Trauma & Injury Prevention

Mechanical Falls

Shan Liu, MD, MPH
Massachusetts General Hospital

Shan LiuThe term “mechanical falls” has become commonly used in emergency departments, yet its definition and clinical implications have not been established. It implies that an external force or object led to the fall. Given that a third of older adults in the United States falls annually, over 2 million older adult non-fatal falls are treated annually in the ED1 and likely to increase as the older adult population grows,2,3 it is important to understand what is often termed “mechanical falls.”

While over a quarter of community-dwelling older adults have falls related to slipping, tripping, or stumbling,4,5 external factors are seldom the only cause of an older adult’s fall. Since older adult fall patients are at high risk for recurrent falls,6,7 ED evaluation should focus on determining such patients’ modifiable fall risk factors. Often, patients with “mechanical falls” have evaluations that focus on any fall-related injury whereas “non-mechanical falls” are often evaluated for potential cardiac etiologies for their fall. This dichotomy of “mechanical” vs. “non-mechanical” may lead to a less-thorough evaluation of the fall as older adult falls are multifactorial.6

We conducted a pilot study through secondary analysis of data from a chart review study that originally examined concordance of ED evaluation of older adult falls with ED fall guidelines.7 We had a sample size of 350 patients and found little difference among associated conditions between the two fall categories “mechanical” vs. “non-mechanical.” While this study was small, we found the term mechanical fall was inconsistently used and not associated with a discrete fall evaluation.

Future studies should further examine whether the term “mechanical fall” has any utility when describing an older adult’s fall etiology. Regardless, the term itself is misleading because it inaccurately implies that a benign etiology for an older person’s fall exists.

  1. Falls Among Older Adults: An Overview [Internet]. Atlanta: Centers for Disease Control and Prevention. [updated 2015 Mar 19; cited 2015 Mar 20] Available from:
  2. Stevens JA, Corso PS, Finkelstein EA, Miller TR. The costs of fatal and non-fatal falls among older adults. Inj Prev. 2006;12:290-295.
  3. Orces CH, Alamgir H. Trends in fall-related injuries among older adults treated in emergency departments in the USA. Inj Prev. 2014;20:421–423. doi:10.1136/injuryprev-2014-041268.
  4. Carpenter CR, Scheatzle MD, D'Antonio JA, Ricci PT, Coben JH. Identification of fall risk factors in older adult emergency department patients. Acad Emerg Med. 2009;16:211–219.
  5. Close J, Ellis M, Hooper R, Glucksman E, Jackson S, Swift C. Prevention of falls in the elderly trial (PROFET): a randomised controlled trial. Lancet. 1999;353:93–97.
  6. Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988;319:1701-1707.
  7. Tirrell GP, Sri-On J, Lipsitz, L, Camargo CA, Kabrhel C, Liu SW. Evaluation of Older Adult Patients with Falls in the Emergency Department: Discordance with National Guidelines. Acad Emerg Med. 2015; 22:461-467. doi: 10.1111/acem.12634.

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