Restricted accessReview articleFirst published online 2025-9
Empowering Fall Prevention Through Integrated Lifestyle Medicine Strategies—From Recognition of Fall Risks to Implementation of Prevention of Falls for all in Practice
Falls remain the leading cause of unintentional injuries across all age groups, prompting many emergency room visits. The annual estimated cost associated with falls is believed to exceed 100 billion dollars. In addressing this trend, health professional team members emerge as key players and can assume a crucial role in bridging the gap between lifestyle medicine and fall prevention. By imparting strategies aligned with the 6 pillars of lifestyle medicine, these professionals can educate individuals on risk factors, assess fall risk, and offer activities to mitigate the likelihood of future falls. This collaborative approach empowers all to take immediate and informed action, fostering a proactive stance against the prevalent issue of fall-related injuries. Through the background and practical strategies described in this paper, health professionals of various disciplines will have access to tools and knowledge to enhance their role in preventing falls using the lens of lifestyle medicine.
VermaSKWillettsJLCornsHLMarucci-WellmanHRLombardiDACourtneyTK. Falls and fall-related injuries among community-dwelling adults in the United States. PLoS One. 2016;11(3):e0150939. doi:10.1371/journal.pone.0150939
ParkkariJKannusPPalvanenM, et al.Majority of hip fractures occur as a result of a fall and impact on the greater trochanter of the femur: a prospective controlled hip fracture study with 206 consecutive patients. Calcif Tissue Int. 1999;65(3):183-187.
4.
TrevisanCCrippaAEkS, et al.Nutritional status, body mass index, and the risk of falls in community-dwelling older adults: a systematic review and meta-analysis. J Am Med Dir Assoc. 2019;20(5):569-582.e7. doi:10.1016/j.jamda.2018.10.027
DhesiJKBearneLMMonizC, et al.Neuromuscular and psychomotor function in elderly subjects who fall and the relationship with vitamin D status. J Bone Miner Res. 2002;17(5):891-897. doi:10.1359/jbmr.2002.17.5.891
7.
LiuYWheatonAGChapmanDPCunninghamTJLuHCroftJB. Prevalence of healthy sleep duration among adults--United States, 2014. MMWR Morb Mortal Wkly Rep. 2016;65(6):137-141. doi:10.15585/mmwr.mm6506a1
8.
BonnetMHArandDL. Clinical effects of sleep fragmentation versus sleep deprivation. Sleep Med Rev. 2003;7(4):297-310. doi:10.1053/smrv.2001.0245
9.
KakazuVAPintoRZDokkedal-SilvaV, et al.Does poor sleep quality and excessive daytime sleepiness influence fear of falling among older adults? A cross-sectional study. Sleep Biol Rhythm. 2022;20(2):287-295. doi:10.1007/s41105-021-00368-z
10.
WuLSunD. Sleep duration and falls: a systemic review and meta-analysis of observational studies. J Sleep Res. 2017;26(3):293-301. doi:10.1111/jsr.12505
11.
ImagamaSItoZWakaoN, et al.Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle-aged and elderly males. Eur Spine J. 2013;22(6):1346-1353. doi:10.1007/s00586-013-2721-9
12.
FernandesVLRibeiroDMFernandesLCMenezesRL. Postural changes versus balance control and falls in community-living older adults: a systematic review. Fisioter mov. 2018;31. doi:10.1590/1980-5918.031.ao25
13.
TrevisanMEBoufleurJSoaresJCHaygertCJPRiesLGKCorrêaECR. Diaphragmatic amplitude and accessory inspiratory muscle activity in nasal and mouth-breathing adults: a cross-sectional study. J Electromyogr Kinesiol. 2015;25(3):463-468. doi:10.1016/j.jelekin.2015.03.006
14.
