An elderly person on stairs symbolizes fall risk linked to changing daily activities.

Are You at Risk? How Daily Activity Changes Can Predict Falls

Soraya Malik in Health & Wellness July 2025 • 4 min read.

"A new study reveals that both declining and improving daily living activities can signal an increased risk of falls in older adults. Learn what to watch for and how to stay safe."

Falls are a major health concern for older adults, leading to significant injury, reduced quality of life, and even mortality. As the global population ages, understanding the factors that contribute to falls is crucial for developing effective prevention strategies.

While many studies have focused on the risks associated with declining physical function, new research suggests that changes in either direction – both deterioration and improvement in activities of daily living (ADL) – can increase the likelihood of falls. This challenges conventional wisdom and highlights the complexity of fall prevention.

This article explores the findings of a 6-year study that examined the relationship between long-term changes in ADL and falls in a general elderly population. We'll delve into the key risk factors identified and discuss how this knowledge can inform targeted interventions to keep our aging loved ones safe and independent.

The Surprising Link Between Activity Changes and Fall Risk

An elderly person on stairs symbolizes fall risk linked to changing daily activities.

A prospective cohort study, "Good Aging in Skåne," followed 1,540 elderly subjects (ages 60-93) over six years to investigate the connection between changes in activities of daily living (ADL) and the incidence of falls. ADL was assessed using the Sonn and Åsberg's revised scale, which measures both instrumental (iADL) and personal (pADL) activities. Falls were recorded based on reports of one or more falls in the six months prior to the follow-up assessment.

The results revealed a significant connection between changes in ADL status and fall risk:

Deterioration Matters: Individuals who experienced a decline of two to eight steps on the ADL staircase (indicating reduced independence) had a significantly higher risk of falls.
Improvement Isn't Always Good: Surprisingly, those who became more independent in iADL also showed an increased risk of falls.
No Change, No Problem?: Individuals who remained stable in their ADL status were less likely to experience falls compared to those with changes in either direction.

These findings suggest that fall prevention strategies need to consider the dynamic nature of an individual's functional abilities and address the specific risk factors associated with both declining and improving ADL.

Personalized Strategies for Fall Prevention

The study emphasizes that effective fall prevention requires tailored interventions based on an individual's specific circumstances. A one-size-fits-all approach may not be sufficient, as the underlying risk factors differ depending on whether someone is experiencing a decline or improvement in ADL.

For those with declining ADL, interventions should focus on addressing underlying health conditions, improving mobility and balance, and modifying the home environment to reduce hazards. This may include physical therapy, medication review, and home safety assessments.

In contrast, individuals who are improving their ADL may need guidance on pacing themselves, avoiding overexertion, and addressing any underlying cardiovascular issues. It's important to ensure that increased activity is done safely and doesn't lead to falls.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.2147/cia.s70075, Alternate LINK

Title: Both Deterioration And Improvement In Activities Of Daily Living Are Related To Falls: A 6-Year Follow-Up Of The General Elderly Population Study Good Aging In Sk&Amp;Aring;Ne

Subject: Geriatrics and Gerontology

Journal: Clinical Interventions in Aging

Publisher: Informa UK Limited

Authors: Magnus Stenhagen, Solve Elmståhl, Henrik Ekstrom, Eva Nordell

Published: 2014-10-01

Everything You Need To Know

What was the research design and who were the participants in the study?

The study "Good Aging in Skåne" followed 1,540 elderly individuals aged 60-93 over six years. It used the Sonn and Åsberg's revised scale to assess Activities of Daily Living (ADL), including both instrumental (iADL) and personal activities (pADL). Falls were recorded based on reports of one or more falls within the six months before each follow-up assessment.

What were the main findings regarding changes in daily activities and the risk of falls?

The study revealed that both deterioration and improvement in Activities of Daily Living (ADL) can increase the risk of falls. A decline of two to eight steps on the ADL staircase, indicating reduced independence, significantly raised the risk. Surprisingly, becoming more independent in instrumental Activities of Daily Living (iADL) also showed an increased risk. Individuals with stable ADL status were less likely to experience falls.

What does instrumental Activities of Daily Living (iADL) include, and how can improvement in these activities increase fall risk?

Instrumental Activities of Daily Living (iADL) refer to activities that require more complex cognitive and physical skills, such as managing finances, preparing meals, doing laundry, and using transportation. An improvement in iADL might lead to increased fall risk due to overexertion or attempting tasks beyond one's current capabilities, or neglecting safety precautions due to overconfidence. This improvement may not always translate to safer habits, hence the increased risk.

Based on the study's findings, how should fall prevention strategies be personalized?

The findings suggest that fall prevention strategies need to be personalized. Interventions should consider whether someone is experiencing a decline or improvement in Activities of Daily Living (ADL). For those declining, focus should be on maintaining strength and balance. For those improving, education on pacing and avoiding overexertion is crucial. A one-size-fits-all approach may not be sufficient, as risk factors differ based on changes in ADL.

What are the implications of these findings for assessing and preventing falls in older adults?

The study highlights the need for continuous assessment and tailored interventions. Regular evaluations of Activities of Daily Living (ADL) using tools like the Sonn and Åsberg's revised scale can help identify changes early. Healthcare providers can then develop personalized plans addressing specific risk factors. Furthermore, it emphasizes the importance of educating older adults and their caregivers about the potential risks associated with both declining and improving ADL to promote safer habits and prevent falls.