My fall last fall: Reaction time and getting older

Robert H. Shmerling, MD

Senior Faculty Editor, Harvard Health Publishing

I remember it like it was just last year — because that’s when it happened. I found myself on the ground with a separated shoulder. I’d gone for a run, wasn’t paying attention to the terrain, and tripped over a rock. And down I went.

Now, all this time later, I’m still struck by something odd: although I’d taken an occasional tumble while jogging over the years, I’d never had more than a skinned knee — so why did I fall so hard that time? And that got me thinking: why do falls tend to cause more serious injuries as we age?

The trouble with falling

As I looked into the connection between aging and fall-related injuries, I was reminded of a joke I heard about an elderly man who was being evaluated for repeatedly falling: he said, “It’s not the falling that bothers me — it’s the landing.” And there is wisdom to his reply — how we land as kids when we trip and fall is very different than how we land in older adulthood. One obvious difference is that the distance and the force are greater: we’re larger as adults and we’re falling from a greater height. But there’s another important difference. As kids, we often “catch ourselves” before landing too hard. An outstretched hand, a quick turn of the body, or grabbing a nearby railing can mean the difference between a minor scrape and a broken bone.

Reaction time changes with age

It may come as no surprise to learn that reaction times tend to slow as we age. Researchers had observed this phenomenon in several older studies, but recently, it was put to the test once more in a more high-tech fashion. The study used a Nintendo Wii computer system to compare reaction times of people ages 25 to 35 with those 65 and older. Each volunteer had to react to a visual signal by “hammering” the keyboard in front of them or stepping on a keyboard in front of them. The findings were striking: the older adults had significantly slower reaction times.,

In addition to slower reaction times, older individuals tend to have poorer coordination and reduced force and speed of movements.

Why does this happen? It’s a combination of age-related changes in the brain, slowed signals from the brain to nerves and muscles, reduced flexibility of joints and tendons, and weaker muscles. In addition, older individuals tend to have less accurate awareness of their extremities’ position in space. These changes conspire to increase the likelihood of falling and to reduce one’s ability to make quick adjustments if a fall does occur.

Falls are not just falls

When an adult falls and has an injury, the first order of business is to assess the severity of the injury and treat it. That part is often the easiest (although a hip fracture or a head or neck injury can be devastating). The next step may be more challenging: figuring out why the fall occurred. Sometimes it’s obvious, such as stepping onto an icy or uneven sidewalk. But, when falls are recurring or seem to happen without an obvious reason, sorting out the cause takes time and judgment. Medications, heart problems, and nerve diseases are just a few of the reasons people fall. When a specific cause can be identified, interventions can help prevent falling in the future.

What can be done?

Clinical studies have observed a reduced rate of falling in older individuals after participation in exercise programs focused on balance, strength, flexibility, and stamina. However, few studies have specifically targeted reaction times. So, it’s possible – but unproven – that faster reaction times can be learned. Maybe we could use that Wii system described earlier to train older folks to react faster. If that’s possible, falling might become rarer and injuries more minor.

Other interventions that are commonly recommended to prevent falls and their complications include:

  • Education. For example, making sure older individuals understand the dangers of falling so that unnecessary risks (such as standing on a chair to change a lightbulb) can be avoided—as well as teaching folks how to avoid those kinds of risks.
  • Making the environment safer. Examples include removal of clutter and loose rugs from the home.
  • Assessing vision. It’s important that older individuals have a thorough eye exam and receive treatment for any eye conditions (such as cataracts) that can impair vision.
  • Getting regular checkups and reviewing all medications. As mentioned, many conditions and medications affect balance and blood pressure and can increase the risk of falls.
  • Moderating alcohol intake. Alcohol affects balance and blood pressure, so drinking too much can encourage falls.
  • Using a walker or cane for added stability if needed.
  • Improving bone mass. Calcium and vitamin D supplements, along with medications to increase bone mass (if needed), can optimize bone strength and lower the risk of a fracture if a fall occurs.


