A fall is defined as an event that occurs when a person inadvertently drops down to the ground or another lower level.
In people ≥ 65 years of age, falls are the leading cause of injury-related death and the seventh leading cause of all deaths (1).
In the United States, over 14 million adults age ≥ 65 years of age report falling each year, accounting for a total of approximately 36 million falls (2). A large number of falls result in an injury, with approximately 37% of people who fall reporting an injury that required medical treatment or that restricted their activity for at least 1 day, resulting in an estimated 9 million fall injuries each year.
The number of falls and related deaths is increasing. The age-adjusted fall death rate increased by 41% from 55.3 per 100,000 older adults in 2012 to 78.0 per 100,000 older adults in 2021 (3). Falls are also more common in women than men and more common in those living in a rural setting as compared to those living in an urban setting.
Falls threaten the independence of older adults and cause a cascade of individual and socioeconomic problems. However, clinicians are often unaware of falls in older adults who do not present with an injury because a routine history and physical examination typically do not include a specific evaluation for falls. Many older adults are reluctant to report a fall because they attribute falling to the aging process or because they fear being subsequently restricted in their activities or institutionalized. Reporting falls to clinicians is necessary for prevention of future falls.
When falls are not reported and preventive measures are not instituted, older adults are at risk of falling again, thereby placing a significant burden on the health care system. This burden is expected to increase given the projected growth of the aging population. Thus, implementing interventions such as fall prevention education and functional exercises (eg, to increase leg strength and balance) as well as injury mitigation strategies are imperative.
References
1. Colón-Emeric CS, McDermott CL, Lee DS, et al. Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review. JAMA. 2024;331(16):1397-1406. doi:10.1001/jama.2024.1416
2. U.S. Centers for Disease Control and Prevention (CDC). Older Adult Falls Data. Accessed June 12, 2025.
3. Kumar S, Cruz F, Yates Z, et al. Falls among older adults: An exploration of trends, clinical outcomes, predisposing risk factors, and intervention strategies. Am J Surg. 2025;245:116385. doi:10.1016/j.amjsurg.2025.116385
Etiology of Falls
The most consistent predictor of falling is a previous fall. However, falls in older adults rarely have a single cause or risk factor. A fall is usually multifactorial, caused by a complex interaction among the following:
Intrinsic factors (age-related decline in function, disorders, and adverse effects of medications)
Extrinsic factors (environmental hazards)
Situational factors (related to the specific activity or circumstances of an activity—eg, rushing to the bathroom in the middle of the night)
Intrinsic factors
Age-related changes can impair systems involved in maintaining balance and stability (eg, while standing, walking, or sitting) and increase the risk of falls. Visual acuity, contrast sensitivity, depth perception, and dark adaptation decline. Sensory loss or disturbances and cerebellar dysfunction can diminish postural reflexes and impair balance. Changes in muscle activation patterns and ability to generate sufficient muscle power and velocity may impair the ability to maintain or recover balance in response to perturbations (eg, stepping onto an uneven surface, being bumped). In fact, muscle weakness of any type is a major predictor of falls. As cognitive impairment increases with age, so does the risk of falls, partly because older adults with cognitive impairment may not remember to take the safety measures that reduce falls.
Chronic and acute disorders (see table Some Disorders That Contribute to Risk of Falls) and use of medications (see table Some Medications That Impact the Risk of Falls and Injuries) are major risk factors for falls. The risk of falls increases with the number of medications taken. Several classes of medications increase risk, but psychoactive medications are most commonly reported as increasing both risk of falls and fall-related injuries.
