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Falls in Older People
Falls in Older People
Risk Factors, Strategies for Prevention
and Implications for Practice

Third Edition

Edited by
Stephen R. Lord
Neuroscience Research Australia and University of New South Wales

Catherine Sherrington
Sydney Local Health District and University of Sydney

Vasi Naganathan
Concord Hospital and University of Sydney
University Printing House, Cambridge CB2 8BS, United Kingdom
One Liberty Plaza, 20th Floor, New York, NY 10006, USA
477 Williamstown Road, Port Melbourne, VIC 3207, Australia
314–321, 3rd Floor, Plot 3, Splendor Forum, Jasola District Centre,
New Delhi – 110025, India
103 Penang Road, #05–06/07, Visioncrest Commercial, Singapore 238467

Cambridge University Press is part of the University of Cambridge.

It furthers the University’s mission by disseminating knowledge in the pursuit of
education, learning, and research at the highest international levels of excellence.

www.cambridge.org
Information on this title: www.cambridge.org/9781108706087
DOI: 10.1017/9781108594455
© Cambridge University Press 2021
This publication is in copyright. Subject to statutory exception
and to the provisions of relevant collective licensing agreements,
no reproduction of any part may take place without the written
permission of Cambridge University Press.
First published 2001
Second Edition 2007
Third Edition 2021
Printed in the United Kingdom by TJ Books Limited, Padstow Cornwall
A catalogue record for this publication is available from the British Library.
ISBN 978-1-108-70608-7 Paperback
Cambridge University Press has no responsibility for the persistence or accuracy of
URLs for external or third-party internet websites referred to in this publication
and does not guarantee that any content on such websites is, or will remain,
accurate or appropriate.

Every effort has been made in preparing this book to provide accurate and up-to-date information
that is in accord with accepted standards and practice at the time of publication. Although case
histories are drawn from actual cases, every effort has been made to disguise the identities of the
individuals involved. Nevertheless, the authors, editors, and publishers can make no warranties that
the information contained herein is totally free from error, not least because clinical standards are
constantly changing through research and regulation. The authors, editors, and publishers therefore
disclaim all liability for direct or consequential damages resulting from the use of material contained
in this book. Readers are strongly advised to pay careful attention to information provided by the
manufacturer of any drugs or equipment that they plan to use.
 Contents

Preface page ix
List of Contributors xiii
PART I – EPIDEMIOLOGY AND RISK FACTORS FOR FALLS 1
1. Epidemiology of Falls and Fall-Related Injuries
(Stephen R. Lord, Catherine Sherrington, and Cameron Hicks) 3
2. Postural Stability and Falls
(Jasmine C. Menant, Yoshiro Okubo, and Hylton B. Menz) 23
3. Gait Characteristics and Falls
(Jasmine C. Menant, Hylton B. Menz, and Carly Chaplin) 51
4. Sensory and Neuromuscular Risk Factors for Falls
(Stephen R. Lord) 87
5. Biomechanics of Balance and Falling
(Daina L. Sturnieks) 105
6. Foot Problems, Footwear, and Falls
(Hylton B. Menz) 119
7. Brain Function and Falls
(Michele Callisaya, Oshadi Jayakody, and Kim Delbaere) 130
8. Impaired Cognition and Falls
(Morag E. Taylor and Julie Whitney) 144
9. The Psychology of Fall Risk: Fear, Anxiety, Depression,
and Balance Confidence
(Thomas Hadjistavropoulos and Kim Delbaere) 160
10. Medical Risk Factors for Falls
(Naomi Noguchi and Vasi Naganathan) 172
11. Medications as Risk Factors for Falls
(Lulu Ma and Vasi Naganathan) 192
12. Environmental Risk Factors for Falls
(Alison Pighills and Lindy Clemson) 202

v
vi Contents

13. Fall Detection and Risk Assessment with New Technologies

(Kimberley S. van Schooten and Matthew A. Brodie) 211
14. Fall Risk Screening and Assessment
(Anne Tiedemann and Stephen R. Lord) 227
15. The Relative Importance of Fall Risk Factors: Analysis and Summary
(Stephen R. Lord, Catherine Sherrington, and Vasi Naganathan) 237
PART II – STRATEGIES FOR PREVENTION 249
16. Exercise to Prevent Falls
(Catherine Sherrington, Anne Tiedemann, and Nicola Fairhall) 251
17. Volitional and Reactive Step Training
(Yoshiro Okubo and Daina L. Sturnieks) 271
18. Cognitive-Motor Interventions and Their Effects on
Fall Risk in Older People
(Daniel S. Schoene and Daina L. Sturnieks) 287
19. Cognitive Behavioural Interventions for Addressing
Fear of Falling and Fall Risk
(G.A. Rixt Zijlstra and Kim Delbaere) 311
20. The Medical Management of Older People at Risk of Falls
(Mark D. Latt and Vasi Naganathan) 322
21. Fall Prevention Interventions for People with Visual Impairment
(Stephen R. Lord) 341
22. Footwear, Orthoses, Walking Aids, Wearable Technology,
and Restraint Devices for Fall Prevention
(Hylton B. Menz) 348
23. Environmental Interventions to Prevent Falls at Home and in the
Community
(Lindy Clemson and Alison Pighills) 360
24. Fall Injury Prevention: Hip Protectors and Compliant Flooring
(Susan Kurrle and Ian Cameron) 378
25. Multi-Factorial Fall Prevention Strategies: Where to Next?
(Sarah E. Lamb and Hopin Lee) 386
26. Fall Prevention in Hospitals
(Anne-Marie Hill) 396
27. Fall Prevention in Residential Aged Care Facilities
(Clemens Becker, Kilian Rapp, and Patrick Roigk) 410
PART III – IMPLICATIONS FOR PRACTICE 425
28. Strategies to Promote Uptake and Adherence to Fall Prevention
Programmes
(Anne Tiedemann, Leanne Hassett, and Catherine Sherrington) 427
vii Contents

29. Translating Fall Prevention Research into Practice

(Kathryn M. Sibley, Alexandra M.B. Korall, and Alexie J. Touchette) 436
30. Interventions Reduce Falls, but What Is the Cost for Better Health
Outcomes?
(Jennifer C. Davis, Teresa Liu-Ambrose, and Chun-Liang Hsu) 460
31. Bringing It All Together
(Stephen R. Lord, Catherine Sherrington, and Vasi Naganathan) 469

Index 481
 Preface

In the preface to the second edition of our book published in 2005, we remarked
on the large amount of work on risk factors for falls in older people and fall
prevention strategies published in the preceding 25 years. Since then, a further
15,000 articles and reviews have been published on this topic in the international
literature (see Figure 0.1) and there have been many substantial gains in the
evidence base that have increased our understanding of fall risk factors, preven-
tion strategies, and how to translate this research into practice. The aim of this
third edition of our book is to review and incorporate this new material to provide
researchers, students, and health care workers with a means for gaining access to
current thinking and best clinical practice. Listed below are some highlights of
progress and encouraging findings.
• Studies aimed at understanding balance have used paradigms such as tripping,
slipping, and stepping to more accurately reflect situations in which people fall.
• A large body of neuropsychological research has shown that balance activities
that were generally considered to be reflex or automatic require attention, and
that impaired executive functioning is an important risk factor for falls.
• New wearable sensor technologies have allowed mobility and fall risk to be
remotely assessed, paving the way for unobtrusive at-home monitoring.
• Several cognitive-motor interventions comprising exergames have been evalu-
ated in randomized controlled trials, where they have been shown to improve
balance. These may be an enjoyable way to facilitate adherence.
• Cognitive behaviour therapy in association with exercise can substantially
reduce fear of falling.
• Systematic reviews have synthesized the findings of randomized controlled
trials that have examined the effects of a range of exercise interventions in
preventing falls in community dwellers. From this large body of evidence, it is
now possible to conclude that effective exercise programs must comprise
challenging, weight-bearing balance exercises.

ix
x Preface

• It is less clear how to prevent falls in residential care, but a recent well-designed
randomized controlled trial has shown that an exercise intervention can prevent
falls in nursing home residents.
• Several fall prevention interventions have now also been demonstrated to be
cost-effective, again particularly exercise interventions in community dwellers.
Two areas of investigation have been less encouraging and will require further
research and consideration.
• Intervention studies aimed at preventing falls in frail older people including
those with dementia and stroke, have generally not been successful, despite well
planned and executed studies.
• A further large trial of risk-factor-based assessment and intervention in the
hospitals setting has failed to prevent falls. The most promising interventions to
date have involved communication with patients and carers so future research
could focus on this area.
The growing literature is evidenced by the change in the title to include implica-
tions for practice and the increase in chapters, from 18 to 31, with the new
chapters addressing exciting new research and implementation areas developed
over the last decade. This edition also differs from the previous two in that the
editors have enlisted the assistance of multiple authors who are expert in the book
chapter fields.
As suggested by the title, the book has three major themes: fall risk factors, fall
prevention strategies, and implications for practice. Part 1 includes an initial
chapter on the epidemiology of falls and fall-related injuries in older people.
Chapters 2 to 12 present critical appraisals of fall risk factors addressed under
the headings of postural stability, gait, sensory and neuromuscular, biomechanics,
feet and footwear, brain function, cognition, depression and fear of falling,
medical, medication, and environmental risk factors. Chapter 13 reviews research
from the emerging field of fall detection with new technologies and Chapter 14
presents findings in fall risk screening and assessment. The final chapter weighs
the importance of the risk factors described in the above chapters as weak,
moderate, or strong, using a simple evidence-based metric.
Part 2 commences with an overview of fall prevention strategies that address
the multitude of fall risk factors. Chapters 16 to 23 summarize the published
findings on ‘single’ strategies for addressing fall risk: exercise, step training,
exergames, cognitive behaviour therapy, medical management, vision correction,
use of safe footwear, aids and appliances, and environmental modifications.
Chapter 24 addresses strategies for minimizing fall injury, Chapter 25 summarizes
the evidence for multi-factorial interventions to prevent falls, and the final two
xi Preface

chapters (Chapters 26 and 27) discuss suggested strategies for preventing falls in
hospitals and residential aged care.
Part 3 synthesizes the information on successful fall prevention strategies in
a format that can be used to facilitate the translation of research findings into
clinical practice. It contains chapters on behaviour change, research translation,
health economics of fall prevention strategies, and optimal interventions for
specific sub-groups of older people. The final chapter reviews the research and
clinical practice issues that still need to be addressed in this field.
In each chapter we have attempted to be analytical in nature. Thus, we have not
simply presented lists of the many and varied factors that have been suggested as
possible (but unproven) risk factors for falls and the suggested (but untested) fall
prevention strategies. Instead, we have attempted to evaluate the evidence for each
factor implicated with falls to determine whether they constitute important areas
for consideration and intervention. For example, we present arguments that
challenge some traditional approaches to the management of older persons at
risk of falls. We question the utility of fall risk assessment based solely on
diagnoses of disease processes and the value of standard clinical tests of vision,
sensation, strength, and balance. We also discuss the role of particular medica-
tions in predisposing older people to falls and why factors such as alcohol use,
vestibular disorders, and postural hypotension have not often been shown to be

1200

1000

800
Number of papers

600

400

200

0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
Year
Figure 0.1 Research publications pertaining to falls in people between 2000 and 2019 (source: PubMed).
xii Preface

significant risk factors for falls in well-planned epidemiological studies. With

regard to interventions, we examine the effectiveness of suggested strategies for
preventing falls and attempt to unravel why many fall prevention interventions
have not been effective.
We hope our book will be of interest to medical practitioners, nurses, physio-
therapists, occupational therapists, podiatrists, research workers in the fields of
gerontology and geriatrics, health service managers, medical and allied health care
undergraduate and postgraduate students, scientists, and health care workers in
the disciplines of public health, injury, and occupational health. We feel that this
book is of relevance to those working in community, hospital, and residential aged
care settings.
 Contributors

