Why do older adults fall on stairs at home? Insights from a nationwide survey of 194 older adults

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.