Risk of a traumatic fall that results in a fracture is increased by:
Osteoporosis and age-related changes in bone quality, which increase bone fragility
Loss of muscle (sarcopenia), which reduces protective responses to perturbations
Some Disorders That Contribute to Risk of Falls
Functional Impairment | Disorder |
|---|---|
Blood pressure regulation | Cardioinhibitory carotid sinus hypersensitivity COPD (chronic obstructive pulmonary disease) Dehydration Infections (eg, pneumonia, sepsis) Metabolic disorders (eg, diabetes, thyroid disorders, hypoglycemia, hyperosmolar states) Neurocardiogenic inhibition after micturition Orthostatic (postural) hypotension Postprandial hypotension |
Central processing | |
Gait | Foot deformities |
Postural and neuromotor function | Myelopathy (eg, due to cervical or lumbar spondylosis) Vertebrobasilar insufficiency |
Proprioception | Peripheral neuropathy (eg, due to diabetes mellitus) |
Otolaryngologic function | Acute labyrinthitis |
Vision | Macular degeneration (age-related) |
Some Medications That Impact the Risk of Falls and Injuries
Medication Class | Effect | Risk of Falls | Impact Injuries |
|---|---|---|---|
Aminoglycosides | Direct vestibular damage | Increases fall risk | — |
Analgesics (especially opioids) | Alertness or slow central processing | Increases fall risk | — |
Antiarrhythmics | Impaired cerebral perfusion | Increases fall risk | — |
Anticoagulants | Increase bleeding risk | — | Negative impact injury potential |
Anticholinergics | Confusion/delirium | Increases fall risk | — |
Antihypertensives (especially vasodilators) | Impaired cerebral perfusion | Increases fall risk | — |
Antipsychotics | Extrapyramidal syndromes, other antiadrenergic effects, reduced alertness, or slow central processing | Increases fall risk | — |
Diuretics (especially when patients are dehydrated) | Impaired cerebral perfusion | Increases fall risk | — |
Psychoactive medications (especially antidepressants, antipsychotics, and benzodiazepines) | Reduced alertness or slow central processing | Increases fall risk | — |
Osteoporosis treatments (calcium, vitamin D, bisphosphates and related medications)Osteoporosis treatments (calcium, vitamin D, bisphosphates and related medications) | Improve bone density | — | Reduces injury potential |
Extrinsic factors
Environmental factors can increase the risk of falls independently or, more importantly, by interacting with intrinsic factors. Risk is highest when the environment requires greater postural control and mobility (eg, when walking on a slippery surface) and when the environment is unfamiliar (eg, when relocated to a new home). Older adults who use mobility assistive devices are more likely to report a history of falls (1), reflecting the underlying mobility limitations and comorbidities that led to device prescription rather than the devices being inherently fall-promoting.
Situational factors
Certain activities or decisions may increase the risk of falls and fall-related injuries. Examples are:
Being distracted (eg, walking while talking or looking at a smart phone) and not noticing an environmental hazard (eg, a curb or step)
Rushing to the bathroom (especially at night when not fully awake or when lighting may be inadequate)
Using a ladder
Dementia can exacerbate many of these hazardous situations that lead to falls. Impaired cognition, judgment, and hazard awareness can cause older adults to become distracted, rush, and not notice environmental hazards, significantly increasing fall risk.
Etiology reference
1. West BA, Bhat G, Stevens J, Bergen G. Assistive device use and mobility-related factors among adults aged ≥ 65years. J Safety Res. 2015;55:147-150. doi:10.1016/j.jsr.2015.08.010
Evaluation of Fall Risks and Falls
Primarily history and physical examination
Performance testing
Sometimes laboratory testing
Clinicians should ask about previous falls as well as conditions, medications, and situational factors that increase fall risk. Fall risk assessment is aimed at identifying older adults who may be at risk for falls in order to implement preventive strategies. This assessment is not a physical exam but a structured review using questionnaires, observation, and targeted screening tools.
After treatment of acute injuries, assessment should aim to identify risk factors and appropriate interventions, in order to decrease the risk of future falls and fall-related injuries (1).
Some falls are promptly recognized because of an obvious fall-related injury or concern about a possible injury. However, because older adults often do not report falls, they should be asked about falls or mobility problems at every visit.
History and physical examination
When a more complete assessment of fall risk factors is needed, the focus is on identifying intrinsic, extrinsic, and situational factors that can be reduced by interventions targeted at them. However, eliminating all risk of future falls may be impossible.
Older adults should be asked open-ended questions about their most recent fall or falls, followed by more specific questions about when and where a fall occurred and what they were doing (situational risk factors). Witnesses are asked the same questions. Older adults should be asked whether they had premonitory or associated symptoms (eg, palpitations, shortness of breath, chest pain, vertigo, light-headedness) and whether consciousness was lost. Older adults should also be asked whether any obvious extrinsic or situational factors may have been involved. The history should include questions about past and present medical problems, use of prescription and over-the-counter medications, and use of alcohol or psychoactive medications. Older adults should be asked whether they were able to get back up without help after falling and whether any injuries occurred; the goal is reducing the risk of complications due to future falls.
