The Near-Misses That Predict Falls

Falls are often treated as the starting point. In reality, they are frequently preceded by events that don’t get reported.

Clinically, a fall is defined as an unintended descent to the ground or a lower level. But in practice, patients don’t always describe it that way.

What often goes unrecognized are the moments just before that:

• A loss of balance that is caught by a wall or piece of furniture
• A misstep that is quickly corrected
• A brief instability that doesn’t result in a fall

These events don’t lead to injury. So they’re rarely mentioned, and often not documented. In many cases, patients avoid labeling these as falls altogether—anything that preserves the sense of independence.

At the same time, subtle behavioral changes begin to appear:

• Walking closer to walls or furniture
• Reaching out for support “just in case”
• Using the environment more to maintain balance

This is often referred to as “furniture walking.”

Research in older adults has shown that changes in balance control, gait variability, and reaction time are associated with increased fall risk before a first reported fall occurs (Hausdorff et al.; Verghese et al.).

And once a fall does occur, the risk changes significantly. Falling once has been shown to double the likelihood of falling again, and roughly half of older adults who fall will experience another fall within the following year (CDC; Porto et al.).

In many cases, patients adapt. They become more cautious and rely more on their surroundings. These adjustments can prevent an immediate fall, but they also indicate that stability is already changing.

By the time a fall is reported, the pattern has often been present for some time.

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