Falls among elderly individuals represent a significant public health issue, especially in urban settings where the aging population is rapidly increasing. With advances in healthcare and improved living standards, life expectancy has risen globally, leading to a higher proportion of older adults in the population. However, aging is commonly associated with a decline in physical, sensory, and cognitive functions, all of which contribute to an increased risk of falls. Falls are not merely accidental events; they are often the result of a complex interplay of intrinsic and extrinsic factors, including physiological changes of aging, environmental hazards, and comorbid health conditions [1].

The World Health Organization (WHO) identifies falls as the second leading cause of accidental or unintentional injury deaths worldwide. Among the elderly, falls are the most common cause of injury-related hospital admissions and long-term disability. Urban environments, although generally offering better access to healthcare and infrastructure, also present unique challenges for the elderly, such as crowded public spaces, slippery sidewalks, and rapidly changing traffic conditions, all of which can contribute to fall risk [2]. Moreover, high-rise buildings, poorly designed staircases, and inadequate lighting in many urban dwellings further increase the danger for seniors with impaired mobility or vision [3].

From a clinical and epidemiological standpoint, falls among the elderly are not only a marker of frailty but also a predictor of subsequent adverse outcomes, including functional decline, institutionalization, and mortality. A single fall can trigger a cycle of reduced mobility, fear of falling, social withdrawal, and depression, ultimately diminishing quality of life [4]. Additionally, repeated falls can result in significant physical injuries such as hip fractures, head trauma, and soft tissue injuries, which necessitate long-term rehabilitation and sometimes surgical intervention [5].

Several risk factors have been consistently associated with increased fall incidence in elderly individuals. These include advanced age, female gender, polypharmacy, impaired balance and gait, vision impairment, cognitive dysfunction, and underlying chronic diseases such as hypertension, diabetes, osteoarthritis, and neurological disorders [6]. Psychosocial factors like isolation, lack of physical activity, and depression also contribute significantly to the vulnerability of elderly urban residents [7]. Importantly, many of these risk factors are modifiable, indicating that falls are not an inevitable consequence of aging but rather a preventable public health issue.

The urban elderly population often faces a unique burden of healthcare neglect, despite proximity to medical services. Many elderly individuals live alone or in nuclear families without adequate caregiver support. This results in delayed reporting of minor falls, lack of regular health check-ups, and poor compliance with prescribed preventive strategies like vitamin D supplementation or physiotherapy exercises [8]. Furthermore, cultural attitudes towards aging, mobility limitations, and dependence may lead to underreporting or normalization of falls, thus skewing epidemiological data and limiting the effectiveness of intervention programs [9].

Understanding the incidence and prevalence of falls in the urban elderly is crucial for informing public health policies, allocating resources, and designing targeted fall-prevention programs. This retrospective study aims to evaluate the frequency, associated risk factors, and clinical outcomes of falls among elderly individuals in an urban population. The data derived can serve as an evidence base for developing comprehensive geriatric care models and environmental modifications aimed at fall prevention [10].

Study Design and Setting

This retrospective observational study was conducted in an urban tertiary care hospital. The study evaluated medical records of elderly patients aged 60 years and above who experienced one or more falls. Ethical clearance was obtained from the Institutional Ethics Committee prior to data collection.

Study Population

All elderly patients (≥60 years) residing in the urban locality and admitted to the hospital with complaints of falls during the study period were considered eligible. Falls were defined as "an event which results in a person coming to rest inadvertently on the ground or floor or other lower level." Patients with falls due to road traffic accidents, seizures, or stroke at onset were excluded.

Sample Size and Sampling Technique

A total of 300 patient records were reviewed using purposive sampling. After applying inclusion and exclusion criteria, 250 cases were finalized for data analysis.

Data Collection

Patient records were accessed from the hospital’s medical record department. A pre-validated data extraction form was used to collect relevant information, which included:

• Sociodemographic data: age, sex, living arrangement, and occupation (if any)
• Medical history: comorbidities such as diabetes, hypertension, osteoporosis, osteoarthritis, visual or auditory impairments
• Medications: number and type of medications (polypharmacy considered as ≥5 drugs)
• Fall details: time, location (home/outdoors), mechanism of fall, and recurrence
• Injury outcomes: fracture, soft tissue injuries, head trauma, hospital stay duration, and rehabilitation requirement

Statistical Analysis

The data were entered into Microsoft Excel and analyzed using IBM SPSS version 25.0. Descriptive statistics such as mean, standard deviation, frequency, and percentages were used for continuous and categorical variables. Chi-square test was used to identify associations between categorical variables such as age groups and incidence of fall-related injuries. A p-value of <0.05 was considered statistically significant.

A total of 250 elderly patients aged 60 years and above with documented fall episodes were included in the study. The mean age of participants was 71.4 ± 7.2 years, with a higher proportion of females (56.4%) compared to males (43.6%).

1. Sociodemographic Characteristics

Most participants belonged to the age group of 70–79 years (44.8%), followed by 60–69 years (32.4%). A majority of the subjects were living in nuclear families (58.8%), and 36% lived alone. Table 1 summarizes the sociodemographic data.

[Table 1: Sociodemographic Profile of Study Population]

2. Clinical Risk Factors and Comorbidities

Hypertension (62%) and diabetes (48.8%) were the most common comorbidities. Polypharmacy was seen in 45.2% of participants. Impaired vision was reported in nearly half the population, and 30% had some degree of balance or gait instability.

