Key facts
- In 2023, WHO estimated there were approximately 842 000 deaths from falls worldwide, making falls the second-leading cause of unintentional injury deaths, after road injuries.
- About 71% of the estimated fall deaths in 2023 occurred among adults aged 60 years and older.
- In the 2023 Global Health Estimates, falls ranked eighth among causes of disability-adjusted life years (DALYs) globally.
- WHO’s Step Safely technical package sets out life-course approaches combining safer people, safer environments, and safer policies and legislation.
- Effective measures include exercise that challenges balance for older people, targeted home-hazard reduction, child-safety measures, and occupational fall-protection systems (1–3).
Overview
A fall is an event in which a person comes to rest inadvertently on the ground, floor or another lower level. Falls may occur on the same level or from a height. Most falls are non-fatal, but injuries can have lasting physical, psychological and economic effects.
WHO’s Global Health Estimates (GHE) estimated about 842 000 deaths from falls worldwide in 2023. Falls were the second-leading cause of unintentional injury death, after road injuries. Non-fatal falls also cause fractures, head injury, loss of independence, disability and long-term care needs.
In WHO’s 2023 GHE, falls ranked eighth among all causes of global disability-adjusted life years (DALYs), a measure combining healthy years lost through premature death and disability. Population ageing and hazards in built, domestic and occupational environments make prevention an important public-health priority.
The 2023 GHE attributed approximately 284 200 fall deaths to the WHO South-East Asia Region and 239 800 to the Western Pacific Region, representing about 62% of all fall deaths worldwide. Some 71% of deaths occurred in people aged 60 years or older. Patterns vary by age, sex and setting; children and workers face distinct hazards. These numbers represent deaths, not all falls or injuries.
In addition to fatal injuries, many falls require medical attention and contribute substantially to disability. These consequences are not captured by mortality figures alone. Estimates of non-fatal injury and demand for treatment should be drawn from sources designed to measure those outcomes, and interpreted alongside estimates of DALYs.
Who is at risk?
Age
Older people: Risk increases with impairments in balance, strength, gait, vision, cognition or mobility, and with medications or conditions that cause dizziness or low blood pressure. Injuries can lead to a loss of confidence, reduced activity and a cycle of increasing frailty. Falls in homes, hospitals and residential care settings require different prevention approaches.
Children and adolescents: Falls are associated with developmental stages and activities such as climbing, playing and exploration. Hazards include unprotected windows, stairs and balconies, unsafe playgrounds and inadequate supervision. Structural safety measures can protect children while allowing them to play and develop safely.
Workers: Falls from height and slips and trips at work are serious risks in construction, agriculture, transport, maintenance and other occupations. Effective prevention requires assessment and control of hazards, safe equipment and appropriate oversight.
Sex and other risk factors
In the 2023 GHE, approximately 481 000 deaths from falls occurred among males and 361 000 among females worldwide. Patterns of non-fatal injury can differ. Other risk factors include alcohol and substance use; neurological or cardiovascular conditions; medicines that increase fall risk; impaired balance or vision; unsafe stairs, lighting or walking surfaces; poverty and substandard housing; and hazardous work at height. These risks often interact with one another and with the social and physical environment.
Prevention
WHO’s Step Safely: Strategies for preventing and managing falls across the life-course (2021) is a practical technical package for policy-makers, practitioners, programme managers and advocates. It includes risk assessment, programme implementation and post-fall management, not just individual behaviour-change advice. Its three safe-systems domains are safer people, safer environments, and safer policies and legislation. It distinguishes interventions categorized as *strongly recommended*, *recommended*, *promising* or *prudent* according to the available evidence.
For children and adolescents
- provide targeted information and support to families, including home-safety visits and measures to protect windows, stairs and balconies;
- make playground design and surfaces safer, with appropriate fall heights and protective surfacing; and
- adopt and enforce product, building and childcare safety standards.
For workers
- eliminate or minimize work at height where feasible;
- use safe platforms, guardrails, scaffolding and fall-protection systems;
- enforce occupational safety standards and provide training, supervision and incident reporting; and
- combine equipment and environmental controls with effective organizational safety systems.
For older people living in the community
- provide tailored exercises that challenge balance and improve functional strength, with regular progression and sufficient duration; Tai Chi is another useful option. A Cochrane review found exercise reduced the overall rate of falls by approximately 23% in trial populations (1).
- offer home fall-hazard assessment and modification particularly to people already at elevated risk; a 2023 Cochrane review found a 38% reduction in fall rates in these higher-risk groups, but not a demonstrated effect in unselected people (2).
- review medicines that increase fall risk and address problems including poor vision, unsafe footwear, dizziness, orthostatic hypotension and mobility limitations; and
- provide individualized, multifactorial assessment and interventions for people with recurrent falls or at high risk (3).
For older people in residential care or hospitals
Interventions should be tailored to health status, level of risk, care environment and staffing. They may include medication review, appropriate supervised exercise, safer environments, staff practices and individualized assessment. Not all interventions effective among community-dwelling older people have the same evidence in institutions (3).
Routine vitamin D supplementation should not be presented as a general fall-prevention strategy for all older adults. Evaluation and management of deficiency may be appropriate for individuals in whom it is clinically indicated; high-dose supplementation may have adverse effects (3).
Education and raising awareness are useful components of prevention, but information alone should not be equated with interventions proven to reduce falls. Step safely calls for applying and evaluating policies, environmental changes and targeted prevention services across the life course (2).
Managing falls and fall-related injuries
Falls prevention also requires timely and effective response after a fall. Relevant measures include first aid, emergency care, prompt recognition and management of fractures and head injury, rehabilitation, support to regain function and reassessment to reduce future risk. Step safely places injury management and targeted secondary prevention alongside measures to avert the initial fall.
WHO response
WHO provides comparative mortality and burden-of-disease estimates through the GHE and promotes effective fall prevention through Step safely, which supports local situation assessments, selection and adaptation of interventions, cross-sector coordination and evaluation. The package contributes to safer cities and homes, safer workplaces and healthier ageing.
References
1. Sherrington C et al. Exercise for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2019;CD012424. https://doi.org/10.1002/14651858.CD012424.pub2
2. Clemson L et al. Environmental interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2023;CD013258. https://doi.org/10.1002/14651858.CD013258.pub2
3. Montero-Odasso M et al. World guidelines for falls prevention and management for older adults: a global initiative. Age Ageing. 2022;51:afac205. https://doi.org/10.1093/ageing/afac205