News article
When life takes a fall
Every year, more than 100,000 people aged 65 and over fall so severely that they require medical care. Of these, around 70,000 are admitted to hospital. For many, a fall marks the beginning of declining health and reduced independence, while others recover surprisingly well. Why do fall injuries have such different consequences – and what determines who manages to recover?
In an ongoing Forte-funded research project, Stina Ek, Associate Professor of Epidemiology, and her colleagues at Karolinska Institutet are studying why fall injuries lead to such varied outcomes, and why the answer cannot be found by pinpointing individual risk factors.
– Fall injuries generally affect the frailer and more vulnerable segment of the older population. The fall is often a continuation of a downward spiral – the culmination of an ongoing decline and loss of function, Stina explains.
Circumstances matter more than the fall itself
Falls are the type of accident that each year result in the highest number of deaths, hospital admissions, and emergency department visits in Sweden. They often lead to long-term functional impairment and increased care needs, yet they are also largely preventable.
Stina’s research shows that it is the conditions before the injury and the interventions after it that largely determine the outcome.
– Both the literature and our own studies indicate that the circumstances a person has prior to a fall injury largely govern how well they can cope with such a trauma, she says.
This is not only about medical diagnoses, but about the entire life situation: physical functioning, social relationships, and socioeconomic conditions.
A critical window with great potential
The period following a fall injury is often decisive in determining whether an older person regains independence or enters a vicious cycle of new falls, hospitalisations, and increasing care needs.
– In fact, the period leading up to the injury is at least as important – but then we don’t know that the fall is going to happen. Ideally, we would strengthen individuals enough to prevent the fall altogether, so-called primary prevention, Stina says.
When a fall does occur, however, an important window for secondary prevention opens.
– Immediately after a fall injury, there is an opportunity to identify those at risk of not regaining physical function and independence, and to put the right support in place in time.
If that opportunity is missed, the consequences risk becoming both long-lasting and costly, and devastating for those affected.
In real life, people are complex, and several factors influence each other simultaneously. If we isolate each factor and study it on its own, we lose that complexity. Then we study factors, not individuals.
Stina Ek
Associate Professor of Epidemiology at Karolinska Institutet
From risk factors to whole lives
A central point of the research is to move away from searching for a single explanation for why falls have such different consequences. Behind every fall accident lies an entire life.
– In real life, people are complex, and several factors influence each other simultaneously. If we isolate each factor and study it on its own, we lose that complexity. Then we study factors, not individuals, Stina says.
Two people may fracture a hip in a similar way yet return to completely different lives. One finds their way back to everyday life; the other gradually loses mobility and independence. The difference rarely lies in a single diagnosis.
Instead, the researchers look for patterns in people’s life situations. They identify profiles of vulnerability and resilience, where age, health, finances, housing, and social relationships are considered together.
– An individual often has both protective factors and factors that increase vulnerability. One can partially offset the other.
It is precisely how these factors interact that can determine whether a fall becomes a temporary setback or the beginning of a long downward spiral.
Unequal opportunities for recovery
How strong a person is before the fall turns out to play a major role in what happens afterwards.
– An individual’s physical functioning prior to a fall injury is crucial. This underscores the importance of long-term efforts to maintain mobility, balance, and walking ability as we age, Stina explains.
But the research shows that the body is not everything. The surrounding living conditions also make a difference.
– Educational level and family income, for example, can partly compensate for a high disease burden.
Those with stronger economic and social resources often find it easier to engage in rehabilitation, receive support in daily life, and return to an active lifestyle. At the same time, the social context matters: whether one lives alone or with others, how socially active one is, and how one perceives one’s own health.
Less suffering, smarter use of resources
By increasing knowledge about vulnerability and resilience, the researchers hope to contribute to more targeted health and social care.
– We want both to show which factors can be strengthened in the general older population and to identify which individuals are particularly vulnerable after a fall injury, Stina says.
There is also a clear societal benefit.
– If we can target resources more effectively, we can reduce both human suffering and the strain on health and social care services – and at the same time prevent many fall accidents before they even occur.
Learn more on Kunskapsguiden
The National Board of Health and Welfare (Socialstyrelsen) has produced several publications and training programmes aimed at supporting professionals in social services and healthcare in fall prevention work. The authority has also developed materials aimed directly at older people. These resources are available in one place on kunskapsguiden.se.
Falls and fall prevention – Kunskapsguiden External link. (in Swedish)
More about the research on the Karolinska Institutet website
Here you can find more information and contact details for Stina Ek. External link.
Michelle Bornestad (English translation by Forte)