[Table 2: Clinical Risk Factors and Comorbidities]

3. Fall Circumstances and Environmental Factors

Most falls occurred indoors (62.4%), particularly in bedrooms and bathrooms. Slippery flooring and poor lighting were identified as contributing environmental hazards. Nearly 38.4% of participants had a previous history of falls.

[Table 3: Characteristics of Fall Incidents]

4. Nature of Injuries and Outcomes

Among the 250 patients, 78 individuals (31.2%) sustained fractures, with hip fractures being the most common. Head injuries were recorded in 12.4% of cases. A significant portion of patients required hospital admission for ≥5 days. Rehabilitation services were utilized in only 22% of the cases.

[Table 4: Injury Pattern and Clinical Outcome]

The present retrospective study examined the incidence, risk factors, and clinical outcomes of falls among elderly individuals residing in an urban setting. The findings underscore that falls are not only prevalent but also a critical health concern in this demographic, with significant implications on mobility, independence, and quality of life. The overall burden of falls identified in this study aligns with global reports indicating that approximately one-third of community-dwelling individuals over the age of 65 experience at least one fall annually [11].

A notable observation in our study was the higher prevalence of falls among females (56.4%), which is consistent with previous epidemiological surveys highlighting gender-specific vulnerability [12]. This may be attributed to lower muscle mass, higher rates of osteoporosis, and post-menopausal hormonal changes, which contribute to frailty in elderly women. Additionally, social and behavioral differences, such as reluctance to seek help or participate in preventive physiotherapy, may further increase fall risk among females.

Age was another significant predictor, with most falls occurring in the 70–79 age group. The progressive decline in neuromuscular coordination, proprioception, and visual acuity with advancing age contributes to impaired balance and increases the likelihood of falling [13]. Moreover, the association of comorbidities such as hypertension, diabetes, osteoarthritis, and visual impairment observed in this study corroborates with existing literature that supports the multifactorial etiology of falls in the elderly [14]. Particularly, polypharmacy—present in 45.2% of our participants—was a major contributor, highlighting the importance of regular medication reviews to identify and eliminate unnecessary or interacting drugs [15].

Environmental factors also played a significant role in fall causation. A majority of falls occurred indoors, particularly in bathrooms and bedrooms, due to slippery surfaces and poor lighting. Despite urban areas offering better access to healthcare, they are often plagued by hazardous housing conditions for the elderly. Uneven flooring, absence of handrails, and poorly maintained public infrastructure are common problems in metropolitan housing complexes [16]. This finding reinforces the urgent need for elderly-friendly urban planning and housing design.

Furthermore, almost 38.4% of the participants had a history of previous falls, which is a well-established predictor of future falls. The fear of falling again often leads to reduced activity, social withdrawal, and physical deconditioning, thus perpetuating a vicious cycle of frailty and dependence [17]. In such cases, early interventions such as balance training, vision correction, and home hazard assessments could prove highly beneficial.

The injury profile in our study revealed that over 31% of patients sustained fractures, with hip fractures being the most common. These injuries were not only physically debilitating but also contributed to prolonged hospital stays, with 26.8% of patients requiring more than five days of inpatient care. Notably, head injuries were seen in 12.4% of patients, indicating that even non-fatal falls can have serious neurologic consequences. Despite the burden of injuries, only 22% of the patients were referred for rehabilitation services, indicating an underutilization of crucial recovery resources in post-fall management [18].

Urban-dwelling elderly individuals often face fragmented family structures and reduced social support, leading to delayed care and underreporting of fall incidents. In our study, 36% of participants lived alone, and this group had higher rates of injury severity. Living alone is associated with delayed detection and management of falls, often leading to complications such as rhabdomyolysis, dehydration, or even mortality in unassisted cases [19]. It is imperative to design community-based surveillance systems and helplines that can provide timely assistance to elderly individuals living in isolation.

Additionally, psychological consequences of falls such as anxiety, depression, and fear of recurrence were reported in several records, although not quantified in this study. These psychosocial impacts have been recognized as key contributors to functional decline, and they call for a multidisciplinary management approach that includes psychological counseling, physiotherapy, and caregiver support [20].

This study's retrospective design enabled access to a large dataset, providing meaningful insights into real-world fall scenarios in the elderly. However, limitations include possible documentation bias, missing data on non-hospitalized falls, and lack of information on functional outcomes post-discharge. Nonetheless, the findings provide compelling evidence for policy makers, clinicians, and urban planners to prioritize fall-prevention strategies tailored to the elderly population.

In conclusion, the high incidence of falls among elderly individuals in urban areas, as demonstrated in this study, reflects a complex interplay of biological, environmental, and psychosocial risk factors. Proactive measures including routine screening for fall risks, medication optimization, home safety modifications, and rehabilitation services must be integrated into standard geriatric care. Strengthening urban health systems and enhancing community awareness are essential to mitigate the burden of falls and preserve the independence and dignity of the aging population.

This retrospective study highlights the significant incidence of falls among elderly individuals in urban areas, with most cases attributed to modifiable risk factors such as comorbidities, polypharmacy, and unsafe home environments. A substantial proportion of falls resulted in serious injuries, including fractures and head trauma, leading to extended hospital stays and underutilized rehabilitation services. The findings underscore the need for proactive fall-prevention strategies, including regular health assessments, medication reviews, environmental modifications, and improved social support for the elderly. Urban health systems must adopt a multidisciplinary approach to reduce fall-related morbidity and enhance the quality of life in the aging population

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