Clemens Becker, Department of Clinical Gerontology, Robert-Bosch-Hospital,

Auerbachstr. 110, 70376 Stuttgart, Germany
Matthew A. Brodie, Falls, Balance and Injury Research Centre, Neuroscience
Research Australia, Sydney, NSW, Australia and Graduate School of Biomedical
Engineering, Faculty of Engineering, UNSW Sydney, Sydney, NSW, Australia
Michele Callisaya, Menzies Institute for Medical Research, University of
Tasmania, Hobart, Tasmania, Australia and Peninsula Clinical School, Central
Clinical School, Monash University, Melbourne, Victoria, Australia
Ian Cameron, John Walsh Centre for Rehabilitation Research, Kolling Institute of
Medical Research, The University of Sydney, Sydney, NSW, Australia
Lindy Clemson, Faculty of Health Sciences, The University of Sydney, Sydney,
NSW, Australia
Carly Chaplin, Falls, Balance and Injury Research Centre, Neuroscience Research
Australia, Sydney, NSW, Australia
Jennifer C. Davis, Centre for Hip Health and Mobility, Vancouver Coastal Health
Research Institute, The University of British Columbia, Vancouver, Canada and
Faculty of Management, The University of British Columbia-Okanagan, Kelowna,
Canada
Kim Delbaere, Falls, Balance and Injury Research Centre, Neuroscience Research
Australia, UNSW Sydney, NSW, Australia and School of Public Health and
Community Medicine, UNSW Sydney, Sydney, NSW, Australia
Nicola Fairhall, Institute for Musculoskeletal Health, School of Public Health,
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
Thomas Hadjistavropoulos, Department of Psychology and Centre on Aging
and Health, University of Regina, Regina, Saskatchewan, Canada
Leanne Hassett, Institute for Musculoskeletal Health, School of Public Health,
Sydney Medical School, The University of Sydney, Sydney, NSW, Australia

xiii
xiv List of Contributors

Cameron Hicks, Falls, Balance and Injury Research Centre, Neuroscience

Research Australia, Sydney, NSW, Australia
Anne-Marie Hill, School of Physiotherapy and Exercise Science, Faculty of
Health Sciences, Curtin University, Perth, Western Australia, Australia
Chun-Liang Hsu, Aging, Mobility and Cognitive Neuroscience Lab,
Department of Physical Therapy, The University of British Columbia,
Vancouver, Canada
Oshadi Jayakody, Menzies Research Institute, University of Tasmania, Hobart,
Australia
Alexandra M.B. Korall, Simon Fraser University, Burnaby, British Columbia,
Canada and Centre for Hip Health and Mobility, Vancouver, British Columbia,
Canada
Susan Kurrle, Cognitive Decline Partnership Centre, Faculty of Medicine and
Health, The University of Sydney, Sydney, NSW, Australia
Sarah E. Lamb Mireille Gillings Professor of Health Innovation, University of
Exeter, Institute of Health Research, College of Medicine and Health, St Luke’s
Campus, Heavitree Road, Exeter, UK
Mark D. Latt, Sydney Medical School, The University of Sydney, Sydney, NSW,
Australia, and Geriatrician, Royal Prince Alfred Hospital, Sydney, NSW, Australia
Teresa Liu-Ambrose, Aging, Mobility, and Cognitive Neuroscience Lab,
Department of Physical Therapy, The University of British Columbia,
Vancouver, British Columbia, Canada
Hopin Lee, Centre for Statistics in Medicine, Rehabilitation Research in Oxford,
Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal
Sciences (NDORMS), University of Oxford, Oxford, UK and School of
Medicine and Public Health, University of Newcastle, Newcastle, NSW, Australia
Stephen R. Lord, Falls, Balance and Injury Research Centre, Neuroscience
Research Australia, Sydney, NSW, Australia and School of Public Health and
Community Medicine, UNSW Sydney, Sydney, NSW, Australia
Lulu Ma, Department of Geriatric Medicine, Prince of Wales Hospital, Sydney,
NSW, Australia
Jasmine C. Menant, Falls, Balance and Injury Research Centre, Neuroscience
Research Australia, Sydney, NSW, Australia and School of Public Health and
Community Medicine, UNSW Sydney, Sydney, NSW, Australia
Hylton B. Menz, La Trobe Sport and Exercise Medicine Research Centre and
School of Allied Health, Human Services and Sport, College of Science, Health
and Engineering, La Trobe University, Melbourne, Victoria, Australia
xv List of Contributors

Vasi Naganathan, Centre for Education and Research on Ageing, The University
of Sydney, Sydney, NSW, Australia and Concord Repatriation General Hospital,
Sydney, NSW, Australia
Naomi Noguchi, School of Public Health, Faculty of Medicine and Health, The
University of Sydney, Sydney, New South Wales, Australia
Yoshiro Okubo, Falls, Balance and Injury Research Centre, Neuroscience
Research Australia, Sydney, NSW, Australia and School of Public Health and
Community Medicine, UNSW Sydney, Sydney, NSW, Australia
Alison Pighills, Mackay Institute of Research and Innovation, Mackay Hospital
and Health Service and the College of Healthcare Sciences, James Cook
University, Townsville, Qld, Australia
Kilian Rapp, Department of Clinical Gerontology, Robert-Bosch-Hospital,
Auerbachstr. 110, 70376 Stuttgart, Germany
Patrick Roigk, Department of Clinical Gerontology, Robert-Bosch-Hospital,
Auerbachstr. 110, 70376 Stuttgart, Germany
Daniel S. Schoene, Institute of Medical Physics, Friedrich-Alexander-Universität
Erlangen-Nürnberg, Erlangen, Bayern, Germany
Catherine Sherrington, Institute for Musculoskeletal Health, School of Public
Health, Sydney Medical School, The University of Sydney, Sydney, NSW,
Australia
Kathryn M. Sibley, Department of Community Health Sciences, University of
Manitoba, Winnipeg, Canada, and Toronto Rehabilitation Institute- University
Health Network, Toronto, Canada
Daina L. Sturnieks, Falls, Balance and Injury Research Centre, Neuroscience
Research Australia, Sydney, NSW, Australia and School of Public Health and
Community Medicine, UNSW Sydney, Sydney NSW, Australia
Morag E. Taylor, Falls, Balance and Injury Research Centre, Neuroscience
Research Australia, Sydney, NSW, Australia and Prince of Wales Clinical
School, Medicine, UNSW Sydney, Sydney, NSW, Australia
Anne Tiedemann, Institute for Musculoskeletal Health, School of Public
Health, Sydney Medical School, The University of Sydney, Sydney, NSW,
Australia
Alexie J. Touchette, Department of Community Health Sciences Rady Faculty of
Health Sciences, University of Manitoba, Winnipeg, Canada
Kimberley S. van Schooten, Falls, Balance and Injury Research Centre,
Neuroscience Research Australia, Sydney, NSW, Australia and School of Public
Health and Community Medicine, UNSW Sydney, Sydney, NSW, Australia
xvi List of Contributors

Julie Whitney, School of Population Health and Environmental Sciences, King’s

College London, London, UK and Department of Clinical Gerontology, King’s
College Hospital, London, UK
G.A. Rixt Zijlstra, Department of Health Services Research, Care and Public
Health Research Institute (CAPHRI), Maastricht University, Maastricht, The
Netherlands
Part I

Epidemiology and Risk Factors for Falls

 1

Epidemiology of Falls and Fall-Related Injuries

Stephen R. Lord, Catherine Sherrington, and Cameron Hicks

In this chapter, we examine the epidemiology of falls in older people. We review

the major studies that have described the incidence of falls, the locations where
falls occur, and falls sequelae. We also examine the costs required to treat and
manage fall-related injuries. Before addressing these issues, however, it is helpful
to briefly discuss three important methodological considerations that are relevant
to all research studies of falls in older people: how falls are defined, how falls are
counted, and what constitutes an older person.

The Definition of a Fall

In 1987, the Kellogg International Working Group on the Prevention of Falls in

the Elderly defined a fall as ‘unintentionally coming to the ground or some lower
level and other than as a consequence of sustaining a violent blow, loss of
consciousness, sudden onset of paralysis as in stroke or an epileptic seizure’ [1].
Since then, many researchers have used this or very similar definitions of a fall.
The Kellogg definition is appropriate for studies aimed at identifying factors that
impair sensorimotor function and balance control, whereas broader definitions
that include dizziness and loss of consciousness are appropriate for studies that
also address cardiovascular and neurological causes of falls such as syncope,
postural hypotension, and transient ischaemic attacks.
The Prevention of Falls Network Europe (ProFaNE) collaborators, in conjunc-
tion with international experts in the field and using consensus methodology,
adopted a simpler definition to include falls that occur from all causes, i.e. ‘an
unexpected event in which the participant comes to rest on the ground, floor or
lower level’ [2]. A comparable definition has also been adopted by the World
Health Organization.1 This simple definition is appropriate for multi-centre
studies requiring a core data set or for situations where details of falls are

1
www.who.int/news-room/fact-sheets/detail/falls

3
4 Falls in Older People

unrecorded (routine surveillance data/accident records) or where a high propor-

tion of participants cannot provide reliable information about their falls (i.e. those
with delirium and cognitive impairment).
Although falls are often referred to as accidents, it has been shown statistically
that fall incidence differs significantly from a Poisson distribution [3]. This
implies that causal processes are involved in falls and that they are not merely
random events.

Falls Ascertainment
The earliest published studies on falls were retrospective in design, in that they
asked participants whether and/or how many times they had fallen over a defined
period of time – usually 12 months. This approach has limitations in that partici-
pants have only limited accuracy in remembering falls over a prolonged period
[4]. Prospective designs, in which participants are followed up for a period, again
usually 12 months, to more accurately determine the incidence of falling, have also
been conducted. Not surprisingly, these studies have usually reported higher rates
of falling. In community studies, despite new technologies designed to detect falls
(see Chapter 13), ascertaining falls by self-report remains the most feasible
method. Methods used to record falls in prospective follow-up periods include
monthly or bi-monthly mail-out questionnaires [5, 6], weekly [7] or monthly falls
calendars [8], and monthly telephone interviews [9].
The ProFaNE collaborators recommend that falls should be recorded using
prospective daily recording and a notification system with a minimum of monthly
reporting [2]. Telephone or face-to-face interview should be used to obtain
missing data and to ascertain further details of falls and injuries. Specific informa-
tion about the circumstances of any falls can also be determined with additional
questions on falls diary forms. Current studies are providing the option for
calendars to be completed online. Telephone interviews gain the same informa-
tion as mail-out questionnaires and falls diaries but may require many calls to
contact active older people. In research studies fall data should be summarized as:
number of falls, number of fallers/non-fallers/frequent fallers, and fall rate per
person years [2] with the rate of falls often being used as the primary outcome. In
trials it is recommended that staff collecting fall data be masked to group
allocation.
However, even with the most rigorous reporting methodology, it is quite likely
that falls are under-reported and that data regarding circumstances surrounding
falls are sometimes incomplete or inaccurate. After a fall, older people are often
shocked and distressed and may not remember the predisposing factors that led to
the fall. Denial is also a factor in under-reporting, as it is common for older people
5 Epidemiology of Falls and Fall-Related Injuries

to lay blame on external factors for their fall, and not count it as a ‘true’ one.
Simply forgetting falls leads to further under-reporting, especially in those with
cognitive impairment. New technologies now allow for automatic detection of
falls and remote monitoring of fall risk in daily life. However, despite encouraging
results in controlled settings, these technologies are not yet ready for clinical use –
see Chapter 13.
In residential aged care settings, the use of online incident monitoring systems
maintained by nursing staff can provide an ancillary method for improving the
accuracy of recording falls. In a study of intermediate care (hostel) residents in
Sydney, Lord et al. [5] found that systematic recording of falls by nurses increased
the number of falls reported by 32%. In hospitals, falls monitoring systems are now
commonly used, but trials of fall prevention intervention often supplement these with
additional methods such as medical records audits and verbal reports from staff [10].

The Definition of a Fall-Related Injury

The definitions of injurious falls have differed considerably in the literature, due
primarily to whether or not minor injuries such as bruises, cuts, and abrasions
have been classified as fall-related injuries. The ProFaNE collaborators recom-
mend that due to difficulties in standardizing definitions and classifications of falls
injury types, the most rigorous definition of a fall-related injury is radiologically
confirmed peripheral fractures, i.e. fractures of the limbs and limb girdles [2].
More recently, it has been acknowledged that the definition of an injurious fall
should be expanded to include traumatic brain injury. In recent years traumatic
brain injuries due to falls have increased significantly, with associated increases in
hospitalizations, disability and death [11].

The Definition of the Older Person

There is no consistency among studies as to what demographic group constitutes
older people. The term is used for age groups starting from as low as 50 years.
However, the most frequently used definition is people aged 65 years and over.
Within this age band, commonly accepted subgroups are those aged 65–74 years,
75–84 years, and 85 years and older.

