Falls are far more than an inconvenient stumble. They are a leading cause of injury, disability, loss of independence and death among older people worldwide. A fall can trigger a cascade of adverse outcomes: fractures, particularly of the hip, hospitalization, fear of falling again, reduced mobility, social isolation and, ultimately, admission to long-term care. Landmark work has demonstrated that falls and fall-related injuries significantly elevate the risk of nursing home admission, while more recent studies have linked falls to accelerated cognitive decline and dementia, and emergency services data show that older adults who fall face elevated mortality and heavy healthcare utilization in the year that follows. Mortality from falls among the oldest adults has been rising in several countries, and the World Guidelines for Falls Prevention and Management, published in 2022 as a global initiative, have emphasized that falls should be treated as a major, modifiable public health problem rather than an inevitable accompaniment of ageing. The new Irish findings give that warning renewed urgency, because they show that a high-income country with an established research infrastructure and clinical awareness of falls is nonetheless seeing the problem grow.

The study, published in European Geriatric Medicine, was conducted by a team from The Irish Longitudinal Study on Ageing at Trinity College Dublin, the Mercer’s Institute for Successful Ageing at St James’s Hospital, and the Royal College of Surgeons in Ireland, led by Kate Doyle and colleagues including Robert Briggs, Rose-Anne Kenny, Frank Moriarty, Amanda Lavan, Siobhan Scarlett and Caoimhe McGarvey. Rather than relying on a single snapshot, the investigators harnessed the longitudinal design of TILDA, a nationally representative cohort that has followed thousands of older Irish adults with detailed health assessments since 2009. The analysis focused on three time points separated by years: Wave 1, carried out between 2009 and 2011 and including 3,507 participants aged 65 or over with a mean age of 73.3 years; Wave 3, conducted between 2014 and 2015 with 3,582 participants of mean age 73.9; and Wave 6, completed between 2021 and 2023 with 3,333 participants whose mean age was 74.3. Women made up slightly more than half of each sample, a proportion that rose modestly from 52.5 percent at Wave 1 to 55.3 percent at Wave 6.

The conceptual heart of the study lies in its focus on modifiable falls risk factors, the concrete, measurable and potentially reversible conditions that clinical guidelines recommend assessing in anyone at high risk of falling. Three domains took center stage. The first was the use of fall-risk-increasing drugs, abbreviated FRIDs, a class of medications identified through a validated instrument known as the Screening Tool of Older Persons Prescriptions in older adults with high fall risk, or STOPPFall. This tool, developed by a European task force on fall-risk-increasing drugs, catalogues medications whose pharmacological actions can precipitate a fall: sedatives and hypnotics that dull arousal and slow reactions, antidepressants that affect balance and blood pressure regulation, antipsychotics, benzodiazepines, opioids, antihypertensives and other agents that can induce dizziness, orthostatic drops in blood pressure, or impaired cognition. Because FRIDs are prescribed, they are in principle directly modifiable through deprescribing and medication review, which is precisely why the research team prioritized tracking them over time.

The second risk factor was orthostatic hypotension, a phenomenon in which blood pressure falls abnormally upon standing, depriving the brain of perfusion and producing dizziness, unsteadiness or frank syncope. In this analysis, orthostatic hypotension was operationalized in a way that captures both the objective hemodynamic measure and the symptomatic experience: a drop in systolic blood pressure of at least 20 millimeters of mercury upon standing from sitting, and/or self-reported orthostatic unsteadiness. This dual definition matters clinically, because research from the TILDA cohort itself has shown that even asymptomatic orthostatic hypotension, detected only on measurement, predicts future falls, and that delayed blood pressure recovery after standing independently predicts fracture in community-dwelling older people. Systematic reviews and meta-analyses confirm that orthostatic hypotension is associated with a substantially elevated risk of falls, and that drug-related causes extend well beyond antihypertensive medications to include antidepressants, dopaminergic agents and other drug classes. The third domain was mobility impairment, quantified using the Timed Up-and-Go test, or TUG, a simple but well-validated performance measure in which an individual rises from a chair, walks three meters, turns, returns and sits down again. A completion time of 12 seconds or longer was classified as mobility impairment. Decades of research have established that TUG times above this threshold predict falls with useful accuracy, reflecting underlying deficits in gait, balance, muscle power and executive function.