The physical examination should be comprehensive enough to exclude obvious intrinsic causes of falls. If the fall occurred recently, temperature should be measured to determine whether fever was a factor. Heart rate and rhythm should be assessed to identify obvious bradycardia, resting tachycardia, or irregular rhythms. Auscultation can detect some cardiac valvular disorders. Blood pressure should be measured with older adults supine and after older adults stand for 1 and 3 minutes to exclude orthostatic hypotension. Visual acuity should be evaluated with older adults wearing their usual corrective lenses if needed. Abnormalities in visual acuity should trigger a more detailed visual examination by an optometrist or ophthalmologist. The neck, spine, and extremities (especially the legs and feet) should be evaluated for weakness, deformities, pain, and limitation in range of motion.
A neurologic examination should begin with a mental status examination to check for cognitive impairment. The neurologic examination also includes testing motor function (including muscle strength and tone and range of motion), sensation (including proprioception), coordination (including cerebellar function), stationary balance, and gait. Basic postural control and the proprioceptive and vestibular systems are evaluated using the Romberg test (in which older adults stand with feet together and eyes both open and closed). Tests to establish high-level balance function include the one-legged stance and tandem gait. If older adults can stand on one leg for 10 seconds with their eyes open and have an accurate 3-meter (10-feet) tandem gait, any intrinsic postural control deficit is likely to be minimal. Clinicians should evaluate positional vestibular function (eg, with the Dix-Hallpike maneuver—see Nystagmus).
Performance tests
A variety of standardized performance-based assessments are available to evaluate gait, balance, and lower extremity strength in older adults at risk for falls. An initial commonly used test to evaluate for a balance or gait problem is the basic Get-Up-and-Go Test (2). For this test, older adults are observed as they rise from a standard armchair, walk 3 meters (approximately 10 feet) in a straight line, turn, walk back to the chair, and sit back down. Observation may detect lower-extremity weakness, imbalance while standing or sitting, or an unsteady gait.
For adults who have difficulty doing the basic Get-Up-and-Go test, a timed version of the test may be performed (3). A time of > 12 seconds indicates a significantly increased risk of falls.
The Performance-Oriented Assessment of Mobility test can also identify problems with balance and stability during walking and other movements that may indicate increased risk of falls. The test includes quantitative scoring of various aspects of balance and gait and takes approximately 10 to 15 minutes to perform. Low scores predict increased risk of falls (see table Performance-Oriented Assessment of Mobility).
Laboratory tests
There is no standard diagnostic laboratory evaluation to determine the exact cause of a fall. Testing should be based on the history and examination results and helps exclude various causes. Some tests include:
A complete blood count (CBC) to exclude anemia or leukocytosis
Blood glucose measurement to exclude hypoglycemia or hyperglycemia
Electrolyte measurement to exclude dehydration
For peripheral neuropathies, CBC, blood glucose level, and electrolytes as well as folate, B12, and TSH levels
Other tests such as electrocardiography (ECG), ambulatory cardiac monitoring, and echocardiography are recommended only when a cardiac cause is suspected. Carotid massage under controlled conditions (IV access and cardiac monitoring) has been proposed to determine carotid hypersensitivity and ultimately who might respond to pacemaker treatment. Spinal radiographs and cranial CT or MRI are indicated only when the history and physical examination detect new neurologic abnormalities. An electromyography/nerve conduction study (EMG/NCS) may be performed if a neuropathy, myopathy, radiculopathy, or other peripheral nervous system disorder is suspected.
Evaluation references
1. US Preventive Services Task Force, Nicholson WK, Silverstein M, et al. Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2024;332(1):51-57. doi:10.1001/jama.2024.8481
2. Mathias S, Nayak US, Isaacs B. Balance in elderly patients: the "get-up and go" test. Arch Phys Med Rehabil. 1986;67(6):387-389.
