Internationally, the World Health Organisation (WHO) and other medical organisations recognise that falls are an important cause of unintentional injury and death among adults aged 60 and over.
The Department of Statistics Malaysia (DOSM) ‘Statistics On Causes Of Death Malaysia 2025’ will show you that the top four causes of medically certified death, in those 60 years and over, were pneumonia, heart disease, diabetes mellitus and stroke. But this does not paint the full picture.
Our cause of death mechanism in Malaysia records the final cause of the death and not the underlying causes of death. For example, if an older person has a fall, with a significant injury or hip fracture, and then is bed-bound and develops pneumonia as a result of the immobility, the cause of death will be recorded as pneumonia, not the fall.
Also note that 38 per cent of all deaths 60 years and over were not medical certified and 19 per cent are classified as ‘sakit tua’ (died of old age). Hence, falls as an important cause of death or precipitator of death is hidden in our health data.
The WHO recognises that falls result in traumatic brain injury, hip fractures, immobility and complications. Extended periods of bed rest or reduced activity can trigger secondary complications, including pneumonia, pressure ulcers and blood clots.
Data shows that about 20–30 per cent of older adults who suffer a hip fracture pass away within one year following the incident and 60 per cent do not fully regain their pre-fracture level of independence.
The data from the National Health and Morbidity Survey (NHMS) on ‘Older Persons Health’ for both 2018 and 2025 showed that 1 in 7 Malaysians, aged 60 years and over, fell at least once in the past 12 months.
Falls in older adults are typically driven by a combination of underlying health issues and environmental factors which include:
- Age-related loss of muscle mass (sarcopenia) and cognitive impairments severely affect balance, gait, and reaction times. NHMS 2025 data for those 60 years and over show that 45 per cent of Malaysians have sarcopenia and 10 per cent have dementia.
- The use of some medications, due to chronic illness, can lead to postural hypotension, dizziness or drowsiness, increasing fall risk. NHMS 2025 data for the age group show that 39 per cent have diabetes and 73 per cent have hypertension.
All of us are becoming disabled to some degree, or less capable, as we grow older, which makes falls more likely. NHMS 2025 for older persons show that 10 per cent have limitations in activities of daily living, 4 per cent have vision limitations and 30 per cent are physically inactive.
Hence, it is imperative as we grow older that we invest in fall prevention.
Our own experience reflects this. Once we both reached 60 years of age, we started routinely using a walking stick, even though we are still quite fit and active.
We use light-weight hiking sticks that are height adjustable. Having used them now for a number of years, we have come to enjoy the extra support that a simple walking stick gives us. It is now second nature for us to not leave our home without a walking stick.
Some people look at us oddly, two fit individuals using a walking stick. But we have seen enough older people fall down, break a bone or two, become bed ridden and eventually die or languish and suffer.
We do not relish the thought of joining this community. A simple walking stick makes us much more stable and steadier on our feet, less wobbling around. Navigating uneven surfaces and steps of buildings and roads can be quite hazardous, not to mention potholes and unexpected gaps.
Sadly, many older persons are ‘malu’ (embarrassed) to be seen using a walking stick. They somehow think it makes them look ‘old’.
Instead, some use an umbrella – an item that cannot bear your weight adequately, is clumsy and often is too short to be used properly. Others we see holding on to their relatives, at times desperately, for support. Some hobble or shuffle around, often unsteadily, making us fearful for them.
If you look at the data from NHMS 2018 (see graphic below) you will recognise that falls also occur in and around the house. We recognise this and have renovated our bathroom floor to a non-slip surface, covered all the drains and lowered high cupboards. As we are reaching 70 years we are planning to install grab bars and rails in the bathroom.
In Malaysia, we have an inordinate fascination with marble floors. Even the Ministry of Health and private hospitals and clinics (not to mention every government department) have extensive marble floors.
Marble floors pose a high risk of slips and falls, especially for older persons, the disabled and young children, because of their naturally smooth, polished surface. They become extremely hazardous when wet or waxed. It is time to move away from such inappropriate design choices, especially in health facilities which most older persons and the disabled use frequently.
If you are 60 years and older and are reading this, you may say “I am still fit and do not need to use a walking stick” but your first fall may be your last.
Falls are a tragic and inglorious way to end or diminish our lives. The rate of older Malaysians ageing well is poor (15 per cent NHMS 2025). Let us all encourage each other to live our lives with better quality.
Datuk Dr Amar-Singh HSS and Datin Dr Lim Swee Im are medical professionals. The views expressed in this article are his own and do not necessarily reflect those of Sinar Daily.