KocjanJAdamekMGzik-ZroskaBCzyżewskiDRydelM. Network of breathing. Multifunctional role of the diaphragm: a review. Response to the letter to editor of Prof. Bordoni. Adv Respir Med. 2017;85(5):292-293. doi:10.5603/ARM.a2017.0048
15.
BergWPAlessioHMMillsEMTongC. Circumstances and consequences of falls in independent community-dwelling older adults. Age Ageing. 1997;26(4):261-268. doi:10.1093/ageing/26.4.261
16.
PhelanEAMahoneyJEVoitJCStevensJA. Assessment and management of fall risk in primary care settings. Med Clin. 2015;99(2):281-293. doi:10.1016/j.mcna.2014.11.004
17.
TolosC. Fall Prevention for All: Physical Therapist Shares Simple Steps You Can Take Today to Reduce Your Fall Risk. Chris the PT Inc; 2022.
18.
EckertCDTarletonEKPellerinJMooneyNGellNM. Nutrition risk is associated with falls risk in an observational study of community-dwelling, rural, older adults. J Aging Health. 2022;34(6–8):1125-1134. doi:10.1177/08982643221096944
19.
DuttonJE. Energize Your Workplace: How to Create and Sustain High-Quality Connections at Work, Vol 50. John Wiley & Sons; 2003.
20.
ChristakisNAFowlerJH. Social contagion theory: examining dynamic social networks and human behavior. Stat Med. 2013;32(4):556-577. doi:10.1002/sim.5408
21.
ChristakisNAFowlerJH. The spread of obesity in a large social network over 32 years. N Engl J Med. 2007;357:370-379. doi:10.1056/NEJMsa066082
22.
TaylorBIrvingHMKanteresF, et al.The more you drink, the harder you fall: a systematic review and meta-analysis of how acute alcohol consumption and injury or collision risk increase together. Drug Alcohol Depend. 2010;110(1-2):108-116. doi:10.1016/j.drugalcdep.2010.02.011
LauGAngJYKimN, et al.Prevalence of alcohol and other drug use in patients presenting to hospital for fall-related injuries: a systematic review. Inj Prev. 2022;28(4):381-393. doi:10.1136/injuryprev-2021-044513
25.
HopkinsREBharatCBuizenL, et al.Age-related risk of serious fall events and opioid analgesic use. JAMA Intern Med. 2024;184(4):394-401. doi:10.1001/jamainternmed.2023.8154
26.
ZaninottoPHuangYTDi GessaGAbellJLassaleCSteptoeA. Polypharmacy is a risk factor for hospital admission due to a fall: evidence from the English Longitudinal Study of Ageing. BMC Publ Health. 2020;20:1804. doi:10.1186/s12889-020-09920-x
27.
HubbardRFarringtonPSmithCSmeethLTattersfieldA. Exposure to tricyclic and selective serotonin reuptake inhibitor antidepressants and the risk of hip fracture. Am J Epidemiol. 2003;158(1):77-84. doi:10.1093/aje/kwg114
28.
ButtDAMamdaniMAustinPCTuKGomesTGlazierRH. The risk of hip fracture after initiating antihypertensive drugs in the elderly. Arch Intern Med. 2012;172(22):1739-1744. doi:10.1001/2013.jamainternmed.469
29.
KorhonenMJPenttiJHartikainenJ, et al.Lifestyle changes in relation to initiation of antihypertensive and lipid-lowering medication: a cohort study. J Am Heart Assoc. 2020;9(4):e014168. doi:10.1161/JAHA.119.014168
30.
GuoXTangPZhangLLiR. Tobacco and alcohol consumption and the risk of frailty and falling: a mendelian randomisation study. J Epidemiol Community Health. 2023;77(6):349-354. doi:10.1136/jech-2022-219855
31.
