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 homici ...

worldwide and a major cause of

personal injury Personal injury is a legal term for an Injury (law), injury to the body, mind, or emotions, as opposed to an injury to property. In common law, common law jurisdictions the term is most commonly used to refer to a type of tort lawsuit in which the ...

, especially for the

elderly Old age is the range of ages for people nearing and surpassing life expectancy. People who are of old age are also referred to as: old people, elderly, elders, senior citizens, seniors or older adults. Old age is not a definite biological sta ...

. Falls in older adults are a major class of preventable injuries.

Construction worker A construction worker is a person employed in the physical construction of the built environment and its infrastructure. Definitions By some definitions, construction workers may be engaged in manual labour as unskilled or semi-skilled workers ...

electrician An electrician is a tradesman, 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 ...

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 (mining), face; cutt ...

s, and

painter Painting is a Visual arts, visual art, which is characterized by the practice of applying paint, pigment, color or other medium to a solid surface (called "matrix" or "Support (art), support"). The medium is commonly applied to the base with ...

s are

occupations Occupation commonly refers to: *Occupation (human activity), or job, one's role in society, often a regular activity performed for payment * Occupation (protest), political demonstration by holding public or symbolic spaces *Military occupation, t ...

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 and risk factors

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 syndrome associated with many neurodegenerative diseases, characterized by a general decline in cognitive abilities that affects a person's ability to perform activities of daily living, everyday activities. This typically invo ...

are at greater risk than young people to injuries due to falling. Older people are at risk due to accidents, gait disturbances, balance disorders, 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 Stroke is a medical condition in which poor cerebral circulation, blood flow to a part of the brain causes cell death. There are two main types of stroke: brain ischemia, ischemic, due to lack of blood flow, and intracranial hemorrhage, hemor ...

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, 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 neurodegenerative disease primarily of the central nervous system, affecting both motor system, motor and non-motor systems. Symptoms typically develop gradually and non-motor issues become ...

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 they are standing up ( orthostasis) or sitting down. Primary orthostatic hypotension is also often referred to as ne ...

, fainting, and

postural orthostatic tachycardia syndrome Postural orthostatic tachycardia syndrome (POTS) is a condition characterized by an abnormally large increase in heart rate upon sitting up or standing. POTS is a disorder of the autonomic nervous system that can lead to a variety of symptoms, ...

; 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 sclerosis (MS) is an autoimmune disease resulting in damage to myelinthe insulating covers of nerve cellsin the brain and spinal cord. As a demyelinating disease, MS disrupts the nervous system's ability to Action potential, transmit ...

are at risk of falling due to gait disturbances, drop foot,

ataxia Ataxia (from Greek α- negative prefix+ -τάξις rder= "lack of order") is a neurological sign consisting of lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in e ...

, reduced

proprioception Proprioception ( ) is the sense of self-movement, force, and body position. Proprioception is mediated by proprioceptors, a type of sensory receptor, located within muscles, tendons, and joints. Most animals possess multiple subtypes of propri ...

, improper or reduced use of assistive devices, reduced vision, cognitive changes, and medications to treat MS.

Workplace

Construction workers not wearing fall protection equipment

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) or occupational health and safety (OHS) is a multidisciplinary field concerned with the safety, health, and welfare of people at work (i.e., while performing duties required by one's occupation). OSH is re ...

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 rails, guardrails, railings 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. Commo ...

system,

safety net A safety net is a type of net (device), net designed to protect people from injury after falling (accident), falling from heights by limiting the distance they fall, and dissipating the impact energy. The term also refers to devices for arres ...

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 stunt, daring acts, often as a career. Stunt performers usually appear in films or on television, as op ...

and skateboarders, falling and learning to fall is part of the job. Spectators look on as Starlin Polanco gets up from an attempt during the best trick contest

Spectators look on as Starlin Polanco gets up from an attempt during the best trick contest

Intentionally caused falls

Injurious falls can be caused intentionally, as in cases of defenestration 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. The height at which 50% of children die is between five and six

storey A storey (English in the Commonwealth of Nations, Commonwealth 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 wor ...

heights above the ground.

Prevention

Prevent falling accidents - NARA - 535301

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. Falls can also be prevented by installing flooring with appropriate amounts of slip resistance for the intended use of the flooring. For instance, a pool deck and an outdoor ramp would need a floor with more wet slip resistance than a floor in a section of a store selling only canned food items. Reliable floor slip resistance testing methods can be very useful in preventing slips and falls in areas expected to get wet or otherwise contaminated in use.

Surviving falls

A falling person at low altitude typically reaches

terminal velocity Terminal velocity is the maximum speed attainable by an object as it falls through a fluid (air is the most common example). It is reached when the sum of the drag force (''Fd'') and the buoyancy is equal to the downward force of gravity (''FG ...

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 flight attendant Vesna Vulović survived a fall of on 26 January 1972, pinned within the broken fuselage of the DC-9 of JAT Flight 367. The plane was brought down by explosives planted by Croatian

Ustaše The Ustaše (), also known by anglicised versions Ustasha or Ustashe, was a Croats, Croatian fascist and ultranationalist organization active, as one organization, between 1929 and 1945, formally known as the Ustaša – Croatian Revolutionar ...

over Srbská Kamenice in the former

Czechoslovakia Czechoslovakia ( ; Czech language, Czech and , ''Česko-Slovensko'') was a landlocked country in Central Europe, created in 1918, when it declared its independence from Austria-Hungary. In 1938, after the Munich Agreement, the Sudetenland beca ...

(now the

Czech Republic The Czech Republic, also known as Czechia, and historically known as Bohemia, is a landlocked country in Central Europe. The country is bordered by Austria to the south, Germany to the west, Poland to the northeast, and Slovakia to the south ...

). The

Serbia , image_flag = Flag of Serbia.svg , national_motto = , image_coat = Coat of arms of Serbia.svg , national_anthem = () , image_map = , map_caption = Location of Serbia (gree ...

n flight attendant 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. Militaries are typically authorized and maintained by a sovereign state, with their members identifiable by a d ...

aircrew Aircrew 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 In commercial aviatio ...

surviving long falls from severely damaged aircraft: Flight Sergeant Nicholas Alkemade jumped at without a parachute and survived as he hit pine trees and soft snow. He suffered a sprained leg. Staff Sergeant Alan Magee exited his aircraft at without a parachute and survived as he crashed through the glass roof of Saint-Nazaire train station. Lieutenant Ivan Chisov 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 language, French ''fuselé'' "spindle-shaped") is an aircraft's main body section. It holds Aircrew, crew, passengers, or cargo. In single-engine aircraft, it will usually contain an Aircraft engine, engine as wel ...

in freefall mode), but died from their injuries before help arrived. Juliane Koepcke survived a long free fall resulting from the 24 December 1971, crash of LANSA Flight 508 (a LANSA Lockheed Electra OB-R-941 commercial airliner) in the Peruvian rainforest. The airplane was struck by

lightning Lightning is a natural phenomenon consisting of electrostatic discharges occurring through the atmosphere between two electrically charged regions. One or both regions are within the atmosphere, with the second region sometimes occurring on ...

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 acoustics, acoustic effect on the Earth's atmosphere, known as thunder. Relatively weak thunderstorm ...

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 successfully jumped without a parachute from about into a net in

California California () is a U.S. state, state in the Western United States that lies on the West Coast of the United States, Pacific Coast. It borders Oregon to the north, Nevada and Arizona to the east, and shares Mexico–United States border, an ...

, 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 A disability-adjusted life year (DALY) is a measure of overall disease burden, representing a year 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 expectancy of ...

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