The Incidence of Falls in Older People

Community-Dwelling Older People

In 1977, Exton-Smith examined the yearly incidence of falls in 963 people over the
age of 65 years living in England [12]. He found that in women, the proportion
6 Falls in Older People

that fell increased with age from 30% in the 65 to 69 years age group to over 50% in
those over the age of 85. In men, the proportion that fell increased from 13% in the
65 to 69 years age group to approximately 30% in those aged 80 years and over.
Retrospective community studies in primarily Caucasian populations under-
taken since Exton-Smith’s work have reported similar findings, i.e. approximately
30% of older adults experience one or more falls per year [13–15]. Campbell et al.
[13] analysed a stratified population sample of 533 participants aged 65 years and
over and found that 33% experienced one or more falls in the previous year. Blake
et al. [15] reported a similar incidence (35%) in a study of 1042 participants aged
65 years and over. In a large study of 2793 participants aged 65 years and over,
Prudham and Grimley-Evans [14] estimated an annual incidence for accidental
falls of 28%, a figure identical to that found in the Australian Dubbo Osteoporosis
Epidemiology Study of 1762 older people aged 60 years and over [16].
Prospective studies undertaken in community settings have found higher fall
incidence rates. In the Randwick Falls and Fractures Study conducted in Australia,
Lord et al. [17] found that 39% of 341 community-dwelling women aged 65 years
and over reported one or more falls in a one-year follow-up period. In a large
study of 761 participants aged 70 years and over undertaken in New Zealand,
Campbell et al. [18] found that 40% of the 465 women and 28% of the 296 men fell
at least once in the study period of one year, an overall incidence rate of 35%. In
the United States, Tinetti et al. [8] found an incidence rate of one or more falls of
32% in 336 participants aged 75 years and over. Similar rates have been reported in
Canada by O’Loughlin et al. [9] in a 48-week prospective study of a random
sample of 409 community-dwelling people aged 65 years and over (29%), and in
Finland by Luukinen et al. [19] in 833 community-dwelling people aged 70 years
and over from five rural districts (30%).
Fall rates also increase beyond the age of 65 years. Figure 1.1 shows the
proportion of women who took part in the Randwick Falls and Fractures Study
[17] who reported falling once, twice, or three or more times in a 12 month
period.
The prospective studies that have reported the incidence of multiple or recur-
rent falls are also in agreement. The incidence of two or more falls in a follow-up
year reported in five studies ranges between 11 and 21% (average 15%). Three
studies have reported data for three or more falls, and all report an incidence
of 8%.
Rigorous data regarding fall incidence in older people from non-Caucasian
populations are now also available. Aoyaga et al. [20] studied falls and related
conditions among 1534 (624 men, 910 women) community-dwelling people aged
65 years and over in Japan. They found that only 9% of the men and 19% of the
women reported one or more falls in the previous year and similarly low incidence
7 Epidemiology of Falls and Fall-Related Injuries

50

45 3+ falls

40 2 falls

35 1 fall

30
Percentage

25

20

15

10

0
65−74 75−85 85+
Age group
Figure 1.1 Proportion of older women who took part in the Randwick Falls and Fractures Study who reported
falling, once, twice, or three or more times in a 12 month period. Diagram adapted from Lord SR,
Ward JA, Williams P et al. An epidemiological study of falls in older community-dwelling women:
the Randwick Falls and Fractures Study. Aust J Public Health. 1993;17:240–245.

rates have also been found in seven other large community studies undertaken in
Japan [21]. As part of the Hawaii Osteoporosis Study, Davis et al. [22] attempted
to identify neuromuscular performance measures and functional disabilities that
could account for such differences in fall rates. They found that the Japanese
women had faster walking speeds, chair stands, and performed better on a series of
balance tests. On the other hand, the Caucasian women had greater strength,
particularly at the quadriceps, and faster hand and foot reaction times. After
adjusting for the neuromuscular test results and the number of functional disabil-
ities, the odds ratio for the risk of falls remained essentially the same. It is possible
that the better performances in the more functional strength and balance tests that
translate more directly to activities of daily living could explain the lower risk of
falls among Japanese women.
Kwan et al. [23] conducted a systematic review of fall incidence and fall risk
factors in Chinese people living in China, Hong Kong, Macao, Singapore, and
Taiwan. In the included 21 studies involving 25,629 people, fall rates ranged
8 Falls in Older People

between 14.7% and 34% per annum (median 18%), i.e. a consistently lower
incidence of self-reported falls than in Caucasian older people. Subsequently,
Kwan et al. [24] investigated why fall rates differ between Chinese and
Caucasian older people. Falls were recorded prospectively in large community-
dwelling samples of Chinese older people living in Taiwan, Hong Kong, and
Australia, as well as Caucasian older people living in Australia. The standardized
annual fall rates for the three Chinese cohorts were 0.21 in Hong Kong, 0.26 in
Taiwan, and 0.36 in Australia, which were significantly lower than that of the
Caucasian cohort at 0.70. The difference in fall rates was not due to better physical
ability in the Chinese cohorts. However, the Chinese cohorts expressed more
concern about falling and did more planned activity. These findings suggest
increased concern is protective for falls in Chinese older people and manifest as
more behaviours to lessen fall risk. Interestingly, such adaptations were partially
lost in the Chinese older people who migrated to a ‘Westernized’ country.
Ellis and Trent [25] compared risks for falls and their consequences among
104,902 people from four major race/ethnic groups who were admitted to non-
federal hospitals in California from 1995 to 1997. Rates per 100,000 for same-
level hospitalized fall injuries for Caucasians (161) were distinctively higher
than for African-Americans (64), Hispanics (43), and Asian/Pacific Islanders
(35). Caucasians were also more likely to have suffered a fracture and to be
discharged to long-term care, suggesting poorer outcomes and greater injury
severity.
Finally, Hanlon et al. [26] found that the hazard ratio of risk of fracture for
people with more than two falls was significantly greater for African-American
and American-Indian women compared to Caucasians, Hispanics and Asians,
perhaps reflecting greater vitamin D deficiency. It is possible that differing levels
of bone density, medical insurance, and family support may account for some of
these differences observed among the groups or that despite no differences in the
rate of falling between Caucasians and African-American women, ethnic differ-
ences in fracture risk may be due in part to the different ways in which they
fall [27].

Seasonal Variations in Falls Frequency

It is possible that the ambient temperature may lead to a seasonal variation in the
incidence of falls. People tend to hurry more in colder weather and mild hypo-
thermia and slowed responses are more common. Equally, people tend to be less
active in winter, the hours of daylight are shorter and vitamin D deficiency is more
likely. There appears to be a seasonal variation in deaths from accidental falls, as
illustrated in Figure 1.2 which shows annualized monthly ratios in England and
Wales for 1993–1997 [27].
9 Epidemiology of Falls and Fall-Related Injuries

135

130 Male
Female
125

120

115

110
Deaths

105

100

95

90

85

80
Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec
Month
Figure 1.2 Deaths from accidental falls – annualized monthly ratios, 1993–1997. Adapted from Office for
National Statistics. 1997 Mortality Statistics: Injury and Poisons. 1999. London, The Stationery
Office.

In a Finnish study, Luukinen et al. [28] found that the incidence of outdoor falls
was higher in periods of extreme cold. However, there was no association between
indoor falls and temperature, which they attributed to adequately heated houses.
A similar study in the UK found that apart from the presence of ground frost,
there was no significant association between the prevailing weather conditions
and the incidence of hip fractures [29]. The precise effect of seasonal change on
the epidemiology of falls is therefore somewhat unclear.

Secular Trends in Fall Injuries

Recent studies have examined routinely collected fall injury and death data as
a means of assessing secular trends in fall incidence. In Australia, it has been
reported that age-standardized hospitalization rates due to falls increased signifi-
cantly by 3% per year for men and 2% for women over the 11 years between 2007
and 2017 [30]. Complementary studies have examined secular changes in fall
injuries. These have found a decrease in the age-standardized rate of hip fractures
of around 1% between 2007 and 2017 and a 7% annual increase in the age-
standardized rate of traumatic brain injury over the same period [30]. US data
also indicate that the age-adjusted death rate due to falls for people aged over 65
10 Falls in Older People

years increased by 31% between 2007 and 2016 and that age-standardized rates of
traumatic brain injury are increasing [31]. Further research is required to eluci-
date why such secular trends in fall injury rates are occurring.

Residents of Residential Aged Care Facilities

Studies on the prevalence of falls have also been conducted in residential aged care
facilities, where the reported frequency of falling is considerably higher than
among those living in their own homes. For example, Luukinen et al. [32] estimate
that among people aged 70 and over in Finland, the rate of falling in the residential
care population is three times higher than that among those living independently
in the community.
Prospective studies conducted in nursing homes have found 12-month fall
incidence rates ranging from 30% to 56%. In an early study, Fernie et al. [33]
studied 205 nursing home residents for 12 months and found 30% of the men and
42% of the women had one or more falls. Other studies have reported higher fall
incidence rates in older people living in residential care facilities. Lipsitz et al. [34]
found that 40% of 901 ambulatory nursing home residents fell two or more times
in six months, and Yip et al. [35] found that 56% of 126 nursing home residents
fell at least once in a year.
Two other studies have calculated fall incidence rates across a number of
nursing homes. Rubenstein et al. [36] summarized the findings from five pub-
lished and two unpublished studies on the incidence of falls in long-term care
facilities. They calculated that the incidence rate ranged between 60% and 290%
per bed, with a mean fall incidence rate of 170% or 1.7 falls per person per year.
Thapa et al. [37] conducted a 12-month prospective study in 12 nursing homes
involving 1228 residents. They report that during the 1003 person-years of follow-
up, 548 residents suffered 1585 falls.
Fall rates are also high in residents living in intermediate-care hostels. Lord
et al. [5] found a yearly fall incidence rate for one or more falls of 52%, and for
two or more falls of 39% in a hostel population of older people. Tinetti et al.
[38] also found a high incidence of falling in 79 persons admitted consecutively
to intermediate care facilities – 32% fell two or more times in a three-month
period.
In the Fracture Risk Epidemiology in the Elderly (FREE) study, 1000 residents
from 26 nursing homes and 17 intermediate-care hostels were followed prospect-
ively for a mean period of 15 months to ascertain risk factors for falls [39]. In this
period, 621 residents fell at least once: 214 fell once only, 102 fell twice, 77 fell three
times, 55 fell four times, and 173 fell five or more times. There were 2554 falls in all
(5.45 falls/1000 resident bed days), with 786 falls (30.9%) resulting in an injury.
Interestingly, there were non-linear associations between physical functioning
11 Epidemiology of Falls and Fall-Related Injuries

and falls in this group, and the fall rate was significantly higher in intermediate-
care residents (65%) compared with the nursing home residents (58%).
Other studies have examined fall incidence in residents of apartment-style
retirement villages. Liu et al. [40] found a relatively high proportion (61%) of 96
residents fell over a 12-month period. In a randomized controlled trial examining
the effects of group exercise on fall incidence, Lord et al. [41] found that 44% of
199 residents of self-care apartments in the control arm of the study fell on one or
more occasions during the one-year trial – a rate that is comparable to commu-
nity-dwelling people of similar age (age range: 62–92 years, mean: 77 years).

Particular Groups
Older people who have suffered a fall are at increased risk of falling again. In
a prospective study of 325 community-dwelling persons who had fallen in the
previous year, Nevitt et al. [7] found that 57% experienced at least one fall in a 12-
month follow-up period and 31% had two or more falls. Not surprisingly, falls are
also more prevalent in frail older people, in those who have difficulties undertak-
ing activities of daily living, and in those with particular medical conditions that
affect posture, balance, and gait. Northridge et al. [42] reported that when
community-dwelling persons were classified as either frail or vigorous, frailer
people were more than twice as likely to fall as vigorous people. Similarly,
Speechley and Tinetti [43] reported 52% of a frail group fell in a one-year
prospective period compared with only 17% of a vigorous group.
Falls are a common presenting condition in hospital emergency departments.
Close et al. [44] found 20% of patients aged 65 years and over attending an
emergency department had a primary diagnosis of a fall, and Davies et al. [45]
reported an even higher percentage (44%) for this age group. Falls also occur
frequently when older people are in hospital. Rates vary from approximately 2% in
general hospitals where lengths of stay are relatively short [46, 47] to 27% in an
acute hospital geriatrics ward [48].
With regard to medical conditions, Mahoney et al. [49] found that 14% of older
patients fell in the first month after discharge from hospital following a medical
illness. Fall rates are also increased in people with diseases that result in sensory
and motor impairments such as stroke, Parkinson’s disease, and cognitive impair-
ment. Forster and Young [50] found that 73% of older stroke patients fell within
six months of hospital discharge. Jorgensen et al. also present evidence that fall
rates remain high in this group [51]. In a prospective study, they found that 23% of
111 community-dwelling people with long-standing stroke fell one or more times
in a four-month period, and that this rate was double that found in 143 age- and
sex-matched controls. Annual fall incidence rates above 60% in community-
dwelling people with Parkinson’s disease have been reported in several studies
12 Falls in Older People

[52–54]. It has also been noted that frequent falls are a problem in Parkinson’s
disease patients, with 13% reporting falling more than once a week [55]. Twelve-
month fall incidence rates above 60% have also been reported for community-
living people with cognitive impairment [56], and that fall rates in nursing home
residents with dementia are double that of that for nursing home residents
without dementia [57]. These high incidence rates appear to be accurate estimates
as cognitive impairment has been found to be a strong independent risk factor for
falls in many prospective studies (see Chapter 8).
Increased fall incidence is also evident in persons with arthritis. Sturnieks et al.
[58] conducted a study of 684 community-dwelling men and women aged 75–98
years, of which 283 reported lower limb osteoarthritis; 137 participants with
arthritis (48.4%) fell in the previous year, compared with 157 (39.2%) participants
without arthritis (sex-adjusted RR: 1.22, 95% CI: 1.03,1.46).
Finally, fall incidence in older people with diabetes has been reported as part of
the Study of Osteoporotic Fractures [59]. This prospective cohort study included
9249 women aged 67 years and over, of which 629 (6.8%) had diabetes, including
99 who used insulin. During an average of 7.2 years, 1640 women (18%) fell more
than once a year. Fall rates were lowest in those without diabetes (17%), inter-
mediate in those with non-insulin treated diabetes (26%) and highest in those with
insulin-treated diabetes (34%). The authors found that the women with diabetes
were at increased risk of falling due in part to increased rates of known fall risk
factors such as poor lower limb sensation and balance.

