachute jumper and stuntman
Luke Aikins Luke Aikins (born November 21, 1973) is an American professional skydiver, BASE jumper, pilot, and aerial photographer. He is the first person to intentionally dive from mid- tropospheric altitude and land safely without a parachute or a wings ...
successfully jumped without a parachute from about into a net in
California California is a state in the Western United States, located along the Pacific Coast. With nearly 39.2million residents across a total area of approximately , it is the most populous U.S. state and the 3rd largest by area. It is also the m ...
, US, on 30 July 2016.


Epidemiology

In 2013, unintentional falls resulted in an estimated 556,000 deaths globally, up from 341,000 deaths in 1990. They are the second most common cause of death from unintentional injuries after motor vehicle collisions. File:Falls world map-Deaths per million persons-WHO2012.svg, Deaths due to falls per million persons in 2012 File:Falls world map - DALY - WHO2004.svg,
Disability-adjusted life year The disability-adjusted life year (DALY) is a measure of overall disease burden, expressed as the number of years lost due to ill-health, disability or early death. It was developed in the 1990s as a way of comparing the overall health and life ex ...
for falls per 100,000 inhabitants in 2004.


United States

They were the most common cause of injury seen in emergency departments in the United States. One study found that there were nearly 7.9 million emergency department visits involving falls, nearly 35.7% of all encounters. Among children 19 and below, about 8,000 visits to the emergency rooms are registered every day. In 2000, in the USA 717 workers died of injuries caused by falls from ladders, scaffolds, buildings, or other elevations. More recent data in 2011, found that STFs contributed to 14% of all workplace fatalities in the United States that year.


References


External links


Falls Among Older Adults: Brochures and Posters (in English, Spanish, and Chinese)
US Centers for Disease Control and Prevention
Falls Among Older Adults: An Overview
US Centers for Disease Control and Prevention
Costs of Falls Among Older Adults
US Centers for Disease Control and Prevention
Hip Fractures Among Older Adults
US Centers for Disease Control and Prevention
Falls in Nursing Homes
US Centers for Disease Control and Prevention
CDC Fall Prevention Activities
US Centers for Disease Control and Prevention
Preventing Falls: What Works―A CDC Compendium of Effective Community-based Interventions from Around the World
US Centers for Disease Control and Prevention (PDF)
Preventing Falls: How to Develop Community-based Fall Prevention Programs for Older Adults
US Centers for Disease Control and Prevention
CDC's Division of Unintentional Injury – Podcasts
US Centers for Disease Control and Prevention {{Authority control Injuries Safety Occupational safety and health