The results concerning these risk factors were strikingly consistent and consistently concerning. At every one of the three waves, more than one in four older Irish adults was taking at least one medication flagged by the STOPPFall criteria, and more than one in seven was taking two or more such drugs. More than one in five of the population met the definition of orthostatic hypotension at each assessment. More than one in four had mobility impairment on the Timed Up-and-Go test. These proportions did not fluctuate dramatically between 2009 and 2023; instead, they formed a stable, elevated plateau of risk factors threading through the entire period. The stability is itself the message: the underlying physiological and pharmacological conditions that make older people prone to falling were pervasive throughout the fifteen-year window, and the rising incidence of falls occurred against this unchanging backdrop of hazard. The combination also paints a mechanistic picture, in which sedating and blood-pressure-lowering medications compromise cardiovascular and neurological resilience, orthostatic hypotension undermines the body’s ability to maintain cerebral perfusion during postural change, and impaired mobility reduces the margin of safety in everyday movement, with their overlap amplifying individual vulnerability.

Weighting the data to reflect the national population sharpened the implications. The rise from 22.1 percent to 29.8 percent in fall incidence corresponds to an increase from roughly 117,665 affected individuals to approximately 228,007, an expansion driven by both a higher rate of falling per person and the growth of the older population itself, as documented in the 2022 Irish census. Each fall carries costs that ripple outward through emergency departments, orthopedic services, rehabilitation units, primary care and family caregiving. Prior TILDA-based research has shown that older people’s use of emergency departments surged even during the COVID-19 pandemic, and fall-related injuries are among the most common reasons older adults require acute care. If roughly three in ten older adults now experience falls in a given period, the arithmetic of an ageing society ensures that absolute numbers of fall-related fractures, head injuries and deaths will continue to climb unless the underlying trajectory changes. The authors argue that this constitutes a clear case for population-level action: falls risk factors, because they are common, modifiable and measurable, are legitimate targets for national falls prevention policy, not merely for individual clinical assessment.

The study also carries practical lessons for how such prevention might work. Multifactorial interventions, which combine medication review, exercise, management of orthostatic hypotension, vision correction and environmental modification, have demonstrated effectiveness in preventing falls among community-dwelling older adults in systematic reviews and meta-analyses. The STOPPFall framework offers clinicians a structured pathway for identifying and, where appropriate, deprescribing fall-risk-increasing drugs, and recent work from specialist falls and syncope services shows that such reviews are feasible in practice and can reshape prescribing patterns. Timed Up-and-Go screening can be administered in primary care with minimal equipment, and orthostatic blood pressure measurement is inexpensive and quick, yet both remain underused outside specialist settings. The Irish findings suggest that screening for these three conditions at a population scale, followed by targeted intervention, represents one of the most concrete available strategies to bend the curve of falls incidence. International guidelines echo this position, calling for health systems to embed falls risk assessment and management into routine care for older adults.

Ultimately, the study is a reminder that scientific progress and public health outcomes are not the same thing. Ireland possesses one of the world’s richest longitudinal datasets on ageing, its researchers have contributed decisively to the global understanding of falls, syncope, medication risk and mobility in later life, and the clinical tools for prevention are validated and available. Yet the incidence of falls has risen from roughly one in five older adults to nearly one in three over the span of the study, and the prevalence of fall-risk-increasing drug use, orthostatic hypotension and mobility impairment has remained stubbornly high throughout. The researchers conclude that addressing falls risk factors must become a priority of national falls prevention policy at the population level, so that the burden of falls and fall-related injuries can be reduced before demographic ageing multiplies it further. For a rapidly ageing world watching closely how societies adapt to longer lives, the Irish data offer both a warning and a blueprint: the components of prevention are known, but they must now be deployed at scale.