Falls Location
In older community-dwelling people, about 50% of falls occur within their homes
and immediate home surroundings (see Figure 1.3) [19, 60]. Most falls occur on
level surfaces within commonly used rooms such as the bedroom, lounge-room,
and kitchen. Comparatively few falls occur in the bathroom, on stairs or from
ladders and stools. While a proportion of falls involve a hazard such as a loose rug
or a slippery floor, many do not involve obvious environmental hazards [60]. The
remaining falls occur in public places and other people’s homes. Commonly
reported environmental factors involved in falls in public places include pavement
cracks and misalignments, gutters, steps, construction works, uneven ground, and
slippery surfaces.
The location of falls is related to age, sex, and frailty. In community-dwelling
older women, Lord et al. [2] found that the number of falls occurring outside the
home decreased with age, with a corresponding increase in the number of falls
occurring inside the home on a level surface (see Figure 1.4). Campbell et al. [60]
found that fewer men than women fell inside the home (44% versus 65%) and
13 Epidemiology of Falls and Fall-Related Injuries

3% 3%
6%

6%

outside the home

level surface
shower / bath
on stairs
56% getting out of bed
26% on chair / ladder

Figure 1.3 Location of falls: 56% of falls occur outside the home (in the garden, street, footpath, or shops),
with the remainder (44%) occurring at various locations in the home. Adapted from Lord SR, Ward
JA, Williams P, Anstey KJ. Physiological factors associated with falls in older community-dwelling
women. Australian Journal of Public Health 1993;17:240-245.

85+ years
chair / ladder 75−84 years
65−74 years

on stairs

getting out of bed

shower / bath

level surface

0 5 10 15 20 25 30 35 40
% of all falls
Figure 1.4 Indoor falls location according to age. Adapted from Lord SR, Ward JA, Williams P et al. An
epidemiological study of falls in older community-dwelling women: the Randwick falls and frac-
tures study. Aust J Public Health. 1993;17:240-5.
14 Falls in Older People

more men fell in the garden (25% versus 11%). Frailer groups with limited
mobility suffer most falls within the home. These findings indicate that the
occurrence of falls is strongly related to exposure, that is, they occur
in situations where older people are undertaking their usual daily activities.
Furthermore, most falls occur during periods of maximum activity in the morning
or afternoon, and only about 20% occur between 9 pm and 7 am [60].

Consequences of Falls
Falls are the leading cause of injury-related hospitalization in persons aged 65
years and over, and account for 14% of emergency admissions [44] and 4% of all
hospital admissions in this age group [61]. Hospital admissions resulting from
falls are uncommon in young adulthood, but with advancing age, the incidence of
fall-related admissions increases dramatically. Beyond 65 years, the admission
rate due to falls increases exponentially for both sexes, with a ninefold increase in
the rate in males and females between the ages of 65 and 85 plus years [62] (see
Figure 1.5). Falls also account for 40% of injury-related deaths, and 1% of total
deaths in this age group [63].
Depending on the population studied, anywhere between 22% and 60% of older
people suffer injuries from falls, 10–15% suffer serious injuries, 2–6% suffer

9000
men
hospital admissions / 100,000 population

8000
women
7000

6000

5000

4000

3000

2000

1000

0
50−54 55−59 60−64 65−69 70−74 75−79 80−84 85+
age (years)
Figure 1.5 Hospital admissions for falls according to age and gender. Adapted from: Kreisfeld R, Moller J. Injury
Amongst Women in Australia. Australian Injury Prevention Bulletin 12. Adelaide: National Injury
Surveillance Unit, 1996.
15 Epidemiology of Falls and Fall-Related Injuries

fractures and 0.2–1.5% suffer hip fractures. The most commonly self-reported
injuries include superficial cuts and abrasions, bruises, and sprains. The most
common injuries that require hospitalization comprise traumatic brain injuries
[11], hip fractures, pelvic fractures, other fractures of the leg, fractures of radius,
ulna, or humerus, and fractures of the neck and trunk [1, 62, 63].
In terms of morbidity and mortality, one of the most serious fall-related injuries
is fracture of the hip. Older people often recover slowly from hip fractures and are
vulnerable to post-operative complications. In many cases, hip fractures result in
death and of those who survive, many never regain complete mobility. Marottoli
et al. [64] analysed the outcomes of 120 participants from a cohort study who
suffered a hip fracture over a six-year period. They found that before their
fractures, 86% could dress independently, 75% could walk independently, and
63% could climb a flight of stairs. Six months after their injuries, these percentages
had fallen to 49%, 15%, and 8%, respectively.
Another consequence of falling is the ‘long lie’ – remaining on the ground or
floor for more than an hour after a fall. The long lie is a marker of weakness,
illness, and social isolation, and is associated with high mortality rates among
older people. Time spent on the floor is associated with fear of falling, muscle
damage, pneumonia, pressure sores, dehydration, and hypothermia [7, 65, 66].
Wild et al. [67] found that half of those who lie on the floor for an hour or longer
die within six months, even if there is no direct injury from the fall. Vellas [68]
found that more than 20% of patients admitted to hospital as a result of a fall had
been on the ground for an hour or more. Such a figure could be expected as Tinetti
et al. [69] found that up to 47% of non-injured fallers are unable to get up off the
floor without assistance.
Falls can result in restriction of activity and fear of falling (see Chapter 9),
reduced quality of life and loss of independence. In a study of 5093 older people,
Kiel et al. [70] found that fallers, and especially recurrent fallers, were at greater
risk of reporting subsequent difficulties with activities of daily living, instrumental
activities of daily living, and more physically demanding activities, after control-
ling for age, sex, self-perceived health status, and pre-existing difficulties with
activities of daily living. Tinetti et al. [71] found similar associations in a study
involving 957 community-dwelling persons over the age of 71 years. They found
that after adjusting for potential confounding factors, both non-injurious and
injurious falls were associated with declines in basic and instrumental activities of
daily living over a three-year prospective period. Furthermore, those who suffered
two or more non-injurious falls reported declines in social activities and those
who suffered one or more injurious falls reported reduced physical activity levels.
Falls can lead to an excessive fear of falling, sometimes referred to as the ‘post-
fall syndrome’ which is manifest as a loss of confidence, hesitancy, tentativeness,
16 Falls in Older People

with resultant loss of mobility and independence. It has been found that after
falling, many older people report a fear of falling [71, 72] and curtailing activities
due to a fear of further falls [7, 73].
Finally, falls can also lead to disability and decreased mobility which often
results in dependency on others and hence an increased probability of requiring
residential care [74, 75].

The Economic Cost of Falls

As indicated above, falls in older people are common and can lead to numerous
disabling conditions, extensive hospital stays, and death. Indeed, as outlined in
Figure 1.6, fall-related injuries incur the biggest direct cost of all injury categories.
Fall-related costs can include the direct costs such as doctor visits, acute hospital
and nursing home care, outpatient clinics, rehabilitation stays, diagnostic tests,
medications, home care, home modifications, equipment, and residential care.
Indirect costs include carer and patient morbidity and mortality costs. There are
many difficulties and limitations involved in estimating the economic cost of any
disease or condition. Problems exist because cost data are only estimates, and
many costs are only relevant to the country in which they are incurred.
Furthermore, because of inflation and other economic and health care factors,
costs are outdated soon after they are published.

falls 333

road traffic injuries 62

sports injuries 40

non-road traffic vehicular accidents 32

fire and scalds 14

environmental injuries 13.6

poisoning 13.2

medical and surgical misadventure 11.7

machine injuries 8

suffocation 1.4

drowning 0.7

0 50 100 150 200 250 300 350

costs (AUD$M)
Figure 1.6 Direct costs for 11 unintentional falls injury categories. Falls injuries account for 62.8% of total
direct costs. Adapted from Potter-Forbes M, Aisbett C. Injury Costs! A Valuation of the Burden of
Injury in New South Wales in 1998–1999. NSW Injury Risk Management Research Centre,
University of New South Wales, 2003.
17 Epidemiology of Falls and Fall-Related Injuries

A number of researchers have estimated the hospital costs of an injurious fall in

absolute terms and as a proportion of health budgets. Englander et al. [76]
projected the cost of falls to the US health care system in 1994 to total
US$20.2 billion, with the cost per injured person being US$7399. The authors
further extrapolated these figures to the year 2020 and estimated the cost of falls
injuries at US$32.4 billion. Recent studies have shown that these costs were
underestimations. Burns et al. [77] found that in 2015 the cost of a medically
treated non-fatal fall was US$9780 and a fatal fall was US$26340, and the total cost
of fatal and non-fatal falls for Medicare was US$32 billion. Furthermore, this
figure increased to US$50.0 billion when Medicaid and out-of-pocket expenses
were also included [78].
In Australia, there were 1.4 million patient days for hospital care related to
injurious falls by people aged 65 years and older in 2013 [79], and it has been
estimated the ageing of the Australian population will have a significant impact on
the Australian health system due to the increased number of older people suffer-
ing fall-related injuries [80]. By 2051, the total health cost attributable to fall-
related injury is predicted to increase almost threefold from current levels to
AUD$1375 million per annum if age-specific fall rates remain unchanged; 886 000
additional hospital bed days or the equivalent of 2500 additional beds perman-
ently allocated to falls injury treatment will be required for the increased demand
and 3320 additional nursing home places will be required. These projections
indicate prevention strategies will need to deliver approximately a 66% reduction
in fall incidence to maintain cost parity over this period.

Conclusions
Despite the disparate methodologies of falls ascertainment used in the above
studies, the incidence rates reported are quite similar. Approximately one-third
of older Caucasian people living in the community fall at least once a year, with
many suffering multiple falls. Fall rates are lower in Japanese, Chinese, African
Americans, Hispanics, and Pacific Islanders. There appears to be a seasonal
variation in the rate of falls in countries with cold climates and there is some
evidence that fall incidence has been increasing over the past one or two decades.
Fall rates are higher in older community-dwelling women (40%) than in older
men (28%) and continue to increase with age above 65 years. The incidence of falls
is increased in people living in retirement villages, hostels, and nursing homes, in
those who have fallen in the past year, and in those with particular medical
conditions that affect muscle strength, balance, and gait. In community-
dwelling older people, about 50% of falls occur within the home and 50% in
public places. Falls account for 4% of hospital admissions, 40% of injury-related
18 Falls in Older People

deaths and 1% of total deaths in persons aged 65 years and over. The major serious
injuries that result from falls include traumatic brain injuries and fractures of the
wrist, neck, trunk, and hip. Falls can also result in disability, restriction of activity
and fear of falling, which can reduce quality of life and independence, and
contribute to an older person being admitted to a nursing home. Finally, as
many fall-related injuries require medical treatment including hospitalization,
falls constitute a condition requiring considerable health care expenditure.

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21 Epidemiology of Falls and Fall-Related Injuries

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22 Falls in Older People

75. Tinetti ME, Williams CS. Falls, injuries due to falls, and the risk of admission to a nursing
home. New Engl J Med. 1997;337:1279–84.
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 2

Postural Stability and Falls

Jasmine C. Menant, Yoshiro Okubo, and Hylton B. Menz

Introduction
Postural stability can be defined as the ability of an individual to maintain the
position of the body, or more specifically, its centre of mass, within specific
boundaries of space, referred to as stability limits. Stability limits are boundaries
in which the body can maintain its position without changing the base of support
[1]. This definition of postural stability is useful as it highlights the need to discuss
stability in the context of a particular task or activity. For example, the stability
limit of normal relaxed standing is the area bounded by the two feet on the
ground, whereas the stability limit of unipedal stance is reduced to the area
covered by the single foot in contact with the ground. Due to this reduction in
the size of the stability limit, unipedal stance is an inherently more challenging
task requiring greater postural control.
Regardless of the task being performed, maintaining postural stability requires
the complex integration of sensory information regarding the position of the body
relative to the surroundings, and the ability to generate forces to control body
movement. Thus, postural stability requires the interaction of musculoskeletal
and sensory systems. The musculoskeletal component of postural stability encom-
passes the biomechanical properties of body segments, muscles, and joints. The
sensory components include vision, vestibular function, and somatosensation
which act to inform the brain of the position and movement of the body in three-
dimensional space. Linking these two components together are the higher-level
neurological processes enabling anticipatory mechanisms responsible for plan-
ning a movement, and adaptive mechanisms responsible for the ability to react to
changing demands of the particular task [1].