3. Podsiadlo D, Richardson S. The timed "Up & Go": A test of basic functional mobility for frail elderly persons. J Am Geriatr Soc. 1991;39 (2), 142–148. https://doi.org/10.1111/j.1532-5415.1991.tb01616.x
Prevention of Falls and Injury Mitigation
The focus should be on preventing or reducing the number of future falls and fall-related injuries and complications while maintaining as much of the older adult’s function and independence as possible. In the periodic physical or wellness examination, older adults should be asked about falls in the past year and difficulty with balance or ambulation (1).
Older adults who report a single fall and who do not have problems with balance or gait on the Get-Up-and-Go Test or a similar test should be given general information about reducing risk of falls. The information should include how to use medications safely and reduce environmental hazards (see table Home Assessment Checklist).
Older adults who report more than one fall or a problem with balance or gait should receive a fall evaluation to identify risk factors and opportunities to lower risk.
While traditional fall management has emphasized prevention, it has been suggested that the focus on prevention may be inadequate (2). Rather, a more comprehensive approach that incorporates injury mitigation strategies may reduce morbidity and mortality when falls do occur. For example, severity of injuries from falls might be reduced if people wear hip pads. Screening for osteoporosis and supplementation with calcium and vitamin D when appropriate might reduce fracture risk from a fall. Implementing these strategies alongside traditional prevention approaches may reduce the morbidity and mortality associated with falls, while maintaining quality of life and functional independence (). Rather, a more comprehensive approach that incorporates injury mitigation strategies may reduce morbidity and mortality when falls do occur. For example, severity of injuries from falls might be reduced if people wear hip pads. Screening for osteoporosis and supplementation with calcium and vitamin D when appropriate might reduce fracture risk from a fall. Implementing these strategies alongside traditional prevention approaches may reduce the morbidity and mortality associated with falls, while maintaining quality of life and functional independence (3).
Home Assessment Checklist for Hazards That Increase Risk of Falling
Location | Hazard | Correction | Rationale |
|---|---|---|---|
General household | |||
Lighting | Too dim | Provide ample lighting in all areas | Improves visual acuity and contrast sensitivity |
Too direct, creating glare | Reduce glare with evenly distributed light, indirect lighting, or translucent shades | Improves visual acuity and contrast sensitivity | |
Inaccessible light switches | Provide night-lights or touch-activated lights Install switches that are immediately accessible when entering a room or motion sensors that activate lights | Reduces risk of tripping over or bumping into unseen obstacles in a dark room | |
Carpets, rugs, linoleum | Torn | Repair or replace torn carpet | Reduces risk of tripping and slipping, especially for people who have difficulty stepping |
Slippery | Provide rugs with nonskid backs | Reduces risk of slipping | |
Curled edges | Tack or tape down rugs or linoleum to prevent curling Replace rugs or linoleum | Reduces risk of tripping | |
Chairs, tables, other furnishings | Unstable | Provide furniture stable enough to support the weight of a person leaning on table edges or chair arms and backs Do not use chairs that have wheels or that swivel Repair legs that are loose | Increases support for people with impaired balance and helps with transferring |
Chairs without armrests | Provide chairs with armrests that extend forward enough to provide leverage when getting up or sitting down | Helps people with proximal muscle weakness and helps with transferring | |
Obstructed pathways | Arrange furnishings so that pathways are not obstructed Remove clutter from hallways | Reduces risk of tripping over or bumping into obstacles, making movement in the home easier and safer, especially for people with impaired peripheral vision | |
Wires and cords | Exposed in pathways | Tack cords above the floor or run beneath floor coverings | Reduces risk of tripping |
Kitchen | |||
Cabinets, shelves | Too high | Keep frequently used items at waist level Install shelves and cupboards at an accessible height | Reduces risk of falls due to frequent reaching or climbing on ladders or chairs |
Floors | Wet or waxed | Place a rubber mat on the floor in the sink area Wear rubber-soled shoes in the kitchen Use nonslip wax | Reduces risk of slipping, especially for people with a gait disorder |
Bathroom | |||
Bathtub or shower | Slippery tub or shower floor | Install skid-resistant strips or rubber mat Use shower shoes or a bath seat (a bath seat enables people with impaired balance to sit while showering) | Reduces risk of sliding on a wet tub or shower floor |
Need to use the side of the bathtub for support or transfer | Install grab bars in shower Install a portable grab bar on the side of the tub Take grab bar on trips | Helps with transferring | |
