Chronic Diseases Raise Fall Risk in Middle-Aged and Older Adults, Study Finds

Falls are one of the most underestimated threats to healthy aging. A single tumble in midlife or beyond can set off a cascade of consequences, from fractured hips and prolonged hospital stays to lost confidence, reduced mobility, and a shrinking circle of independent daily activities. Now, a new cross-sectional study from Saudi Arabia, published in BMC Public Health, offers a detailed portrait of how common falls are among middle-aged and older adults, and how strongly they intertwine with the chronic diseases that accumulate with age. The findings carry a warning that resonates well beyond the Gulf region: nearly three in ten adults studied had fallen within a single year, and the presence of even one chronic condition significantly raised the odds of falling.

The research team, led by Saud F. Alsubaie of Prince Sattam bin Abdulaziz University and colleagues from several Saudi institutions, set out to answer two intertwined questions. First, how prevalent are falls and chronic diseases among people aged 45 to 90 in Saudi Arabia? Second, which specific conditions and characteristics actually predict falling once the data are carefully adjusted for demographic and clinical confounders? Falls are a well-recognized geriatric syndrome worldwide, but regional data from the Middle East have been comparatively sparse, making the study a valuable addition to the global evidence base on aging and injury prevention.

To investigate, the researchers recruited 437 participants, comprising 179 men and 258 women, spanning ages 45 to 90. The design was cross-sectional, meaning the team captured a snapshot in time rather than following individuals forward over years. Each participant’s history of chronic diseases was documented alongside any previous falls, allowing direct comparison between those who had fallen, called fallers, and those who had not, the non-fallers. The analytical toolkit was appropriately chosen for categorical and non-normally distributed data: chi-square tests were used to compare the proportions of fallers and non-fallers across categories of chronic disease, while Mann–Whitney U tests compared the number of chronic conditions between the two groups. Crucially, the team also computed odds ratios, expressing the strength of the association between specific diseases and falling, and then applied successive layers of statistical adjustment, first controlling for demographic characteristics and then adding clinical characteristics in a fully adjusted model.

The headline number is striking: 128 participants, or 29.3 percent, reported having fallen during the previous 12 months. That figure climbed sharply with age. Among older adults, 37.4 percent had fallen in the past year, compared with 24.1 percent of the middle-aged group, a difference the authors report as statistically significant with a p-value of 0.003. In practical terms, this means that for every four middle-aged adults who fell during a year, roughly six older adults did so, a gap that underscores how the risk of falling accelerates as people cross into older adulthood.

Chronic disease burden in the cohort was even more pervasive than the fall statistics. A total of 317 participants, representing 72.5 percent, reported living with at least one chronic disease. As expected, prevalence rose with age: 88.3 percent of older adults reported one or more chronic conditions, compared with 62.4 percent of those who were middle-aged, a highly significant difference with a p-value at or below 0.001. When the researchers cross-tabulated disease status against fall history, the relationship became clear. Among people who had fallen, 84.4 percent carried at least one chronic diagnosis, versus 67.6 percent of those who had not fallen. Participants with at least one chronic disease were significantly more likely to experience falls, with the association again reaching the strictest significance threshold reported in the study.

That first pass through the data is where the physiological story gets interesting. Chronic diseases can compromise the body’s postural control systems through multiple, sometimes overlapping, pathways. Cardiovascular conditions can trigger dizziness and fainting through arrhythmias, orthostatic hypotension, or the blood-pressure-lowering effects of medications. Respiratory diseases such as asthma, when poorly controlled, can limit exercise tolerance, disturb sleep, and reduce the physical conditioning that keeps balance reflexes sharp. Neurological and musculoskeletal disorders can weaken muscles and slow reaction times, while vision-robbing conditions degrade the sensory inputs the brain relies on to keep the body upright. The study’s partially adjusted analysis, which controlled for demographic characteristics such as age and sex, pointed to two specific culprits: heart disease and asthma were both significantly associated with falls.

The heart disease finding aligns with a substantial international literature. Cardiac arrhythmias, heart failure, and the polypharmacy that often accompanies cardiac care can all destabilize blood pressure regulation and cerebral perfusion, creating transient moments when the brain is briefly under-supplied and a fall becomes far more likely. The asthma association is less commonly reported but biologically plausible. Reduced aerobic capacity, breathlessness during exertion, possible steroid-related effects on muscle and bone, and sedentary deconditioning can all erode the physical reserve that protects against stumbles. The finding suggests that respiratory health deserves a place alongside cardiac, neurological, and musculoskeletal screening in fall risk assessments.

However, the fully adjusted model delivered the study’s most instructive twist. When the researchers additionally controlled for clinical characteristics, the independent associations of heart disease and asthma with falls no longer held, while two other factors emerged as the strongest independent predictors: female sex and the use of a walking aid. This statistical reshuffling matters. It indicates that some of the apparent disease-fall link is carried by other variables, such as sex differences, mobility limitations, or the clinical profiles of the participants. It also highlights that needing a walking aid is not merely a marker of existing frailty but a signal of substantially elevated fall risk in its own right, potentially reflecting underlying weakness, balance deficits, or unsafe mobility patterns even when assistance is used.

The prominence of female sex as an independent predictor echoes decades of global research. Women tend to have lower baseline muscle mass, greater rates of osteoporosis and sarcopenia, and different patterns of physical activity, all of which can compound fall vulnerability. In the Saudi context, cultural and lifestyle factors may add further layers, making the finding a call for sex-sensitive prevention strategies. The authors conclude that falls are common among middle-aged and older adults in Saudi Arabia, especially among women, and that while heart disease and asthma were associated with falls in the partially adjusted analyses, female sex and walking aid use emerged as the strongest independent predictors after full adjustment. Their work was supported by the Deanship of Research and Graduate Studies at Prince Sattam bin Abdulaziz University and funded by the Deanship of Postgraduate Studies and Scientific Research at Majmaah University through project number R-2026-2832, with ethics approval granted by the Research Ethics Committee at Prince Sattam bin Abdulaziz University in January 2022.

For clinicians and public health planners, the study’s message is practical. Fall prevention should begin well before old age, since nearly a quarter of middle-aged participants had already fallen within a year. Screening for chronic disease burden, paying particular attention to cardiac and respiratory health, and treating walking aid use as a red flag rather than a reassurance could all sharpen risk stratification. Because the design is cross-sectional, the study cannot prove that chronic diseases cause falls; it may equally be that people who fall become more sedentary and develop more conditions. Longitudinal follow-up would help disentangle that directionality. Still, with almost three in ten adults in this Saudi cohort falling each year and nearly three in four carrying a chronic diagnosis, the overlap between aging, disease, and falls is too substantial to ignore, and targeted, evidence-based interventions, from balance training and medication review to home hazard modification, stand to prevent injuries, preserve independence, and reduce the human and economic costs of what is often dismissed as an inevitable part of getting older.

Subject of Research: The association between chronic diseases and falls among middle-aged and older adults in Saudi Arabia

Article Title: Association between chronic diseases and falls among middle-aged and older adults

Article References: Alsubaie, S. F., Alruayni, H. H., Alshehri, R. F., Alghamdi, A. M., Alomereni, A. A., & Alkathiry, A. A. (2026). Association between chronic diseases and falls among middle-aged and older adults. BMC Public Health. https://doi.org/10.1186/s12889-026-29663-5

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29663-5

Keywords: falls, chronic diseases, older adults, middle-aged adults, heart disease, asthma, walking aid use, female sex, geriatrics, public health, Saudi Arabia, fall risk factors