BurtscherMPühringerRWernerI, et al.Gender-Specific effects of smoking and alcohol consumption on the risk of falling in downhill skiers. J ASTM Int. 2010;7:1-4. doi:10.1520/JAI102815
ElgaddalNKramarowEAReubenC. Physical Activity Among Adults Aged 18 and over: United States, 2020. Hyattsville, MD: National Center for Health Statistics; 2022. NCHS Data Brief, no 443. doi:10.15620/cdc:120213
34.
PeetersGCooperRToothLvan SchoorNMKennyRA. A comprehensive assessment of risk factors for falls in middle-aged adults: Co-ordinated analyses of cohort studies in four countries. Osteoporos Int. 2019;30:2099-2117. doi:10.1007/s00198-019-05034-2
35.
LeeJ. The association between physical activity and risk of falling in older adults: a systematic review and meta-analysis of prospective cohort studies. Geriatr Nurs. 2020;41(6):747-753. doi:10.1016/j.gerinurse.2020.05.005
36.
SocietyAGSocietyGofAAOn Falls PreventionOSP. Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001;49(5):664-672. doi:10.1046/j.1532-5415.2001.49115.x
37.
LustosaLGRudolerDTheouODograS. Leisure sedentary time is associated with self-reported falls in middle-aged and older females and males: an analysis of the CLSA. Can Geriatr J. 2023;26(2):239-246. doi:10.5770/cgj.26.636
38.
OzakiEMatsuiDKuriyamaNTomidaSNukayaYKoyamaT. Association between sedentary time and falls among middle-aged women in Japan. Healthcare. 2022;10(12):2354. doi:10.3390/healthcare10122354
39.
JiangYWangMLiuSYaXDuanGWangZ. The association between sedentary behavior and falls in older adults: a systematic review and meta-analysis. Front Public Health. 2022;10:1019551. doi:10.3389/fpubh.2022.1019551
40.
VellasBJWayneSJRomeroLBaumgartnerRNRubensteinLZGarryPJ. One-leg balance is an important predictor of injurious falls in older persons. J Am Geriatr Soc. 1997;45(6):735-738.
41.
SpringerBAMarinRCyhanTRobertsHGillNW. Normative values for the unipedal stance test with eyes open and closed. J Geriatr Phys Ther. 2007;30(1):8-15.
HallKSCohenHJPieperCF, et al.Physical performance across the adult life span: correlates with age and physical activity. J Gerontol A Biol Sci Med Sci. 2017;72(4):572-578. doi:10.1093/gerona/glw120
44.
Abellan Van KanGRollandYAndrieuS, et al.Gait speed at usual pace as a predictor of adverse outcomes in community-dwelling older people: an international academy on nutrition and aging (IANA) Task Force. J Nutr Health Aging. 2009;13(10):881-889. doi:10.1007/s12603-009-0246-z
US Preventive Services Task ForceNicholsonWKSilversteinM, et al.Interventions to prevent falls in community-dwelling older adults: US preventive services task force recommendation statement. JAMA. 2024;332(1):51-57. doi:10.1001/jama.2024.8481
Gomes-OsmanJCabralDFMorrisTP, et al.Exercise for cognitive brain health in aging: a systematic review for an evaluation of dose. Neurol Clin Pract. 2018;8(3):257-265. doi:10.1212/CPJ.0000000000000460
Canadian 24-hour movement guidelines. 24 hour movement guidelines. https://csepguidelines.ca/. Accessed August 31, 2024.
52.
Carcelén-FraileMDCMartín-BauteMRLedesma-CerratoMI, et al.Effects of a yoga program combined with a mediterranean diet on nutritional status and functional capacity in community-dwelling older adults: a randomized controlled clinical trial. Nutrients. 2024;16(11):1601. doi:10.3390/nu16111601
53.
ChenWLiMLiHLinYFengZ. Tai chi for fall prevention and balance improvement in older adults: a systematic review and meta-analysis of randomized controlled trials. Front Public Health. 2023;11:1236050. doi:10.3389/fpubh.2023.1236050
54.
