Why do older adults fall on stairs at home? Insights from a nationwide survey of 194 older adults
Abstract
Introduction
Stair falls cause major morbidity and mortality in older adults. Despite this, stair-focused recommendations are lacking from the 2022 World Falls Guidelines. We aimed to characterise environmental risk factors and consequences of home stair falls and near-falls, and demographics of older adults reporting them.
Method
Co-designed online survey of adults ≥60 years in England (N=194). Respondents provided demographics, indices of multiple deprivation (IMD), concern about falling, and injury outcomes for home falls/near-falls over two years. This analysis focuses on the stair/step incident subset; respondents selected causes of stair falls and near-falls from a predefined list.
Results
Among respondents reporting falls on stairs (n=33; mean age 70), 76% were female, 69% lived in lower-deprivation areas (IMD quartile 4/5). Most (91%) had low/moderate concern about falling (Short FES-I). Causes of falls were misjudged step/stair-edge location (23/33, 70%), no handrail/grabrail (7/33, 21%), and choice of footwear (6/33, 18%). Injuries included aches/pains (17/33, 52%), stiffness (16/33, 48%), cuts/bruises (16/33, 48%), fracture (5/33, 15%), and head injury/concussion (4/33, 12%). Among respondents reporting stair near-falls (n=20; mean age 68), 55% were female and 70% lived in lower-deprivation areas (IMD quartile 4/5). Most (95%) had low/moderate concern about falling (Short FES-I). Causes of near-falls included misjudged step/stair-edge location (13/20, 65%), choice of footwear (7/20, 35%). Injuries included stiffness (7/20, 35%) and aches/pains (4/20, 20%).
Conclusions
Similarity between stair falls and near-falls indicates shared risks, justifying early, feature-specific home modifications triggered by near-falls. Older adults reported modifiable, stair-specific factors including step-edge misjudgement, missing handrails, and footwear, as salient contributors to home stair incidents. These findings support feature-specific home assessments and low-cost stair adaptations (e.g., high-contrast step-edge markers, continuous handrails). Our previous work shows step-edge highlighters can improve foot clearance, but implementation barriers remain (aesthetics, acceptability, installation). Stair safety should be addressed explicitly in falls-prevention practice and guidance.
Comments
informative poster, thank…
informative poster, thank you for sharing.
I wonder if you have any insights on what potentially causes the older adults to misjudge step-edges? Did older adults share information on things like: time of the day (fatigued?) or visibility of the stairs (lighting)?
Great work!
Really interesting and clinically relevant poster. I liked the focus on stair-specific risks and how near-falls could act as an early warning point for simple, low-cost interventions like step-edge markers, handrails and footwear advice.
Stair falls
Very interesting subject and very insightful recommendations. I wonder how young fallers compared to age and ADL matched controls would be different from those who are elderly and also matched by age and mobility and ADL.
Insightful
Thanks for sharing. This is great and really interesting. What was your sample like? Where they all community living? If so could this underestimate the implications of falls on stairs as it would not include those who did not manage to return home after a serious fall, or obviously those who died following a fall making this even more important? It would also be interesting to know how these falls impacted services e.g. days in hospital, GP appointments etc. Does eyesight play a role in misjudging steps? It would be great to folllow it up with some work looking to gain more detail about how these midjudments occur.