A new study has uncovered the most frequent cause of falls among older people. The verdict? Surprisingly, incorrect weight shifting is most often to blame, not slips or trips.

Falling down, a major cause of injury and hospitalization, is responsible for 90 percent of hip and wrist fractures in those 65 years of age and older.

Canadian researchers wanted to better understand the causes of these falls in order to design better interventions. To learn more, they analyzed three years’ worth of video from public areas (like dining rooms, hallways and lounges) at two long-term care facilities in British Columbia, Canada. The study was published online in The Lancet in October.

They found that 41 percent of the time, people were unable to get in a stable final position while rising or couldn’t stop their forward momentum after taking a misstep. The other surprising finding is that falls were just as likely to occur when people were lowering themselves into a seated position or while standing (either due to being bumped or losing balance while initiating an activity such as turning or reaching) – even though previous studies have suggested most falls occur only while people are walking.

“It did surprise us. Previous research had suggested that the main causes of falls in older adults are slips and trips while walking. We found slips are, in fact, very rare,” explains one of the senior authors, Stephen Robinovitch, PhD, professor in the Department of Biomedical Physiology and Kinesiology at Simon Fraser University, Burnaby. “That did open our eyes toward the fact that the mechanisms of falls are different than what was previously reported.”

Trips, the second-most common cause of a fall, are still an important factor to consider because they were responsible for nearly a quarter of the falls. Often, people simply stumbled or one foot collided with the other, especially while turning. And a quarter of the time, the obstacle was a chair leg or table leg. “There’s an opportunity there for improved environmental design,” Robinovitch says. “One thought is to select furniture so there’s a single central flaring support that provides for stability but removes the tripping hazard.”

A number of falls also occurred among people who should have been using assistive devices, but were not at the time of the fall.

John FitzGerald, MD, associate clinical professor of medicine in the division of rheumatology at the David Geffen School of Medicine at the University of California, Los Angeles, says these findings can be helpful for some arthritis patients.

“If [people] have arthritis of the lower extremities, they can have an abnormal gait that can throw off balance and make them more susceptible to falls. And some arthritis medicines can further increase the risk of falls – specifically [opioid] pain relievers,” Dr. FitzGerald explains.

He says if you or a family member have already fallen a few times or have come close to falling, you might want to talk with a doctor. “There are a lot of little things that could lead to falls [that] are correctible,” Dr. FitzGerald says. “There are programs that can help reduce fall risk with core-strengthening and balance exercises.” Reviewing medications, using assistive devices and correcting foot abnormalities with orthotics can also help reduce the risk, he adds.

In addition to paying attention to environmental hazards – for example, ensuring you have proper lighting and handrails in key spots like stairways, and removing tripping hazards – resistance-training exercises to improve balance, flexibility and strength are also important, especially for the upper arms, which can help break a fall, Robinovitch says.

“There are three essential abilities related to falls,” he explains. “One is the ability to safely move about without losing your balance. The others are the ability to recover balance by taking a step or grasping a nearby object, and then, if a fall does occur, the ability to protect yourself and land safely.”