23
24 Falls in Older People

Normal ageing is associated with cognitive decline and changes in function of

each of the sub-components of musculoskeletal and sensory systems which
contribute to postural stability [2–7]. Consequently, ageing may manifest as
a measurable deficit in any task involving maintaining postural stability, such as
quiet standing, performing voluntary movements, and responding to external
perturbations.

Standing
Normal relaxed standing is characterized by small amounts of postural sway,
which has been defined by Sheldon as ‘the constant small deviations from the
vertical and their subsequent correction to which all human beings are subject
when standing upright’ [8]. Control of postural sway when standing involves
continual muscle activity (primarily of the calf muscles) and requires an inte-
grated reflex response to visual, vestibular, and somatosensory inputs [9]. The
relative contribution of each of these systems has been determined by experimen-
tally blocking each of the inputs and measuring the subsequent increase in
postural sway. The role of vision has been assessed by simply asking people to
close their eyes, vestibular input has been minimized by tilting the head [10] or
assessing the ability to balance an equivalent mechanical body [11], and somato-
sensory input has been blocked by ischaemia [9], standing on compliant surfaces
[12, 13] and immersing the feet in cold water [14–16]. Such investigations have
revealed that if any of these inputs are removed, postural sway increases. Although
the extent to which one input can compensate for the loss of another is still
unclear, peripheral sensation appears to be the most important sensory system in
the regulation of standing balance in older adults [13].
Visual-field dependency, as assessed using the Roll Vection Test (i.e. attempt to
align a rod to the vertical while exposed to a rotating visual field) has been
associated with reduced sway. Although this appears counterintuitive, it is postu-
lated that it might be due to a stiffening strategy to maintain stance [17]. Similar
reductions in postural sway responses have also been reported in fear-inducing
environmental conditions, at elevated height for example [18]. In response to
a postural threat (standing on a 65-cm-high platform), non-anxious older partici-
pants showed an adaptive tightening of balance control, effectively reducing sway
range in the elevated condition, whereas the anxious participants increased their
sway frequency but did not reduce sway range. These findings suggest that
generalized anxiety in older adults appears to differentially affect postural control
strategies under threatening conditions [18].
The generalized decline in sensory functions due to normal ageing and its
contribution to increased postural sway have been widely evaluated in the
25 Postural Stability and Falls

literature. Although interest in the measurement of sway dates back to the classic
studies on tabes dorsalis by Romberg in 1853 [19], the first attempt to assess age-
related changes in postural sway was conducted by Hellbrandt and Braun in 1939
[20], who measured sway in people aged from three to 86 years. The results
showed that the magnitude of sway was largest in the very young and very old
participants. A similar study by Boman and Javalisto [21] measured sway with an
overhead camera in people aged 18–30 and 61–88 years, and reported that sway
was greater in the older group, particularly in those aged over 80 years. Since these
early investigations, many studies have reported age-associated increases in
standing postural sway after the age of 30 years using various swaymeters, optical
systems, force platforms, and accelerometers, particularly with the eyes closed [8,
22–45]. There is no clear consensus in the literature regarding sex differences in
sway; although some studies report higher postural sway values in women com-
pared to men across a range of age groups [22, 25, 28, 45], other authors have
reported no significant differences [31, 33, 38, 46].
Factors found to be highly correlated with increased sway include reduced
lower-extremity muscle strength [13, 47–50], reduced peripheral sensation [26,
48, 51–54], poor near visual acuity [13, 55], and slowed reaction time [13, 56].
Lord et al. [13] found that while reaction time is not associated with sway when
standing on a firm surface, when participants stand on a compliant foam rubber
surface a significant association between sway and reaction time is evident. This
suggests that people can perceive large amounts of sway and consciously control
their body movements. Smaller associations between vestibular function and sway
have been reported [10, 13, 26, 57], and postural sway does not appear to be
strongly associated with anthropometric measures. Danis et al. [58] reported that
skeletal alignment was not associated with postural sway on a force plate, however
Lichtenstein et al. [55] and Era et al. [48] reported that low body mass is associated
with greater sway in both men and women. Kejonen et al. [59] measured a broad
range of anthropometric parameters in 100 people aged 31–80 years, and found
that few measures were strongly correlated with body displacement when stand-
ing. More recently, Reynart et al. [45] recorded postural sway during 12 quiet
standing tasks with an accelerometer fixed onto the sternum on 100 men and
women aged 20 to 60 years. They found no significant effect of height or weight on
the average amplitude of the acceleration signal (root mean square) that they
defined as an indirect measure of thorax sway.
Measurement of postural sway when standing has been reported to be a useful
predictor of falls in older people. Although the evidence is not entirely consistent,
a number of cross-sectional studies have reported significantly greater sway in
older people with a history of falling compared to those without such a history [25,
46, 60, 61]. Similarly, numerous prospective studies have revealed that the
26 Falls in Older People

measurement of an individual’s sway is a useful predictor of falls during follow-up

periods [62–67]. Despite using a range of sway measurements of varying com-
plexity, encompassing balance boards [68], inertial sensors [69], and force plat-
forms [70], findings from recent large studies concur. In studies by Lord et al. [62,
71–73], people with a history of falls showed greater sway in four test conditions:
standing on a firm base with the eyes open; standing on a firm base with the eyes
closed; standing on a 15-cm thick high-density foam rubber mat with the eyes
open; and standing on the foam rubber with the eyes closed. In each of these
studies, a validated, portable ‘sway-meter’ was used to record displacements of the
body at the level of the waist (see Figure 2.1) [74].
In addition to the investigation of standing postural sway, several other stand-
ing tests have been developed which provide a greater challenge to the postural
control system. One technique is to simply alter the foot position, thereby
decreasing the size of the stability limit. This concept was first explored by
Romberg [19], who assessed balance by observing the ability of patients to stand
with their feet together. The effect of foot position on sway has more recently been
evaluated in detail by numerous authors [45, 75–78], who evaluated postural
stability on a force plate or with trunk inertial sensors with participants standing
with their feet in varying positions (i.e. toe-in, toe-out, variations in space between
the heels, and tandem stance). Increased sway was apparent with the more
challenging conditions due to the reduction in the size of the stability limit. In
accordance with investigations into normal bipedal standing, ageing is also
associated with poorer performance in tandem standing [49, 79–83] and unipedal
stance [27, 28, 45, 79–82, 84–88] with no significant effect of leg dominance [45].
Lord et al. [89] has also reported that older people with a history of falls had
increased lateral sway with the eyes open and closed when undertaking a Near
Tandem Stability Test. Those who had fallen were also significantly more likely to
take a protective step when undertaking the test with the eyes closed. Consistent
with this finding, a study of 439 older people in the Netherlands found that an
inability to stand in the tandem position for at least 10 seconds was a significant
independent predictor of recurrent falls in a 12-month follow-up period [67].
Similarly, three studies have reported that performance in the Unipedal Standing
Test can predict falls in older people [88, 90, 91]; however, the utility of timed
unipedal standing as a falls predictor is limited, as many frail older people are
unable to attempt this test.

Leaning
Another approach to challenge postural control is to measure sway when the
participant is placed at the perimeter of their stability limit, or to measure the
27 Postural Stability and Falls

sway-meter

adjustable height table

sway-meter

adjustable height table

foam rubber mat

Figure 2.1 The portable ‘sway meter’ used to measure body displacements at the level of the waist. A: sway on
the floor, B: sway on a foam rubber mat.
28 Falls in Older People

dimensions of the stability limit itself. Hasselkus and Shambes [24] assessed
postural sway in young and older women in normal relaxed stance and when
the participants leaned forward at the waist approximately 45°. The results
revealed that sway was greater in the older group in both conditions, but particu-
larly so when leaning forward, suggesting that the older women were less able to
stabilize their posture when approaching the perimeter of their stability limit.
King et al. [92] evaluated the ability of women aged 20 to 91 years to reach as far
forward and backward as possible when standing, in order to establish age-related
differences in functional base of support. Decreased functional base of support
was evident after the age of 60 years and declined 16% per decade thereafter.
A similar technique is the Functional Reach Test, which involves the measure-
ment of the ability to reach forward as far as possible with the arm positioned at
90° of shoulder flexion. This test was first described by Duncan et al. [93], who
evaluated participants aged 21 to 87 years and reported a significant age-related
decline in functional reach. Similar results were reported by Hagemon et al. [38],
who reported that older people exhibited a smaller mean reach than younger
people. Even though subsequent investigations of functional reach have shown
the test to be correlated with performance in activities of daily living [94] and
sensitive to improvements in function following rehabilitation [95], it does not
appear to be a valid indicator of dynamic balance, due to the variety of strategies
that can be used to extend the arm from the shoulder [96].
Furthermore, according to a recent systematic review and meta-analysis [97],
performance in the Functional Reach Test is not predictive of falls: data from five
prospective studies showed that older non-fallers could reach on average only
2.30 cm further (95% CI: –0.43,5.04) than older fallers, and two out of three
additional studies, which were not included in the meta-analysis (n = 1373 and n =
1200, respectively), supported these findings [98, 99], suggesting that their inclu-
sion would not have changed the findings.
Two variations on this test have also been proposed – the Lateral Reach Test
[100] and the Multi-Direction Reach Test [101]. The Lateral Reach Test involves
the clinical measurement of maximal excursion of the extended arm in conjunc-
tion with laboratory measures of centre of pressure displacement when partici-
pants lean as far as possible to the right and left sides [100]. The Multi-Direction
Reach Test involves participants leaning forward, to the right, to the left and
leaning backwards while the excursion of their arm is measured [101]. Despite
their theoretical advantages over the Functional Reach Test, neither test has been
found to be an accurate predictor of falls [101, 102].
Lord et al. [103] developed two additional leaning tests as measures of postural
stability. The Maximum Balance Range Test involves the participant leaning
forward and backward from the ankles as far as possible (without moving their
Other documents randomly have
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The Project Gutenberg eBook of A Preliminary
Dissertation on the Mechanisms of the
Heavens
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Title: A Preliminary Dissertation on the Mechanisms of the Heavens

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*** START OF THE PROJECT GUTENBERG EBOOK A PRELIMINARY

DISSERTATION ON THE MECHANISMS OF THE HEAVENS ***
 A
PRELIMINARY
DISSERTATION
ON THE
MECHANISM OF THE
HEAVENS.

BY
 MRS. SOMMERVILLE

PHILADELPHIA:

