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14 Dec 2022

Fear of falling


The anthropomorphic egg Humpty Dumpty did not have the best outcome from his wall sitting predilections. Despite the efforts of a cadre of concerned people he simply could not be put together again once he took his immortalised tumble.

Fortunately, in the real world people are not so blaze about the effects of falling.  It is a major issue particularly among people 60 years and older.

Statistics from the World Health Organisation paint the grim picture of the damage caused by falling.  Globally, falls are a major public health problem. An estimated 684 000 fatal falls occur each year, making it the second leading cause of unintentional injury death, after road traffic injuries.

Over 80% of fall-related fatalities occur in low- and middle-income countries, with regions of the Western Pacific and South East Asia accounting for 60% of these deaths. In all regions of the world, death rates are highest among adults over the age of 60 years.

Though not fatal, approximately 37.3 million falls annually are severe enough to require medical attention. Globally, falls are responsible for over 38 million DALYs (disability-adjusted life years) lost each year and result in more years lived with disability than transport injury, drowning, burns and poisoning combined.

The financial costs from fall-related injuries are substantial. For people aged 65 years or older, the average health system cost per fall injury in the Republic of Finland and Australia are US$ 3611 and US$ 1049 respectively. Evidence from Canada suggests the implementation of effective prevention strategies with a subsequent 20% reduction in the incidence of falls among children under 10 years of age could create a net savings of over US$ 120 million each year.

The New Zealand experience follows similar lines.  In New Zealand each year, about one in three people over the age of 65 will have a fall. Older people are more likely to fall because of muscle weakness especially in hips and legs, poor balance, eyesight problems, nutritional deficiencies, hazards in the environment, or side effects from medications. Falls can cause serious injury in older people, and in some cases can result in death. A focus on falls prevention can improve safety and confidence.

Information collected by the Accident Compensation Corporation (ACC) reveals that:

  1. Falling is the most common way of injuring yourself in New Zealand. Injuries from falling represent a whopping 39% of all ACC claims and cost $1.1 billion. 785,063 new fall-related claims were made in 2018, up slightly from 781,122 in 2017.
  2. The prize for 'most popular place to fall over' goes to your own home. Ironically one would expect where you live should be a safe zone. Yet (in the latest available statistics) 388,310 people get hurt at home per year.
  3. Women are slightly more likely to be injured by falling, 398,337 women had injuries caused from falling, compared with 386,725 men.
  4. Age is the biggest risk. If you're under 19 years old, you're more likely to be injured through a fall, as 234,468 unfortunate young people could attest to in 2018.

However, older people have more severe falls and therefore worse injuries on average. Every year, one in three people over 65 injures themselves in a fall. This rises to one in two once you reach age 80.

For those in the 65 + age group, (2017):

  • 193,954 older people had injuries from falling.
  • These injuries came at a cost of $267,275,845.
  • Falls accounted for two-thirds of all ACC claims in the 85+ age group.
  • A serious fall, resulting in a fracture can cost up to $120,000 to repair and rehabilitate

The organisation Aged Concern talk about the ‘fall cycle’ as being a real challenge to a successful, and sustained, recovery. They state that if you have previously had falls, you may have lost confidence in your abilities and restrict the activities you participate in to avoid future falls. However, this is somewhat of a double edged sword as avoidance can lead to a cycle of deconditioning. Participating in less activities for fear of falling can lead to decreased muscle strength and poor balance, which increases your risk of falling in the future. Instead, if you have a fall it is better to focus on maintaining activity to build muscle strength, balance, and coordination, and to improve your blood pressure, blood sugar levels, and to reduce weight.


One way to reduce your risk of falling over, if you’re over 65, is to increase your leg strength (pelvis, hips and legs), balance, flexibility, and general fitness. There are a number of specially developed courses that help older people achieve this. The ACC in partnership with The Ministry of Health and NZ Health Quality & Safety Commission have created Live Stronger for Longer information website which lists the community strength and balance classes located throughout Aotearoa New Zealand Home (livestronger.org.nz). Similarly Age Concern offer The Steady as You Go programmes designed to build strength and improve balance Exercise (ageconcern.org.nz).

Did you know?
Some say Humpty Dumpty is a sly allusion to King Richard III, whose brutal 26-month reign ended with his death in the Battle of Bosworth in 1485. In this speculative version, King Richard III’s horse was supposedly called “Wall,” off of which he fell during battle. Another theory is focused on a large and heavy cannon, nicknamed Humpty Dumpty, was strategically placed atop St Mary’s as the Wall Church to defend the city, and manned by “One-Eyed” Jack Thompson. The top of the church tower was hit by the enemy, causing the cannon to tumble to the ground, where it shattered and could not be put back together again. Humpty Dumpty and Alice.

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Date Published: December 2022

To be reviewed: January 2026