The Fall Prevention Frontier: Predicting the Most Preventable Cause of Disability

Every year, millions of older adults experience a fall. For some, it’s a short-lived scare. For others, it can mark a profound change that can redefine independence, confidence and daily life.

Falls remain the leading cause of injury-related hospitalisation among adults over 65, and one of the most preventable causes of disability worldwide. Yet, in most healthcare systems, we still treat them as accidents to respond to, rather than events to predict (PMC).

At Health Impact Alliance (HIA), we see a better way. Falls can be anticipated, measured, and often prevented if we learn to recognise the early signals.

When One Fall Changes Everything

For many older adults, a single fall can trigger a chain reaction of consequences that extend far beyond the initial injury. The physical impact alone is significant: about one in five falls leads to serious injuries such as hip fractures or head trauma, and nearly 300,000 older Americans are hospitalized each year for hip fractures.

But what follows is often more subtle and more damaging. After a fall, many individuals develop a persistent fear of falling again. That fear causes them to move less, lose strength, and withdraw from daily activities. Over time, this creates a dangerous cycle: less mobility leads to weaker muscles, poorer balance, and a much higher risk of another fall (PMC).

This cascade is why falls are considered a leading indicator of decline. In one major study, older adults who experienced a fall were 42% more likely to develop impairments in daily activities such as dressing, walking, or preparing meals, even after controlling for health conditions and medication use. For many, a single fall represents the beginning of a gradual transition toward dependency and long-term care (PLOS One).

Understanding Why Falls Happen

The causes of falls are rarely simple. They result from a web of interacting factors:

• Physical changes, such as loss of muscle mass, slower reflexes, and impaired balance.

• Medication effects, especially when multiple prescriptions (polypharmacy) create dizziness or fatigue.

• Cognitive decline, which can affect coordination and awareness of surroundings.

• Environmental hazards, from uneven flooring to poor lighting.

These factors accumulate over time. What begins as a slightly slower gait or minor dizziness can evolve into significant instability. Unfortunately, most health systems still rely on episodic assessments like annual checkups or one-time physical tests that capture only a snapshot in time (NIH).

The key is catching the risks before they’re obvious, because by that time it may be too late. 

A Global and Growing Challenge

Reports have shown that falls are becoming more of a risk for older adults. According to the World Health Organization, 28–35% of adults aged 65 and older experience at least one fall each year. For those over 70, that number rises to more than 40%.

Falls are the second leading cause of unintentional injury deaths globally, claiming an estimated 684,000 lives annually. In the United States, over 14 million older adults report falling each year, and the death rate from falls has increased by 41% since 2012. 

The burden isn’t limited to high-income countries. In fact, over 80% of fall-related deaths occur in low and middle-income regions, where people don’t have easy access to early screening and rehabilitation. Even non-fatal falls often have long-term consequences: more than 37 million falls each year require medical attention, and the resulting injuries contribute to over 38 million years of life lived with disability (DALYs) worldwide (WHO).

These statistics represent real people: a person, a parent, a grandparent, a community member, whose independence could have been preserved with earlier recognition of risk.

The Cost of Inaction

The economic ripple effects of falls mirror their prevalence. In the United States, medical costs related to falls exceeded $50 billion in 2015 and are projected to reach $74 billion by 2030. Across high-income countries, fall-related injuries account for roughly 1%–1.5% of total healthcare spending each year (BMJ).

In the U.K., the National Health Service spends over £2.3 billion annually on falls among older adults, much of it tied to hospitalizations, rehabilitation, and community care. The costs don’t stop once a patient leaves the hospital. Studies show that healthcare and social care expenses quadruple in the 12 months following a fall, with community care costs increasing by more than 160% (Arquella).

These figures highlight a fundamental misalignment: enormous resources go into reacting to falls, when a fraction of that investment in prevention and prediction could yield better outcomes and lower costs.

Preventing falls goes beyond protecting seniors; it will also aid in alleviating a massive economic burden on medical institutions. 

The Limitations of Current Screening

For decades, clinicians have relied on tools like the Timed Up and Go (TUG) Test, which measures how long it takes a person to stand up, walk three metres, and sit down. W-hile useful for identifying mobility issues, studies show its ability to predict falls is limited.

Meta-analyses report that TUG’s specificity is around 0.74, meaning it performs reasonably well at identifying individuals who are not at risk, but its sensitivity is only around 0.31, meaning it misses a large portion of those who are at risk (PMC). 

That’s because falls are rarely caused by a single variable. They emerge from the interaction between physical, cognitive, and environmental factors, something a one-time test cannot capture.

To truly prevent falls, screening must evolve from static measurements to continuous, personalized insight. We need tools that can detect subtle changes in real-world movement and behavior, the kind that precede a fall by weeks or months, not minutes.

From Detection to Prediction

This shift, from detection to prediction, is already beginning to take shape.

At HIA, we are developing intelligent systems that continuously monitor real-world movement, balance, and daily activity patterns. These tools, designed with sensitivity and respect for privacy, can detect early indicators that often precede a fall: slower walking speed, subtle asymmetry in gait, reduced step length, or less time spent upright during the day.

Combined with contextual data, such as medication changes or environmental conditions,  these insights can create a comprehensive risk profile for each individual. Instead of waiting for a fall to happen, care teams can be notified when risk begins to rise, allowing for timely interventions such as medication adjustments, physical therapy, or home modifications.

This is the foundation of proactive, connected care: using data not to replace human judgment, but to enhance it. The goal is to empower clinicians, caregivers, and families with actionable information before a fall occurs.

A Future Built on Independence, Not Fear

The goal of fall prevention isn’t just to reduce hospitalizations, it’s to preserve autonomy. Each prevented fall represents not only avoided medical costs but also an older adult who continues walking, exercising, and participating in daily life without fear.

As technology advances, fall prediction can evolve into a natural extension of care, embedded within devices that support daily routines rather than disrupt them. Whether it’s discreet mobility sensors, adaptive walking aids, or connected home systems, the focus is on creating an ecosystem of gentle, continuous awareness that helps people stay active and confident.

This approach aligns with HIA’s broader mission: to extend healthy years of life through proactive, measurable, and human-centred innovation.

Looking Ahead: Redefining What’s Preventable

Falls will never be entirely eliminated, but they can become far less frequent and far less devastating. The key lies in shifting our perspective from reactive response to early prediction.

The science is clear: small, measurable changes in gait, balance, and activity often occur long before the first fall. By detecting those changes early, we can act before independence is lost.

At HIA, we believe this represents a new era of preventive care, one in which technology and empathy work hand in hand to redefine aging itself. Because every prevented fall is more than a data point. It’s another year of freedom, confidence, and connection for the people who built the world we now care for.

To realize this vision, HIA is building collaborations across healthcare, technology, and design. We welcome partners developing data-driven, compassionate solutions that make independent living safer and more sustainable.

If your organization is working toward this future, we’d love to connect.