SherringtonCFairhallNKwokW, et al.Evidence on physical activity and falls prevention for people aged 65+ years: systematic review to inform the WHO guidelines on physical activity and sedentary behaviour. Int J Behav Nutr Phys Activ. 2020;17:144. doi:10.1186/s12966-020-01041-3
55.
WebsterJDalla ViaJLangleyCSmithCSaleCSimM. Nutritional strategies to optimise musculoskeletal health for fall and fracture prevention: Looking beyond calcium, vitamin D and protein. Bone Rep. 2023;19:101684. doi:10.1016/j.bonr.2023.101684
56.
DelaireLCourtayAHumblotJ, et al.Implementation and core components of a multimodal program including exercise and nutrition in prevention and treatment of frailty in community-dwelling older adults: a narrative review. Nutrients. 2023;15(19):4100. doi:10.3390/nu15194100
57.
NguyenHHDoDVToKGDoanHTNOddyWH. The effect of dietary patterns on reducing falls and falls risk in adults: a systematic review. Curr Nutr Rep. 2024;13(1):15-22. doi:10.1007/s13668-023-00516-6
ShahVPNayfehTAlsawafY, et al.A systematic review supporting the endocrine society clinical practice guidelines on vitamin D. J Clin Endocrinol Metab. 2024;109(8):1961-1974. doi:10.1210/clinem/dgae312
ChenTYLeeSHsuKWBuxtonOM. Poor sleep health predicts the onset of a fear of falling among community-dwelling older adults. Sleep Health. 2024;10(1):137-143. doi:10.1016/j.sleh.2023.10.007
64.
ZhouTDaiXYuanY, et al.Adherence to a healthy sleep pattern is associated with lower risks of incident falls and fractures during aging. Front Immunol. 2023;14:1234102. doi:10.3389/fimmu.2023.1234102
65.
LeeSChungJHKimJH. Association between sleep quality and falls: a nationwide population-based study from South Korea. Int J Gen Med. 2021;14:7423-7433. doi:10.2147/IJGM.S331103
66.
KoffelEAncoli-IsraelSZeePDzierzewskiJM. Sleep health and aging: recommendations for promoting healthy sleep among older adults: a national sleep foundation report. Sleep Health. 2023;9(6):821-824. doi:10.1016/j.sleh.2023.08.018
67.
ClaytonJSBonnetJ. Foundations of Lifestyle Medicine Board Review Manual. 4th ed.American College of Lifestyle Medicine. 2023.
68.
WangFBorosS. The effect of daily walking exercise on sleep quality in healthy young adults. Sport Sci Health. 2020;17:393-401. doi:10.1007/s11332-020-00702-x
69.
Solis-NavarroLMasotOTorres-CastroR, et al.Effects on sleep quality of physical exercise programs in older adults: a Systematic Review and Meta-Analysis. Clocks Sleep. 2023;5(2):152-166. doi:10.3390/clockssleep5020014
BesselVDK. The Body Keeps the Score: Brain, Mind, and Body in the Healing of Trauma. 1st ed.Penguin Books; 2015:79-88.
72.
Saffel-ShrierSJohnsonMAFrancisSL. Position of the academy of nutrition and dietetics and the society for nutrition education and behavior: food and nutrition programs for community-residing older adults. J Nutr Educ Behav. 2019;51(7):781-797. doi:10.1016/j.jneb.2019.03.007
73.
FowlerJHChristakisNA. Dynamic spread of happiness in a large social network: longitudinal analysis over 20 years in the Framingham Heart Study. BMJ. 2008;337:a2338. doi:10.1136/bmj.a2338
74.
de JongMRVan der ElstMHartholtKA. Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies. Ther Adv Drug Saf. 2013;4(4):147-154. doi:10.1177/2042098613486829
75.
SchultzABAshton-MillerJAAlexanderNB. What leads to age and gender differences in balance maintenance and recovery?Muscle Nerve Suppl. 1997;5:S60-S64.
