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Risk Factors for Falls in Community-dwelling Older People: A Systematic Review and Meta-analysis

Deandrea, Silviaa,b; Lucenteforte, Ersiliaa,b; Bravi, Francescaa,b; Foschi, Robertoa; La Vecchia, Carloa,b; Negri, Evaa

doi: 10.1097/EDE.0b013e3181e89905
Injury: Review Article

Background: Falls are the main cause of accidental death in persons aged 65 years or older.

Methods: Using MEDLINE and previous reviews, we searched for prospective studies investigating risk factors for falls among community-dwelling older people. For risk factors investigated by at least 5 studies in a comparable way, we computed pooled odds ratios (ORs) using random-effects models, with a test for heterogeneity.

Results: A total of 74 studies met the inclusion criteria and 31 risk factors were considered, including sociodemographic, mobility, sensory, psychologic, and medical factors and medication use. The strongest associations were found for history of falls (OR = 2.8 for all fallers; OR = 3.5 for recurrent fallers), gait problems (OR = 2.1; 2.2), walking aids use (OR = 2.2; 3.1), vertigo (OR = 1.8; 2.3), Parkinson disease (OR = 2.7; 2.8), and antiepileptic drug use (OR = 1.9; 2.7). For most other factors, the ORs were moderately above 1. ORs were generally higher for recurrent fallers than for all fallers. For some factors, there was substantial heterogeneity among studies. For some important factors (eg, balance and muscle weakness), we did not compute a summary estimate because the measures used in various studies were not comparable.

Conclusions: This meta-analysis provides comprehensive evidence-based assessment of risk factors for falls in older people, confirming their multifactorial etiology. Some nonspecific indicators of high baseline risk were also strong predictors of the risk of falling.


From the aDepartment of Epidemiology, Istituto di Ricerche Farmacologiche “Mario Negri,” Milan, Italy; and bSezione di Statistica Medica, Dipartimento di Medicina del Lavoro, Università degli Studi di Milano, Milan, Italy.

Submitted 19 July 2009, accepted 3 March 2010; posted 28 June 2010.

Supported (in part) by the Directorate General for Health and Consumers (DGSANCO) of the European Union “Strategies and best practices for the reduction of Injuries” (APOLLO) program (Grant Agreement 2004119).

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Correspondence: Eva Negri, Department of Epidemiology, Istituto di Ricerche Farmacologiche “Mario Negri,” Via Giuseppe La Masa 19, 20156 Milan, Italy. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.