My shoulder is fine now, but it took weeks in a sling, months in physical therapy, and lots of exercises at home to get better. The fact is, I probably could have prevented the fall and shoulder injury I suffered last year if I’d paid more attention to the terrain and avoided tripping in the first place. But I have little doubt that my reaction time has slowed as I’ve gotten older. Is there anything I can do about that? Can we learn to hasten our reaction times or learn to “fall better”? I certainly hope so — for the sake of my own safety and the millions of others at risk of falling.


  1. W. Herr

    I think as we age we also shuffle our feet more (i.e., lift our feet less) and that this can lead to to tripping.

  2. carmel galea

    I read your interesting article about falling. it inerests me most since I am very aware of falling since I’m getting older. I believe that your article is relevant to older people. since I heard a lot of stories people falling and that’s the end of their life. because as soon as they stop with their normal way of life,than complications stats one after the other.

  3. D Spero

    I was wondering about your theory of growing older being the cause. Perhaps as someone who only runs you do not exercise the muscles you need in a fall. I am 65 and have almost fallen on multiple occasions but I have never hit the ground. I think it might be because my exercise is a Dance Program where we use use legs, arms and really work on our core. Perhaps if you were to include different kinds of exercise in your workout you might not fall???

  4. Paul Dickson

    Vision isn’t just your eyesight and eye health, each semicircular canal of the middle ear is linked to a pair of extra ocular eye muscles, neurologically. Eye movement control and binocularity are directly related to depth perception and timing etc. These aspects of your vision need attention too.

  5. Michelle Seligson

    My diploma thesis two years ago for the C.G.Jung Institute- Boston was titled: the Archetype of Falling. As I aged I started falling more and injuring myself. My thesis topic had to deal with the developing vulnerability of ageing but went beyond the physical falls and touched on the metaphorical. We fall in many ways.

  6. Marguerite Thomas

    Dear Dr. Shmerling, Please allow me to introduce myself as the coordinator of the Ontario Fall Prevention Community of Practice. We publish a bi-weekly mini-newsletter on our website We feature two articles or library services and we would like to ask you about posting your fall article. Could we please repost with your permission and giving you credit? Another option would be to do an introduction and a link, but the posting would be preferable. Thank you in advance for your work in preventing falls.

  7. Mary Oravitz

    I fell backwards a few weeks ago , trying to jump up to reach the chain pull on my ceiling fan in my sunroom . I lost my balance , falling , hitting my back & head against the frame of the lanai. The shock of my fall went all thru my lower back as I landed on my dieire. Needless to say , my back is still suffering, I also lengthened the pull chains on all my fans. Starting to be more aware of what I can do , no spring chicken any longer

  8. Wayne Jupiter

    All forms of Taiji (TaiChi, T’ai Chi, Tai Chi Quan) are great for helping seniors prevent falls. The chinese word “Quan” translates to “fist”. It is the martial art type of Taiji. I teach at a Senior Services Center to help seniors regain some of their balance and it definitely helps. Many teachers teach just the form and while it is great exercise, it may not help unless the student understands the principles of Taiji. Students must develop a sense of where their balance is how they move their center of gravity as they are moving. A full compliment of Qigong, standing meditation, Tai chi walking, and the Tai chi form (preferably the Yang style short form) is best to achieve results.

  9. Ruth D. Bernstein

    Some older people have dizziness caused by inner ear problems. Hearing loss is a factor because we may not hear environmental signals fast enough. I’m taking a Fall Stop class and find it has helped my balance and reaction time.

  10. Gail

    I recently fell face first onto concrete. Apparently I stepped on a dome-shaped raised light in the pavement. It happened so fast that I didn’t have time to try to catch myself or tuck and roll, even though I knew that’s what one should do. One second I was taking a step, the next I was flying through the air. An unconscious reflex to catch myself with my hand may have caused the sprained wrist I sustained. I also had an avulsion fracture in the opposite foot, probably from stepping on the light. The architect should lose his license.