CAREY & LEA

1832

In order to convey some idea of the object of this work, it may be

useful to offer a few preliminary observations on the nature of the
subject which it is intended to investigate, and of the means that
have already been adopted with so much success to bring within the
reach of our faculties, those truths which might seem to be placed
so far beyond them.
All the knowledge we possess of external objects is founded upon
experience, which furnishes a knowledge of facts, and the
comparison of these facts establishes relations, from which,
induction, the intuitive belief that like causes will produce like
effects, leads us to general laws. Thus, experience teaches that
bodies fall at the surface of the earth with an accelerated velocity,
and proportional to their masses. Newton proved, by comparison,
that the force which occasions the fall of bodies at the earth's
surface, is identical with that which retains the moon in her orbit;
and induction led him to conclude that as the moon is kept in her
orbit by the attraction of the earth, so the planets might be retained
in their orbits by the attraction of the sun. By such steps he was led
to the discovery of one of those powers with which the Creator has
ordained that matter should reciprocally act upon matter.
Physical astronomy is the science which compares and identifies
the laws of motion observed on earth with the motions that take
place in the heavens, and which traces, by an uninterrupted chain of
deduction from the great principle that governs the universe, the
revolutions and rotations of the planets, and the oscillations of the
fluids at their surfaces, and which estimates the changes the system
has hitherto undergone or may hereafter experience, changes which
require millions of years for their accomplishment.
The combined efforts of astronomers, from the earliest dawn of
civilization, have been requisite to establish the mechanical theory of
astronomy: the courses of the planets have been observed for ages
with a degree of perseverance that is astonishing, if we consider the
imperfection, and even the want of instruments. The real motions of
the earth have been separated from the apparent motions of the
planets; the laws of the planetary revolutions have been discovered;
and the discovery of these laws has led to the knowledge of the
gravitation of matter. On the other hand, descending from the
principle of gravitation, every motion in the system of the world has
been so completely explained, that no astronomical phenomenon
can now be transmitted to posterity of which the laws have not been
determined.
Science, regarded as the pursuit of truth, which can only be
attained by patient and unprejudiced investigation, wherein nothing
is too great to be attempted, nothing so minute as to be justly
disregarded, must ever afford occupation of consummate interest
and of elevated meditation. The contemplation of the works of
creation elevates the mind to the admiration of whatever is great
and noble, accomplishing the object of all study, which in the
elegant language of Sir James Mackintosh is to inspire the love of
truth, of wisdom, of beauty, especially of goodness, the highest
beauty, and of that supreme and eternal mind, which contains all
truth and wisdom, all beauty and goodness. By the love or delightful
contemplation and pursuit of these transcendent aims for their own
sake only, the mind of man is raised from low and perishable
objects, and prepared for those high destinies which are appointed
for all those who are capable of them.
The heavens afford the most sublime subject of study which can
be derived from science: the magnitude and splendour of the
objects, the inconceivable rapidity with which they move, and the
enormous distances between them, impress the mind with some
notion of the energy that maintains them in their motions with a
durability to which we can see no limits. Equally conspicuous is the
goodness of the great First Cause in having endowed man with
faculties by which he can not only appreciate the magnificence of his
works, but trace, with precision, the operation of his laws, use the
globe he inhabits us a base wherewith to measure the magnitude
and distance of the sun and planets, and make the diameter of the
earth's orbit the first step of a scale by which he may ascend to the
starry firmament. Such pursuits, while they ennoble the mind, at the
same time inculcate humility, by showing that there is a barrier,
which no energy, mental or physical, can ever enable us to pass:
that however profoundly we may penetrate the depths of space,
there still remain innumerable systems compared with which those
which seem so mighty to us must dwindle into insignificance, or
even become invisible; and that not only man, but the globe he
inhabits, nay the whole system of which it forms so small a part,
might be annihilated, and its extinction be unperceived in the
immensity or creation.
A complete acquaintance with Physical Astronomy can only be
attained by those who are well versed in the higher branches of
mathematical and mechanical science: such alone can appreciate the
extreme beauty of the results, and of the means by which these
results are obtained. Nevertheless a sufficient skill in analysis to
follow the general outline, to see the mutual dependence of the
different parts of the system, and to comprehend by what means
some of the most extraordinary conclusions have been arrived at, is
within the reach of many who shrink from the task, appalled by
difficulties, which perhaps are not more formidable than those
incident to the study of the elements of every branch of knowledge,
and possibly overrating them by not making a sufficient distinction
between the degree of mathematical acquirement necessary for
making discoveries, and that which is requisite for understanding
what others have done. That the study of mathematics and their
application to astronomy are full of interest will be allowed by all
who have devoted their time and attention to these pursuits, and
they only can estimate the delight of arriving at truth, whether it be
in the discovery of a world, or of a new property of numbers.
It has been proved by Newton that a particle of matter placed
without the surface of a hollow sphere is attracted by it in the name
manner as if its mass, or the whole matter it contains, were
collected in its centre. The same is therefore true of a solid sphere
which may be supposed to consist of an infinite number of
concentric hollow spheres. This however is not the case with a
spheroid, but the celestial bodies are so nearly spherical, and at such
remote distances from each other, that they attract and are attracted
as if each were a dense point situate in its centre of gravity, a
circumstance which greatly facilitates the investigation of their
motions.
The attraction of the earth on bodies at its surface in that
latitude, the square of whose sine is ⅓, is the same as if it were a
sphere; and experience shows that bodies there fall through 16.0697
feet in a second. The mean distance of the moon from the earth is
about sixty times the mean radius of the earth. When the number
16.0697 is diminished in the ratio of 1 to 3600, which is the square
of the moon's distance from the earth, it is found to be exactly the
space the moon would fall through in the first second of her descent
to the earth, were she not prevented by her centrifugal force, arising
from the velocity with which she moves in her orbit. So that the
moon is retained in her orbit by a force having the same origin and
regulated by the same law with that which causes a stone to fall at
the earth's surface. The earth may therefore be regarded as the
centre of a force which extends to the moon; but as experience
shows that the action and reaction of matter are equal and contrary,
the moon must attract the earth with an equal and contrary force.
Newton proved that a body projected in space will move in a
conic section, if it be attracted by a force directed towards a fixed
point, and having an intensity inversely as the square of the
distance; but that any deviation from that law will cause it to move
in a curve of a different nature. Kepler ascertained by direct
observation that the planets describe ellipses round the sun, and
later observations show that comets also move in conic sections: it
consequently follows that the sun attracts all the planets and comets
inversely as the square of their distances from his centre; the sun
therefore is the centre of a force extending indefinitely in space, and
including all the bodies of the system in its action.
Kepler also deduced from observation, that the squares of the
periodic times of the planets, or the times of their revolutions round
the sun, are proportional to the cubes of their mean distances from
his centre: whence it follows, that the intensity of gravitation of all
the bodies towards the sun is the same at equal distances;
consequently gravitation is proportional to the masses, for if the
planets and comets be supposed to be at equal distances from the
sun and left to the effects of gravity, they would arrive at his surface
at the same time. The satellites also gravitate to their primaries
according to the same law that their primaries do to the sun. Hence,
by the law of action and reaction, each body is itself the centre of an
attractive force extending indefinitely in space, whence proceed all
the mutual disturbances that render the celestial motions so
complicated, and their investigation so difficult.
The gravitation of matter directed to a centre, and attracting
directly as the mass, and inversely as the square of the distance,
does not belong to it when taken in mass; particle acts on particle
according to the same law when at sensible distances from each
other. If the sun acted on the centre of the earth without attracting
each of its particles, the tides would be very much greater than they
now are, and in other respects they also would be very different.
The gravitation of the earth to the sun results from the gravitation of
all its particles, which in their turn attract the sun in the ratio of their
respective masses. There is a reciprocal action likewise between the
earth and every particle at its surface; were this not the case, and
were any portion of the earth, however small, to attract another
portion and not be itself attracted, the centre of gravity of the earth
would be moved in space, which is impossible.
The form of the planets results from the reciprocal attraction of
their component particles. A detached fluid mass, if at rest, would
assume the form of a sphere, from the reciprocal attraction of its
particles; but if the mass revolves about an axis, it becomes
flattened at the poles, and bulges at the equator, in consequence of
the centrifugal force arising from the velocity of rotation. For, the
centrifugal force diminishes the gravity of the particles at the
equator, and equilibrium can only exist when these two forces are
balanced by an increase of gravity; therefore, as the attractive force
is the same on all particles at equal distances from the centre of a
sphere, the equatorial particles would recede from the centre till
their increase in number balanced the centrifugal force by their
attraction, consequently the sphere would become an oblate
spheroid; and a fluid partially or entirely covering a solid, as the
ocean and atmosphere cover the earth, must assume that form in
order to remain in equilibrio. The surface of the sea is therefore
spheroidal, and the surface of the earth only deviates from that
figure where it rises above or sinks below the level of the sea; but
the deviation is so small that it is unimportant when compared with
the magnitude of the earth. Such is the form of the earth and
planets, but the compression or flattening at their poles is so small,
that even Jupiter, whose rotation is the most rapid, differs but little
from a sphere. Although the planets attract each other as if they
were spheres on account of their immense distances, yet the
satellites are near enough to be sensibly affected in their motions by
the forms of their primaries. The moon for example is so near the
earth, that the reciprocal attraction between each of her particles
and each of the particles in the prominent mass at the terrestrial
equator, occasions considerable disturbances in the motions of both
bodies. For, the action of the moon on the matter at the earth's
equator produces a nutation in the axis of rotation, and the reaction
of that matter on the moon is the cause of a corresponding nutation
in the lunar orbit.
If a sphere at rest in space receives an impulse passing through
its centre of gravity, all its parts will move with an equal velocity in a
straight line; but if the impulse does not pass through the centre of
gravity, its particles having unequal velocities, will give it a rotatory
motion at the same time that it is translated in space. These motions
are independent of one another, so that a contrary impulse passing
through its centre of gravity will impede its progression, without
interfering with its rotation. As the sun rotates about an axis, it
seems probable if an impulse in a contrary direction has not been
given to his centre of gravity, that he moves in space accompanied
by all those bodies which compose the solar system, a circumstance
that would in no way interfere with their relative motions; for, in
consequence of our experience that force is proportional to velocity,
the reciprocal attractions of a system remain the same, whether its
centre of gravity be at rest, or moving uniformly in space. It is
computed that had the earth received its motion from a single
impulse, such impulse must have passed through a point about
twenty-five miles from its centre.
Since the motions of the rotation and translation of the planets
are independent of each other, though probably communicated by
the same impulse, they form separate subjects of investigation.
A planet moves in its elliptical orbit with a velocity varying every
instant, in consequence of two forces, one tending to the centre of
the sun, and the other in the direction of a tangent to its orbit,
arising from the primitive impulse given at the time when it was
launched into space: should the force in the tangent cease, the
planet would fall to the sun by its gravity; were the sun not to
attract it, the planet would fly off in the tangent. Thus, when a
planet is in its aphelion or at the point where the orbit is farthest
from the sun, his action overcomes its velocity, and brings it towards
him with such an accelerated motion, that it at last overcomes the
sun's attraction, and shoots past him; then, gradually decreasing in
velocity, it arrives at the aphelion where the sun's attraction again
prevails. In this motion the radii vectores, or imaginary lines joining
the centres of the sun and planets, pass over equal areas in equal
times.
If the planets were attracted by the sun only, this would ever be
their course; and because his action is proportional to his mass,
which is immensely larger than that of all the planets put together,
the elliptical is the nearest approximation to their true motions,
which are extremely complicated, in consequence of their mutual
attraction, so that they do not move in any known or symmetrical
curve, but in paths now approaching to, and now receding from the
elliptical form, and their radii vectores do not describe areas exactly
proportional to the time. Thus the areas become a test of the
existence of disturbing forces.
To determine the motion of each body when disturbed by all the
rest is beyond the power of analysis; it is therefore necessary to
estimate the disturbing action of one planet at a time, whence arises
the celebrated problem of the three bodies, which originally was that
of the moon, the earth, and the sun, namely,—the masses being
given of three bodies projected from three given points, with
velocities given both in quantity and direction; and supposing the
bodies to gravitate to one another with forces that are directly as
their masses, and inversely as the squares of the distances, to find
the lines described by these bodies, and their position at any given
instant.
By this problem the motions of translation of all the celestial
bodies are determined. It is one of extreme difficulty, and would be
of infinitely greater difficulty, if the disturbing action were not very
small, when compared with the central force. As the disturbing
influence of each body may be found separately, it is assumed that
the action of the whole system in disturbing any one planet is equal
to the sum of all the particular disturbances it experiences, on the
general mechanical principle, that the sum of any number of small
oscillations is nearly equal to their simultaneous and joint effect.
On account of the reciprocal action of matter, the stability of the
system depends on the intensity of the primitive momentum of the
planets, and the ratio of their masses to that of the sun: for the
nature of the conic sections in which the celestial bodies move,
depends on the velocity with which they were first propelled in
space; had that velocity been such as to make the planets move in
orbits of unstable equilibrium, their mutual attractions might have
changed them into parabolas or even hyperbolas; so that the earth
and planets might ages ago have been sweeping through the abyss
of space: but as the orbits differ very little from circles, the
momentum of the planets when projected, must have been exactly
sufficient to ensure the permanency and stability of the system.
Besides the mass of the sun is immensely greater than those of the
planets; and as their inequalities bear the same ratio to their
elliptical motions as their masses do to that of the sun, their mutual
disturbances only increase or diminish the eccentricities of their
orbits by very minute quantities; consequently the magnitude of the
sun's mass is the principal cause of the stability of the system. There
is not in the physical world a more splendid example of the
adaptation of means to the accomplishment of the end, than is
exhibited in the nice adjustment of these forces.
The orbits of the planets have a very small inclination to the plane
of the ecliptic in which the earth moves; and on that account,
astronomers refer their motions to it at a given epoch as a known
and fixed position. The paths of the planets, when their mutual
disturbances are omitted, are ellipses nearly approaching to circles,
whose planes, slightly inclined to the ecliptic: cut it in straight lines
passing through the centre of the sun; the points where the orbit
intersects the plane of the ecliptic are its nodes.
The orbits of the recently discovered planets deviate more from
the ecliptic: that of Pallas has an inclination of 35° to it: on that
account it will be more difficult to determine their motions. These
little planets have no sensible effect in disturbing the rest, though
their own motions are rendered very irregular by the proximity of
Jupiter and Saturn.
The planets are subject to disturbances of two distinct kinds, both
resulting from the constant operation of their reciprocal attraction,
one kind depending upon their positions with regard to each other,
begins from zero, increases to a maximum, decreases and becomes
zero again, when the planets return to the same relative positions.
In consequence of these, the troubled planet is sometimes drawn
away from the sun, sometimes brought nearer to him; at one time it
is drawn above the plane of its orbit, at another time below it,
according to the position of the disturbing body. All such changes,
being accomplished in short periods, some in a few months, others
in years, or in hundreds of years, are denominated Periodic
Inequalities.
The inequalities of the other kind, though occasioned likewise by
the disturbing energy of the planets, are entirely independent of
their relative positions; they depend on the relative positions of the
orbits alone, whose forms and places in space are altered by very
minute quantities in immense periods of time, and are therefore
called Secular Inequalities.
In consequence of disturbances of this kind, the apsides, or
extremities of the major axes of all the orbits, have a direct, but
variable motion in space, excepting those of Venus, which are
retrograde; and the lines of the nodes move with a variable velocity
in the contrary direction. The motions of both are extremely slow; it
requires more than 109770 years for the major axis of the earth's
orbit to accomplish a sidereal revolution, and 20935 years to
complete its tropical motion. The major axis of Jupiter's orbit
requires no less than 197561 years to perform its revolution from
the disturbing action of Saturn alone. The periods in which the
nodes revolve are also very great. Beside these, the inclination and
eccentricity of every orbit are in a state of perpetual, but slow
change. At the present time, the inclinations of all the orbits are
decreasing; but so slowly, that the inclination of Jupiter's orbit is only
six minutes less now than it was in the age of Ptolemy. The
terrestrial eccentricity is decreasing at the rate of 3914 miles in a
century; and if it were to decrease equably, it would be 36300 years
before the earth's orbit became a circle. But in the midst of all these
vicissitudes, the major axes and mean motions of the planets remain
permanently independent of secular changes; they are so connected
by Kepler's law of the squares of the periodic times being
proportional to the cubes of the mean distances of the planets from
the sun, that one cannot vary without affecting the other.
With the exception of these two elements, it appears, that all the
bodies are in motion, and every orbit is in a state of perpetual
change. Minute as these changes are, they might be supposed liable
to accumulate in the course of ages sufficiently to derange the whole
order of nature, to alter the relative positions of the planets, to put
an end to the vicissitudes of the seasons, and to bring about
collisions, which would involve our whole system, now so
harmonious, in chaotic confusion. The consequences being so
dreadful, it is natural to inquire, what proof exists that creation will
be preserved from such a catastrophe? For nothing can be known
from observation, since the existence of the human race has
occupied but a point in duration, while these vicissitudes embrace
myriads of ages. The proof is simple and convincing. All the
variations of the solar system, as well secular as periodic, are
expressed analytically by the sines and cosines of circular arcs,
which increase with the time; and as a sine or cosine never can
exceed the radius, but must oscillate between zero and unity,
however much the time may increase, it follows, that when the
variations have by slow changes accumulated in however long a time
to a maximum, they decrease by the same slow degrees, till they
arrive at their smallest value, and then begin a new course, thus for
ever oscillating about a mean value. This, however, would not be the
case if the planets moved in a resisting medium, for then both the
eccentricity and the major axes of the orbits would vary with the
time, so that the stability of the system would be ultimately
destroyed. But if the planets do move in an ethereal medium, it must
be of extreme rarity, since its resistance has hitherto been quite
insensible.
Three circumstances have generally been supposed necessary to
prove the stability of the system: the small eccentricities of the
planetary orbits, their small inclinations, and the revolution of all the
bodies, as well planets as satellites, in the same direction. These,
however, are not necessary conditions: the periodicity of the terms
in which the inequalities are expressed is sufficient to assure us, that
though we do not know the extent of the limits, nor the period of
that grand cycle which probably embraces millions of years, yet they
never will exceed what is requisite for the stability and harmony of
the whole, for the preservation of which every circumstance is so
beautifully and wonderfully adapted.
The plane of the ecliptic itself, though assumed to be fixed at a
given epoch for the convenience of astronomical computation, is
subject to a minute secular variation of 52"·109, occasioned by the
reciprocal action of the planets; but as this is also periodical, the
terrestrial equator, which is inclined to it at an angle of about 23°
28', will never coincide with the plane of the ecliptic; so there never
can be perpetual spring.
The rotation of the earth is uniform; therefore day and night,
summer and winter, will continue their vicissitudes while the system
endures, or is untroubled by foreign causes.