Subject of Research: Longitudinal trends in falls incidence and modifiable falls risk factors among community-dwelling older adults in Ireland

Article Title: Longitudinal trends in the incidence of falls and prevalence of risk factors for falls in community-dwelling older people in Ireland

Article References: Doyle, K., McGarvey, C., Scarlett, S., Moriarty, F., Lavan, A., Kenny, R.-A., & Briggs, R. (2026). Longitudinal trends in the incidence of falls and prevalence of risk factors for falls in community-dwelling older people in Ireland. European Geriatric Medicine. https://doi.org/10.1007/s41999-026-01602-y

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01602-y

Keywords: falls, older people, community-dwelling, fall-risk-increasing drugs, STOPPFall, orthostatic hypotension, Timed Up-and-Go, mobility impairment, TILDA, ageing, epidemiology, falls prevention

The research team, led by Samuel R. Nyman and Lynn McKeague of the University of Winchester together with Liam P. Satchell of the University of Winchester and University of Portsmouth, set out to answer three questions that had never been directly examined: do older adults perceive a stigma around concerns about falls, how do they actually talk about those concerns, and what do they think of the terminology used to describe them. Falls remain a dominant health threat in ageing populations worldwide. The World Health Organization’s 2021 report Step Safely identified falls as the second leading cause of unintentional injury deaths globally, and economic analyses published in the Journal of the American Geriatrics Society have estimated the medical costs of fatal and nonfatal falls among older adults in the United States alone in the billions of dollars annually. Beyond the physical harm, falls and the fear they generate restrict activity, erode quality of life, and accelerate social withdrawal.

To investigate the lived experience behind these statistics, the researchers conducted six focus groups with 22 community-dwelling older adults, sixteen women and six men, with a mean age of 75.10 years. Focus groups were chosen deliberately: unlike one-to-one interviews, they allow participants to build on each other’s accounts, challenge one another, and reveal the shared social norms that govern what can and cannot be said about a sensitive topic. Audio recordings of the sessions were transcribed verbatim and subjected to thematic analysis, first inductively, allowing themes to emerge from the data without a predetermined framework, and then deductively, returning to the transcripts to interrogate the material specifically for evidence of stigma and attitudes toward terminology. The study was approved by the university’s Research Ethics Committee and every participant gave written informed consent before taking part.

The analysis produced two principal themes. The first concerns the psychology of falling itself: participants used the words ‘fear’ and ‘anxiety’ interchangeably in everyday conversation, yet on closer examination these labels described two phenomenologically distinct experiences. Fear, in the participants’ accounts, was a protective instinct triggered by a specific threat of falling in the moment, the sudden icy patch on the pavement, the unsteady staircase, the moment of losing balance on a wet floor. Anxiety, by contrast, was a worry about an indirect threat of falling outside of its immediate context, a low-grade, persistent apprehension that shadowed the person through situations where no fall was imminent. This distinction echoes theoretical work on the neuropsychology of fear and anxiety, which holds that fear is a response to present danger while anxiety anticipates diffuse or removed threat, and it aligns with recent clinical frameworks such as the perceived control model of falling developed to understand maladaptive fear of falling.

The second theme is the study’s most striking contribution: stigma. Participants reported feeling entirely at ease discussing their concerns about falls within their own peer group, where shared experience normalised the conversation, but they avoided the topic with people outside that circle. Most consequentially, they expressed a clear reluctance to speak with their doctors about their concerns about falling. This pattern is especially paradoxical because physicians are precisely the professionals the international guidelines expect to screen for and address fall-related concerns. The researchers’ conclusion is blunt: the stigma of concerns about falling may actively inhibit older adults from seeking support to reduce their risk, meaning that practitioners will need to be proactive and sensitive in raising the subject themselves rather than waiting for patients to disclose it.

The concept of falls as a stigmatising topic has theoretical precedent. An earlier analysis published in Disability and Health Journal argued that falls should be approached as a stigmatising subject because they threaten older adults’ sense of identity, competence, and independence. A fall can signify to the person and to others that the ageing body is failing, triggering anxieties about dependency, institutionalisation, and loss of autonomy. Qualitative studies have repeatedly shown that falls are experienced as threats to identity, that older adults narrate the decision to ask for help after a fall as fraught with implications for self-image, and that fear of falling is associated with loneliness and reduced social participation in large survey datasets such as SHARE. The new study extends this literature by demonstrating that the stigma attaches not only to falls themselves but to the concern about falling, the anticipatory worry that clinicians now want measured in every assessment.