  11. David Malcolm

    To Test a Persons Reaction Time.

    Have the candidate place forearm on a table top with wrist & fingers overhanging the table edge.

    Take a one foot ruler,suspending it by holding the 12″ mark between your finger and thumb, ask the candidate to part their finger & thumb approximately 3″,ie 1.5 ” per side at the lower end.

    Ask the candidate if they are ready, release the ruler within 20seconds, They should be able to lock the ruler between their thumb & forefinger about the 4″ to 6″ mark.
    I am 83 years old and can still achieve this.

  12. Florence Britschgi

    I have gone to Silver Sneakers, a program with exercises targeted for seniors. The instructors are very well trained and I have improved in
    my balance. I had fallen but never injured.

  13. Janet Lott

    Research is being done on the Alexander Technique and its affect on balance and falling. I have had particular success with improving balance for my students. I plan to address falling in future.

  14. Maria Jasmine Freeman

    The article and the comments are really very helpful. Thanks for all.

  15. vicki Lindner

    Everyone talks about Tai Chi and balance exercises, and here, Pilates as an antidote to old age falls. I have done all of that and I am here to declare that nothing works as well as yoga, especially Iyengar Yoga, which offers well trained and certified instructors and props that help you do poses.. My bone density in hip and spine improved after a couple of years of practice– i had isteoporosis and took Fosamax but it didnt come back when i went off it. I’m 71 and haven’t fallen for close to five years. Thanks to yoga! When I did it was because I tripped on a plastic bottle, the only object in a parking lot. Some tips: 1. When in a foreign country or strange hotel room, be very careful to inspect the premises for holes, weird curbs, gutters and steps that are different than we have here. 2. Be aware that falling is always a danger as you grow older. In other words, keep in mind the way you look both ways when crossing a street, climbing stairs, ( never carry an object in front of you) and as someone else said, buying shoes. Hike with hiking poles….

    • alexis

      consider changing your statement from this:
      ” I am here to declare that nothing works as well as yoga . . . ”
      to this:
      ” I am here to declare that nothing works as well as yoga for me . . . ”
      and the remainder of your statement has more validity.
      Thanks for consideration.

  16. Alice Engelman

    I recommend Tai Ji Quan Movement for Better Balance, an amended form of tai chi specifically developed for older people or anyone seeking to improve their balance.

  17. Carol T.

    With regard to how to fall:
    Try to keep everything bent and roll off to the side slightly so your weight is distributed over a larger part of your body. Falling forward: turn your head to the side, keep your arms bent and raise them up to protect your head while you roll to the side. (Natural instinct is to straighten arms but this results in wrist fractures and banged heads) Falling backward: bend your knees and roll slightly to the side taking weight first on the side of your lower leg, then your buttock and finally your back and shoulders as you roll. Keeping the momentum and rolling is the most important part to minimize injury. Think: TUCK and ROLL.

  18. Carol T.

    There are multiple aspects to preventing falls that need to be assessed and addressed; vision, environmental hazards, footwear, bone and muscle strength, and inner ear function to name a few. Training can help strengthen the muscles you need to recover from a loss of balance. There are multiple programs out there: FallProof! is one but it does require a fair amount of equipment, the Otago exercise program is an evidence-based exercise program that a physical therapist can teach you and it uses ankle weights. Practicing losing your balance and recovering in a controlled environment can also improve the “muscle memory” so your brain/body reacts better. See

  19. Philip Dawson

    Had a fall down the cellar bottom step in the dark. Was dizzy and my shoulder is still sore.
    Going to see a neurologist in 2 days time.
    Did not hit my head, but Doc says I had a stroke and that a person can have a stroke from whiplash. He says all kinds of people are walking around after having a fall and they have suffered a stroke and do not even know about it.
    Where does the line form for the time machine. Set my dial to 12.
    Getting old is for the birds.