Yonder starry sphere

Of planets, and of fix'd, in all her wheels
Resembles nearest, mazes intricate,
Eccentric, intervolv'd, yet regular
Then most, when most irregular they seem.

The stability of our system was established by La Grange, 'a

discovery,' says Professor Playfair, 'that must render the name for
ever memorable in science, and revered by those who delight in the
contemplation of whatever is excellent and sublime. After Newton's
discovery of the elliptical orbits of the planets, La Grange's discovery
of their periodical inequalities is without doubt the noblest truth in
physical astronomy; and, in respect of the doctrine of final causes, it
may be regarded as the greatest of all.'
Notwithstanding the permanency of our system, the secular
variations in the planetary orbits would have been extremely
embarrassing to astronomers, when it became necessary to compare
observations separated by long periods. This difficulty is obviated by
La Place, who has shown that whatever changes time may induce
either in the orbits themselves, or in the plane of the ecliptic, there
exists an invariable plane passing through the centre of gravity of
the sun, about which the whole system oscillates within narrow
limits, and which is determined by this property; that if every body
in the system be projected on it, and if the mass of each be
multiplied by the area described in a given time by its projection on
this plane, the sum of all these products will be a maximum. This
plane of greatest inertia, by no means peculiar to the solar system,
but existing in every system of bodies submitted to their mutual
attractions only, always remains parallel to itself, and maintains a
fixed position, whence the oscillations of the system may be
estimated through unlimited time. It is situate nearly half way
between the orbits of Jupiter and Saturn, and is inclined to the
ecliptic at an angle of about 1° 35' 31".
All the periodic and secular inequalities deduced from the law of
gravitation are so perfectly confirmed by observations, that analysis
has become one of the most certain means of discovering the
planetary irregularities, either when they are too small, or too long
in their periods, to be detected by other methods. Jupiter and
Saturn, however, exhibit inequalities which for a long time seemed
discordant with that law. All observations, from those of the Chinese
and Arabs down to the present day, prove that for ages the mean
motions of Jupiter and Saturn have been affected by great
inequalities of very long periods, forming what appeared an anomaly
in the theory of the planets. It was long known by observation, that
five times the mean motion of Saturn is nearly equal to twice that of
Jupiter; a relation which the sagacity of La Place perceived to be the
cause of a periodic inequality in the mean motion of each of these
planets, which completes its period in nearly 929 Julian years, the
one being retarded, while the other is accelerated. These inequalities
are strictly periodical, since they depend on the configuration of the
two planets; and the theory is perfectly confirmed by observation,
which shows that in the course of twenty centuries, Jupiter's mean
motion has been accelerated by 3° 23', and Saturn's retarded by 5°
13'.
It might be imagined that the reciprocal action of such planets as
have satellites would be different from the influence of those that
have none; but the distances of the satellites from their primaries
are incomparably less than the distances of the planets from the
sun, and from one another, so that the system of a planet and its
satellites moves nearly as if all those bodies were united in their
common centre of gravity; the action of the sun however disturbs in
some degree the motion of the satellites about their primary.
The changes that take place in the planetary system are exhibited
on a small scale by Jupiter and his satellites; and as the period
requisite for the development of the inequalities of these little moons
only extends to a few centuries, it may be regarded as an epitome of
that grand cycle which will not be accomplished by the planets in
myriads of centuries. The revolutions of the satellites about Jupiter
are precisely similar to those of the planets about the sun; it is true
they are disturbed by the sun, but his distance is so great, that their
motions are nearly the same as if they were not under his influence.
The satellites like the planets, were probably projected in elliptical
orbits, but the compression of Jupiter's spheroid is very great in
consequence of his rapid rotation; and as the masses of the
satellites are nearly 100000 times less than that of Jupiter, the
immense quantity of prominent matter at his equator must soon
have given the circular form observed in the orbits of the first and
second satellites, which its superior attraction will always maintain.
The third and fourth satellites being further removed from its
influence, move in orbits with a very small eccentricity. The same
cause occasions the orbits of the satellites to remain nearly in the
plane of Jupiter's equator, on account of which they are always seen
nearly in the same line; and the powerful action of that quantity of
prominent matter is the reason why the motion of the nodes of
these little bodies is so much more rapid than those of the planet.
The nodes of the fourth satellite accomplish a revolution in 520
years, while those of Jupiter's orbit require no less than 50673 years,
a proof of the reciprocal attraction between each particle of Jupiter's
equator and of the satellites. Although the two first satellites
sensibly move in circles, they acquire a small ellipticity from the
disturbances they experience.
The orbits of the satellites do not retain a permanent inclination,
either to the plane of Jupiter's equator, or to that of his orbit, but to
certain planes passing between the two, and through their
intersection; these have a greater inclination to his equator the
further the satellite is removed, a circumstance entirely owing to the
influence of Jupiter's compression.
A singular law obtains among the mean motions and mean
longitudes of the three first satellites. It appears from observation,
that the mean motion of the first satellite, plus twice that of the
third, is equal to three times that of the second, and that the mean
longitude of the first satellite, minus three times that of the second,
plus twice that of the third, is always equal to two right angles. It is
proved by theory, that if these relations had only been approximate
when the satellites were first launched into space, their mutual
attractions would have established and maintained them. They
extend to the synodic motions of the satellites, consequently they
affect their eclipses, and have a very great influence on their whole
theory. The satellites move so nearly in the plane of Jupiter's
equator, which has a very small inclination to his orbit, that they are
frequently eclipsed by the planet. The instant of the beginning or
end of an eclipse of a satellite marks the same instant of absolute
time to all the inhabitants of the earth; therefore the time of these
eclipses observed by a traveller, when compared with the time of the
eclipse computed for Greenwich or any other fixed meridian, gives
the difference of the meridians in time, and consequently the
longitude of the place of observation. It has required all the
refinements of modern instruments to render the eclipses of these
remote moons available to the mariner; now however, that system of
bodies invisible to the naked eye, known to man by the aid of
science alone, enables him to traverse the ocean, spreading the light
of knowledge and the blessings of civilization over the most remote
regions, and to return loaded with the productions of another
hemisphere. Nor is this all: the eclipses of Jupiter's satellites have
been the means or a discovery, which, though not so immediately
applicable to the wants of man, unfolds a property of light, that
medium, without whose cheering influence all the beauties of the
creation would have been to us a blank. It is observed, that those
eclipses of the first satellite which happen when Jupiter is near
conjunction, are later by 16' 26" than those which take place when
the planet is in opposition. But as Jupiter is nearer to us when in
opposition by the whole breadth of the earth's orbit than when in
conjunction, this circumstance was attributed to the time employed
by the rays of light in crossing the earth's orbit, a distance of 192
millions of miles; whence it is estimated, that light travels at the rate
of 192000 miles in one second. Such is its velocity, that the earth,
moving at the rate of nineteen miles in a second, would take two
months to pass through a distance which a ray of light would dart
over in eight minutes. The subsequent discovery of the aberration of
light confirmed this astonishing result.
Objects appear to be situate in the direction of the rays that
proceed from them. Were light propagated instantaneously, every
object, whether at rest or in motion, would appear in the direction of
these rays; but as light takes some time to travel, when Jupiter is in
conjunction, we see him by means of rays that left him 16' 26"
before; but during that time we have changed our position, in
consequence of the motion of the earth in its orbit; we therefore
refer Jupiter to a place in which he is not. His true position is in the
diagonal of the parallelogram, whose sides are in the ratio of the
velocity of light to the velocity of the earth in its orbit, which is as
192000 to 19. In consequence of aberration, none of the heavenly
bodies are in the place in which they seem to be. In fact, if the earth
were at rest, rays from a star would pass along the axis of a
telescope directed to it; but if the earth were to begin to move in its
orbit with its usual velocity, these rays would strike against the side
of the tube; it would therefore be necessary to incline the telescope
a little, in order to see the star. The angle contained between the
axis of the telescope and a line drawn to the true place of the star, is
its aberration, which varies in quantity and direction in different
parts of the earth's orbit; but as it never exceeds twenty seconds, in
ordinary cases.
The velocity of light deduced from the observed aberration of the
fixed stars, perfectly corresponds with that given by the eclipses of
the first satellite. The same result obtained from sources so
different, leaves not a doubt of its truth. Many such beautiful
coincidences, derived from apparently the most unpromising and
dissimilar circumstances, occur in physical astronomy, and prove
dependences which we might otherwise be unable to trace. The
identity of the velocity of light at the distance of Jupiter and on the
earth's surface shows that its velocity is uniform; and if light consists
in the vibrations of an elastic fluid or ether filling space, which
hypothesis accords best with observed phenomena, the uniformity of
its velocity shows that the density of the fluid throughout the whole
extent of the solar system, must be proportional to its elasticity.
Among the fortunate conjectures which have been confirmed by
subsequent experience, that of Bacon is not the least remarkable. "It
produces in me," says the restorer of true philosophy, "a doubt,
whether the face of the serene and starry heavens be seen at the
instant it really exists, or not till some time later; and whether there
be not, with respect to the heavenly bodies, a true time and an
apparent time, no less than a true place and an apparent place, as
astronomers say, on account of parallax. For it seems incredible that
the species or rays of the celestial bodies can pass through the
immense interval between them and us in an instant; or that they do
not even require some considerable portion of time."
As great discoveries generally lead to a variety of conclusions, the
aberration of light affords a direct proof of the motion of the earth in
its orbit; and its rotation is proved by the theory of falling bodies,
since the centrifugal force it induces retards the oscillations of the
pendulum in going from the pole to the equator. Thus a high degree
of scientific knowledge has been requisite to dispel the errors of the
senses.
The little that is known of the theories of the satellites of Saturn
and Uranus is in all respects similar to that of Jupiter. The great
compression of Saturn occasions its satellites to move nearly in the
plane of its equator. Of the situation of the equator of Uranus we
know nothing, nor of its compression. The orbits of its satellites are
nearly perpendicular to the plane of the ecliptic.
Our constant companion the moon next claims attention. Several
circumstances concur to render her motions the most interesting,
and at the same time the most difficult to investigate of all the
bodies of our system. In the solar system planet troubles planet, but
in the lunar theory the sun is the great disturbing cause; his vast
distance being compensated by his enormous magnitude, so that the
motions of the moon are more irregular than those of the planets;
and on account of the great ellipticity of her orbit and the size of the
sun, the approximations to her motions are tedious and difficult,
beyond what those unaccustomed to such investigations could
imagine. Neither the eccentricity of the lunar orbit, nor its inclination
to the plane of the ecliptic, have experienced any changes from
secular inequalities; but the mean motion, the nodes, and the
perigee, are subject to very remarkable variations.
From an eclipse observed at Babylon by the Chaldeans, on the