Notably, the participants in this sample expressed no strong preference for any particular terminology when discussing their concerns about falling. The researchers had anticipated that the guideline recommendation to use ‘concerns about falling’ rather than ‘fear of falling’ might itself be a live issue for older adults, but the data did not support that expectation; the terms were used fluidly and without evident offence. What mattered to participants was not the label but the social context in which the conversation occurred. This nuance matters for clinical communication. It suggests that the effort invested in terminology reform, while valuable for standardising measurement and research, may not by itself lower the conversational barriers that stigma creates. Changing the word does not change the shame.

The implications for practice are concrete. The World Guidelines of 2022 called for concerns about falling to be incorporated into fall risk assessments worldwide, and validated instruments exist to measure this construct, yet screening only works if patients answer honestly. A reluctance to discuss fall concerns with doctors creates a systematic blind spot: the patients with the most entrenched worries may be the least likely to volunteer them, and clinicians may underestimate psychological risk while focusing on physiological risk factors such as balance, muscle strength, medication side effects, and vision. Prior cohort research has shown that perceived fall risk frequently diverges from physiological fall risk, and that the mismatch predicts future falls, so accurate self-report is not a luxury but a clinical necessity. The study’s authors argue that practitioners must therefore open these conversations themselves, approaching the topic proactively and with sensitivity rather than relying on disclosure.

Sensitivity, in this context, means framing fall-related concerns in ways that do not reinforce the identity threat. Evidence from stigma research in mental health, including the Lancet Commission on ending stigma and discrimination in mental health, shows that disclosure is shaped by anticipated judgement and that simple techniques, such as affirming personal values before sensitive screenings, can reduce perceived self-stigma and increase self-disclosure. Parallel qualitative work shows that older adults engage with fall prevention when it is framed around maintaining activity and independence, ‘walking toward health’ rather than avoiding danger, and that persistence of physical activity is best supported when the goals that matter to the older person are placed at the centre. Translating these lessons into falls services could mean normalising the question in routine consultations, using peer-led group formats where disclosure is already comfortable, and training clinicians to respond to expressed concerns without invoking images of frailty or decline.

The study also contributes methodologically. By analysing focus group transcripts both inductively and deductively, and by continuing recruitment to data saturation, the team provided a transparent account of how the two themes, the fear-anxiety distinction and the stigma of falls, were derived. The anonymised transcripts are available to non-commercial researchers on request, supporting reproducibility in a field where qualitative findings are often difficult to verify. The work was supported by the University of Winchester Research Funding, and the authors report no conflicts of interest. Its limitations are those inherent to any qualitative design: 22 participants, predominantly women, in one region of England, cannot represent all older adults, and cultural differences in how falls are stigmatised, as illustrated by recent qualitative work on barriers to reporting fear of falling in Pakistan, remain an open question for international research.

Nevertheless, the central message stands out with unusual clarity for a qualitative study: stigma is not a marginal inconvenience but a mechanism that can quietly undermine one of the most important reforms in geriatric medicine. The global guidelines envision a future in which every older adult’s psychological relationship with falling is assessed and addressed alongside their physical risk. This research shows that the future depends on whether older adults are willing to answer the question, and it warns that many will not, unless the professionals asking are prepared to break the silence first.

Subject of Research: Stigma and lived experience of fear and anxiety about falling among community-dwelling older adults

Article Title: Stigma of concerns about falling among older adults

Article References: Stigma of concerns about falling among older adults. (n.d.). https://doi.org/10.1007/s41999-026-01589-6

Image Credits: AI Generated

DOI: 10.1007/s41999-026-01589-6

Keywords: fear of falling, stigma, older adults, falls prevention, anxiety, qualitative research, focus groups, thematic analysis, fall risk assessment, geriatric medicine, European Geriatric Medicine, community-dwelling