  20. Sonja Y.

    SHOES MATTER! As a young woman, I wore high heels. I was thin, agile, and liked the way they looked. When I reached 50, I had gained some weight and also started having back pain. Long story short, I had to retire the high heels and wear shoes with a low heel. I also found it uncomfortable when fully dressed bending over so started wearing mules – no back and easy to slip on. I also wanted to have some height so wore mules with a wedge, which were comfortable but I did not realize they were not easy to balance on. I figured if I was careful, no problem. One day while rounding a corner on the sidewalk, I lost my balance and in trying to regain it, my foot twisted and I broke my ankle. Besides the pain, eight weeks of wearing a boot and having to stay off my foot as much as possible created a great deal of inconvenience. I have since retired the mules. Now I wear shoes that are made for the “elderly” that are comfortable and hug my foot so I feel more sure-footed. I was even able to find some fashionable looking ones- a Mary Jane style with an elastic band and a thin wedge. One must certainly be careful while walking but you never know when something will get in your path to upset your stride. But one thing you can do is make sure you are wearing the RIGHT shoes to better maintain your balance and regain your balance when thrown off.

  21. Marcia Peters

    When my husband, a telemark skier, loses his balance, he jumps up, losing contact with the ground, then repositions his feet under himself. It’s hard-wired & it’s amazing. When my feet go out from under me on unseen ice, I land on a hip. No fractures so far despite osteoporosis (on a scale developed by a panel developed by the drug industry, I hasten to add), but I would love to learn how to fall, or rather not fall.

  22. Hal Bohner

    My kids when they were young had martial arts training which included learning how to fall safely. Can similar training be provided to older folks? I have considered taking martial arts classes just to learn how to fall but I assume that the training provided to kids would not work well for me, being over 60. I have spoken to some physicians to see if they would help with this but they have not been interested. I wonder if Harvard Health Publishing would be interested in providing help and guidance.

    • Clyde Beury

      Learning how to fall with martial arts training is one piece. I teach three different classes of Tai Chi with a predominately senior class roster. I emphasize balance, core strength and flexibility as the primary benefits of Yang style Tai Chi. The slow continuous movement also aids in muscle and bone strength. I also talk about clutter, pets and range of motion activity with hips, legs and ankles as a means of helping to ward off distal neuropathy and better walking as well as good shoes.

    • Wayne Jupiter

      Martial arts training may help, but a better plan is to try to prevent the fall in the first place. Tai Chi (or Taiji) training and learning to be aware of your balance and center of gravity at all times is one great way to help prevent falls. I teach at a Senior Services Center and the classes include Qigong, Standing meditation, Tai Chi walking, and the Yang style short Tai chi form.

  23. Marcia Seligson

    I have been doing Pilates for 5 years, and it has totally changed my balance, strength and flexibility. I totally recommend it for everybody, but especially for aging folks. I had a hip replacement four months ago, and the surgeon, nurses and physical therapy people all commented on my basic strength and how that has helped me get back into shape relativity quickly.

  24. Jean-Victor Côté

    Aïkido and Judo training to break falls is something that should be taught from an early age, so that the reflexes are there when needed.

  25. Jerry Amos

    I’m 81 my wife in her 70’s. We eat plant foods mostly and do fitness exercise most days. I ski, fall sometimes hard. I hike these NH hills, trip and fall from time to time. No breaks yet. Sometimes a sore joint for a while.

    Journal of Gerontology 55 (2000) Department of Medicine at the University of California at San Francisco “A high ratio of vegetable to animal protein consumption was found to be impressively associated with a virtual disappearance of bone fractures.” For charts and related studies see “The China Study” by Cornell nutritional biochemist prof. T. Colin Campbell pages 206 to 208.


    I am currently participating in a research study at the VA Hospital, Salt Lake City, which is exploring “strength training-induced responses in older adults: attenuation of descending neural drive with age”. I suggest interested parties access the publication of the title referenced above in quotes, online publication date 5 May 2015, American Aging Association.