19th of March, seven hundred and twenty-one years before the
Christian era, the place of the moon is known from that of the sun at
the instant of opposition; whence her mean longitude may be found;
but the comparison of this mean longitude with another mean
longitude, computed back for the instant of the eclipse from modern
observations, shows that the moon performs her revolution round
the earth more rapidly and in a shorter time now, than she did
formerly; and that the acceleration in her mean motion has been
increasing from age to age as the square of the time; all the ancient
and intermediate eclipses confirm this result. As the mean motions
of the planets have no secular inequalities, this seemed to be an
unaccountable anomaly, and it was at one time attributed to the
resistance of an ethereal medium pervading space; at another to the
successive transmission of the gravitating force: but as La Place
proved that neither of these causes, even if they exist, have any
influence on the motions of the lunar perigee or nodes, they could
not affect the mean motion, a variation in the latter from such a
cause being inseparably connected with variations in the two former
of these elements. That great mathematician, however, in studying
the theory of Jupiter's satellites, perceived that the secular variations
in the elements of Jupiter's orbit, from the action of the planets,
occasion corresponding changes in the motions of the satellites: this
led him to suspect that the acceleration in the mean motion of the
moon might be connected with the secular variation in the
eccentricity of the terrestrial orbit; and analysis has proved that he
assigned the true cause.
If the eccentricity of the earth's orbit were invariable, the moon
would be exposed to a variable disturbance from the action of the
sun, in consequence of the earth's annual revolution; but it would be
periodic, since it would be the same as often as the sun, the earth,
and the moon returned to the same relative positions: on account
however of the slow and incessant diminution in the eccentricity of
the terrestrial orbit, the revolution of our planet is performed at
different distances from the sun every year. The position of the
moon with regard to the sun, undergoes a corresponding change; so
that the mean action of the sun on the moon varies from one
century to another, and occasions the secular increase in the moon's
velocity called the acceleration, a name which is very appropriate in
the present age, and which will continue to be so for a vast number
of ages to come; because, as long as the earth's eccentricity
diminishes, the moon's mean motion will be accelerated; but when
the eccentricity has passed its minimum and begins to increase, the
mean motion will be retarded from age to age. At present the
secular acceleration is about 10", but its effect on the moon's place
increases as the square of the time. It is remarkable that the action
of the planets thus reflected by the sun to the moon, is much more
sensible than their direct action, either on the earth or moon. The
secular diminution in the eccentricity, which has not altered the
equation of the centre of the sun by eight minutes since the earliest
recorded eclipses, has produced a variation of 1° 48' in the moon's
longitude, and of 7° 12' in her mean anomaly.
The action of the sun occasions a rapid but variable motion in the
nodes and perigee of the lunar orbit; the former, though they recede
during the greater part of the moon's revolution, and advance during
the smaller, perform their sidereal revolutions in 6793days.4212, and
the latter, though its motion is sometimes retrograde and sometimes
direct, in 3232days.5807, or a little more than nine years: but such is
the difference between the disturbing energy of the sun and that of
all the planets put together, that it requires no less than 109770
years for the greater axis of the terrestrial orbit to do the same. It is
evident that the same secular variation which changes the sun's
distance from the earth, and occasions the acceleration in the
moon's mean motion, must affect the motion of the nodes and
perigee; and it consequently appears, from theory as well as
observation, that both these elements are subject to a secular
inequality, arising from the variation in the eccentricity of the earth's
orbit, which connects them with the acceleration; so that both are
retarded when the mean motion is anticipated. The secular
variations in these three elements are in the ratio of the numbers 3,
0.735, and 1; whence the three motions of the moon, with regard to
the sun, to her perigee, and to her nodes, are continually
accelerated, and their secular equations are as the numbers 1, 4,
and 0.265, or according to the most recent investigations as 1, 4,
6776 and 0.391. A comparison of ancient eclipses observed by the
Arabs, Greeks, and Chaldeans, imperfect as they are, with modern
observations, perfectly confirms these results of analysis.
Future ages will develop these great inequalities, which at some
most distant period will amount to many circumferences. They are
indeed periodic; but who shall tell their period? Millions of years
must elapse before that great cycle is accomplished; but 'such
changes, though rare in time, are frequent in eternity.'
The moon is so near, that the excess of matter at the earth's
equator occasions periodic variations in her longitude and latitude;
and, as the cause must be proportional to the effect, a comparison
of these inequalities, computed from theory, with the same given by
observation, shows that the compression of the terrestrial spheroid,
or the ratio of the difference between the polar and equatorial
diameter to the diameter of the equator is ¹⁄₃₀₅.₀₅ It is proved
analytically, that if a fluid mass of homogeneous matter, whose
particles attract each other inversely as the square of the distance,
were to revolve about an axis, as the earth, it would assume the
form of a spheroid, whose compression is ¹⁄₂₃₀. Whence it appears,
that the earth is not homogeneous, but decreases in density from its
centre to its circumference. Thus the moon's eclipses show the earth
to be round, and her inequalities not only determine the form, but
the internal structure of our planet; results of analysis which could
not have been anticipated. Similar inequalities in Jupiter's satellites
prove that his mass is not homogeneous, and that his compression
is ¹⁄₁₃.₈.
The motions of the moon have now become of more importance
to the navigator and geographer than those of any other body, from
the precision with which the longitude is determined by the
occultations of stars and lunar distances. The lunar theory is brought
to such perfection, that the times of these phenomena, observed
under any meridian, when compared with that computed for
Greenwich in the Nautical Almanack, gives the longitude of the
observer within a few miles. The accuracy of that work is obviously
of extreme importance to a maritime nation; we have reason to
hope that the new Ephemeris, now in preparation, will be by far the
most perfect work of the kind that ever has been published.
From the lunar theory, the mean distance of the sun from the
earth, and thence the whole dimensions of the solar system are
known; for the forces which retain the earth and moon in their
orbits, are respectively proportional to the radii vectores of the earth
and moon, each being divided by the square of its periodic time; and
as the lunar theory gives the ratio of the forces, the ratio of the
distance of the sun and moon from the earth is obtained: whence it
appears that the sun's distance from the earth is nearly 396 times
greater than that of the moon.
The method however of finding the absolute distances of the
celestial bodies in miles, is in fact the same with that employed in
measuring distances of terrestrial objects. From the extremities of a
known base the angles which the visual rays from the object form
with it, are measured; their sum subtracted from two right-angles
gives the angle opposite the base; therefore by trigonometry, all the
angles and sides of the triangle may be computed; consequently the
distance of the object is found. The angle under which the base of
the triangle is seen from the object, is the parallax of that object; it
evidently increases and decreases with the distance; therefore the
base must be very great indeed, to be visible at all from the celestial
bodies. But the globe itself whose dimensions are ascertained by
actual admeasurement, furnishes a standard of measures, with
which we compare the distances, masses, densities, and volumes of
the sun and planets.
The courses of the great rivers, which are in general navigable to
a considerable extent, prove that the curvature of the land differs
but little from that of the ocean; and as the heights of the mountains
and continents are, at any rate, quite inconsiderable when compared
with the magnitude of the earth, its figure is understood to be
determined by a surface at every point perpendicular to the direction
of gravity, or of the plumb-line, and is the same which the sea would
have if it were continued all round the earth beneath the continents.
Such is the figure that has been measured in the following manner:
—
A terrestrial meridian is a line passing through both poles, all the
points of which have contemporaneously the same noon. Were the
lengths and curvatures of different meridians known, the figure of
the earth might be determined; but the length of one degree is
sufficient to give the figure of the earth, if it be measured on
different meridians, and in a variety of latitudes; for if the earth were
a sphere, all degrees would be of the same length, but if not, the
lengths of the degrees will be greatest where the curvature is least;
a comparison of the length of the degrees in different parts of the
earth's surface will therefore determine its size and form.
An arc of the meridian may be measured by observing the
latitude of its extreme points, and then measuring the distance
between them in feet or fathoms; the distance thus determined on
the surface of the earth, divided by the degrees and parts of a
degree contained in the difference of the latitudes, will give the
exact length of one degree, the difference of the latitudes being the
angle contained between the verticals at the extremities of the arc.
This would be easily accomplished were the distance unobstructed,
and on a level with the sea; but on account of the innumerable
obstacles on the surface of the earth, it is necessary to connect the
extreme points of the arc by a series of triangles, the sides and
angles of which are either measured or computed, so that the length
of the arc is ascertained with much laborious computation. In
consequence of the inequalities of the surface, each triangle is in a
different plane; they must therefore be reduced by computation to
what they would have been, had they been measured on the surface
of the sea; and as the earth is spherical, they require a correction to
reduce them from plane to spherical triangles.
Arcs of the meridian have been measured in a variety of latitudes,
both north and south, as well as arcs perpendicular to the meridian.
From these measurements it appears that the length of the degrees
increase from the equator to the poles, nearly as the square of the
sine of the latitude; consequently, the convexity of the earth
diminishes from the equator to the poles. Many discrepancies occur,
but the figure that most nearly follows this law is an ellipsoid of
revolution, whose equatorial radius is 3962.6 miles, and the polar
radius 3949.7; the difference, or 12.9 miles, divided by the
equatorial radius, is ¹⁄₃₀₈.₇, or ¹⁄₃₀₉ nearly; this fraction is called
the compression of the earth, because, according as it is greater or
less, the terrestrial ellipsoid is more or less flattened at the poles; it
does not differ much from that given by the lunar inequalities. If we
assume the earth to be a sphere, the length of a degree of the
meridian is 69 ¹⁄₂₂ British miles; therefore 360 degrees, or the
whole circumference of the globe is 24856, and the diameter, which
is something less than a third of the circumference, is 7916 or 8000
miles nearly. Eratosthenes, who died 194 years before the Christian
era, was the first to give an approximate value of the earth's
circumference, by the mensuration of an arc between Alexandria and
Syene.
But there is another method of finding the figure of the earth,
totally independent of either of the preceding. If the earth were a
homogeneous sphere without rotation, its attraction on bodies at its
surface would be everywhere the same; if it be elliptical, the force of
gravity theoretically ought to increase, from the equator to the pole
as the square of the sine of the latitude; but for a spheroid in
rotation, by the laws of mechanics the centrifugal force varies as the
square of the sine of the latitude from the equator where it is
greatest, to the pole where it vanishes; and as it tends to make
bodies fly off the surface, it diminishes the effects of gravity by a
small quantity. Hence by gravitation, which is the difference of these
two forces, the fall of bodies ought to be accelerated in going from
the equator to the poles, proportionably to the square of the sine of
the latitude; and the weight of the same body ought to increase in
that ratio. This is directly proved by the oscillations of the pendulum;
for if the fall of bodies be accelerated, the oscillations will be more
rapid; and that they may always be performed in the same time, the
length of the pendulum must be altered. Now, by numerous and
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