The Fall Risk That Starts Decades Earlier Than Most People Realize

A Warning That Comes Too Late for Most People

Most people don't start thinking about falling until they're well into their 60s or 70s — and by then, they've already lost years of preventive ground. That's one of the key messages from Nathalie van der Velde, a leading expert in aging at the Amsterdam University Medical Center, who says staying active is key for preventing falls as you age. Her research and clinical work offer a stark reality check: the biological changes that lead to falls begin far earlier than most of us assume.

Most people think aging starts in their 60s, but in fact we spend most of our life span undergoing the process of decline, typically beginning in our 30s. Research consistently shows that proprioceptive sensitivity — the body's ability to sense its own position — begins declining as early as your 40s, accelerating through the 50s and 60s. By the time a first fall occurs, the body has often been quietly losing its defenses for decades.

The Numbers Behind the Risk

Accidental falls can lead to injury for anyone, but for adults over the age of 65, falls are more likely and more serious. According to the CDC, one in four older adults experiences a fall each year, and about 37% of those falls require medical care. The financial toll is staggering too. The National Council on Aging says that the average cost of an emergency department visit to address a fall injury is $1,112, and an inpatient hospital stay for more severe injuries averages more than $18,000.

What makes falls so dangerous isn't just the impact — it's what happens next. After age 30, adults lose roughly 10% of muscle strength per decade. But it's muscle power — the explosive strength needed to catch a stumble mid-fall — that declines even faster, at approximately 30% per decade after 60. This is why an 80-year-old cannot self-correct the way a 50-year-old can. The sharp increase in the prevalence of falls in middle age, particularly among women, supports the notion that falls are not just a problem of old age, and that middle age may be a critical life stage for preventive interventions.

What the Expert Actually Does Every Day

Professor van der Velde has been a consultant geriatrician since 2010 and is the principal investigator and leader of the research line on person-centred falls and fracture prevention at Amsterdam UMC. Her current focus includes optimizing and personalizing the deprescribing of fall-risk-increasing drugs and diagnosing and treating cardiovascular-related fall risk. In other words, she doesn't just study falls from a distance — she actively works to remove the hidden triggers that cause them.

The pillars of daily prevention that experts like van der Velde champion are consistent and well-supported by evidence. Physical activity can go a long way toward fall prevention. Activities such as strength training, walking, water workouts, or tai chi reduce the risk of falls by improving strength, balance, coordination, and flexibility. Tai chi interventions alone have been associated with approximately 31–58% reductions in falls. Medication management is equally critical. Many seniors take multiple medications, some of which can cause dizziness or drowsiness, contributing to fall risks.

Small Habits, Big Consequences

Prevention isn't about dramatic interventions. It's about the accumulation of small, consistent choices. Changing your footwear is one simple step — high heels, floppy slippers, and shoes with slick soles can make you slip, stumble, and fall, as can walking in stocking feet. Many falls are preventable with a consistent, mindful daily routine tailored to support balance, strength, and safety — implementing practical daily habits can empower people to live more confidently and independently.

The broader takeaway from van der Velde's work is that fall prevention is not a conversation to have after a first fall — it's one to have right now, regardless of age. Physical inactivity leads to reduced strength, endurance, flexibility, and overall functional health, requiring greater effort for daily tasks. Early detection of reduced physical fitness and the implementation of targeted exercise programs are essential to prevent functional decline and falls. The body gives warnings long before the first stumble. The question is whether we're paying attention early enough to act on them.