    • Catherine F. Smith

      Hello Joan,

      I accessed the abstract, but can’t access the full article without purchasing. Do you have a PDF copy that you’re willing to provide?

      Thanks for your comment,
      Catherine F. Smith

      • JOAN OGDEN

        I only have hard copy — 13 pages. Does your local library give you access to journals as mine does? I can scan and e-mail, but the copy I have is somewhat pale and will scan even more pale. 🙁

        The gist of the article is that using a typical gym machine that is for thigh muscles, lifting separately each leg 4 sets of 4 reps at about as much weight as you can manage three times a week for 8 weeks takes you from nerve response rate about 10% that of young healthy males to 40% of that of young healthy males. While it is not perfect, it is a tripling of where one was.

      • Caroline

        Could you tell me more about which gm machine? The thigh one where one pushes out with knees or pushes in with knees?

  27. Karen Fernandes

    DES Info: A DES Daughter shares her story about DES exposure and brittle bones…
    It’s interesting watching our roles within the family change over time. I saw my mother and grandmothers grow old and slow… Now, I am there, but I am only in my 60s and a DES Daughter (more on that later).

    In the 1980s, I had a back x-ray following a fall. The orthopedist said, “your bones look like that of an 80 year old!” Deep breaths, I am ok and only in my 40s…but what will this mean for my future?

    I went to see my primary care physician who referred me to an Endocrinologist. The bone density test showed osteoporosis. I was young and hoped for a magic pill to help. I was prescribed medication and took it for many months with no side effects. One day, I started itching in various parts of my body, went back to the Endocrinologist who felt I was having an adverse reaction to the medication and I was advised to stop it. Years went by. I tried a new medication, but began experiencing stomach discomfort. I decided that I could not deal with that, so I stopped that medication.

    In 1984, I broke a rib during an excited “bear” hug from my son who played college football. I lived through the pain and chocked it up to a chance occurrence. In 2004, I miss-stepped off a curb, my ankle rolled and I thought I had suffered a sprain. When my symptoms did not improve after a couple of weeks, I saw another orthopedist and found out that I had experienced a fractured ankle in addition to the strain. It was a rough recovery, but I made it.
    I started a consulting business in 2004 and it had been going well until the fracture of my left ankle. My primary physician referred me to a new orthopedist. He ordered X-Rays and a MRI. When I returned for the results, he told me that I must retire. I had osteoporosis and degeneration of my entire spine along with stenosis. I was shocked and distressed.

    I continued to work and in July of 2008, while leaning over the arm of a chair, I felt my right ribs “Pop”! Fractured ribs… it was tough sleeping and being patient with the healing, but I returned to normal. In October of 2008, I was flying for business and leaned over my lap to retrieve my purse. I felt the right ribs fracture again. This time the pain was severe, the recovery longer and more difficult. Later in 2008, I fractured my left toe by stubbing it in a hotel room…crutches and a boot!

    From 2009 to 2011, I suffered a series of bad falls and painful fractures – all requiring long recovery periods and a lot of time spent in a boot with crutches. My ribs seem to be especially fragile. I fractured more ribs on my right side in May of 2010, December 2012, and again in May of 2013. Recovery is long and painful, especially trying to sleep. After the December fracture, I saw my physician again, who said, “I don’t know why you are breaking so easily!”

    As I mentioned earlier, I am a DES Daughter. Throughout life I have experienced reproductive and infertility issues. I discovered that there is some research that suggests that in-utero exposure to DES (Diethylstilbestrol) may affect the skeleton. I believe that DES affected my skeletal structure before I was born and had lasting effects. Knowing the reason why I have osteoporosis and brittle bones helps, but it does not change the difficulties I face. One is “The FEAR of Falling.” After a few falls, which resulted in fractures that fear is always with me. I am a nurse and have cared for patients that had a fear of falling…now I live it every day!

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