Towel racks, sink tops | Unstable for use as support while transferring from the toilet, tub, or shower | Fasten grab rails to wall studs | Helps with transferring |
Toilet seat | Too low | Use elevated toilet seat | Helps with transferring to and from the toilet |
Doors | Locks | Remove locks from bathroom doors or use locks that can be opened from both sides of the door | Enables other people to enter if a person falls |
Stairways | |||
Height | Height of steps too high | Correct step height to < 15 cm | Reduces risk of tripping, especially for people who have difficulty stepping |
Handrails | Missing | Install and anchor rails well on both sides of the stairway Use cylindrical rails placed 2.5–5 cm from the wall | Provides support and enables people to grasp the rail with either hand |
Too short and end of rail unclear | Extend beyond the top and bottom step and turn ends inward | Signals that the top or bottom step has been reached | |
Configuration | Too steep or too long | Install landings on stairways when feasible or select a residence with a stairway landing | Provides a rest stop, especially for people with heart or pulmonary disorders |
Condition | Slippery | Place nonskid treads securely on all steps | Prevents slipping |
Lighting | Inadequate | Install adequate lighting at both the top and bottom of stairway Provide night-lights or bright-colored adhesive strips to clearly mark steps | Outlines location of steps, especially for people with impaired vision or perception |
Physical therapy and exercise
Older adults who have fallen more than once or who have problems during initial balance and gait testing should be referred to physical therapy or an exercise program. Physical therapy and exercise programs can be done in the home if older adults have limited mobility.
Physical therapists customize exercise programs to improve balance and gait and to correct specific problems and underlying conditions contributing to fall risk (eg, Parkinson disease [4]). They also may provide walking aids and assistance devices, as well as provide important education and training on their use.
More general exercise programs in health care or community settings can also improve balance and gait. For example, tai chi may be effective and can be done alone or in groups. Beyond preventing falls, specific exercises can also mitigate injury severity if falls do occur. Training in proper falling techniques (such as tucking the chin to protect the head and learning to roll during a fall) and exercises that strengthen bones and increase muscle padding over vulnerable areas can significantly reduce injury risk. The most effective exercise programs to reduce fall risk are those that:
Are tailored to the older adult’s deficit
Are provided by a trained professional
Have a sufficient balance challenge component
Are provided over the long term (eg, ≥ 4 months)
Many senior citizen centers, fitness centers, or other health clubs offer free or low-cost group exercise classes tailored to senior citizens, and these classes can help with accessibility and adherence. The savings from decreased fall-related expenses exceed the costs of these programs (5).
Assistive devices
Some older adults benefit from use of an assistive device (eg, cane, walker). Canes may be adequate for older adults with minimal unilateral muscle or joint impairment, but walkers, especially wheeled walkers, are more appropriate for older adults with increased risk of falls attributable to bilateral leg weakness or impaired coordination (wheeled walkers can be dangerous for older adults who cannot control them properly). Physical therapists can help fit or size the devices and teach older adults how to use them. To mitigate injury potential, assistive devices should be regularly inspected for wear and damage, and older adults should be taught proper falling techniques while using these devices, including how to position the device during a fall to avoid additional injury from the device itself.
Advanced wearable assistive devices are emerging as promising technologies for fall reduction and injury mitigation. Hip protectors, which are specialized undergarments with padding over the greater trochanter, can reduce hip fracture risk during falls. Other technologies such as smart wearable belts that deploy airbags to protect the hips upon fall detection combine fall detection with protective mechanisms. These devices can be particularly beneficial for high-risk individuals who have poor balance control or a history of injurious falls.
Medical management
Medications should be regularly reviewed for their impact on both fall risk and injury potential (see table Some Medications That Impact the Risk of Falls and Injuries). Medications that increase fall risk should be stopped when possible, or the dosage should be adjusted to the lowest effective dose.
For example, anticoagulants increase bleeding risk and can negatively impact injury potential by increasing the severity of bleeding (eg, intracranial hemorrhage or exsanguination from lacerations) in the setting of a fall. For older adults requiring anticoagulants who are at high risk for falls, clinicians should regularly reassess the risk-benefit ratio of continuing these medications, considering alternative therapies or adjust dosing where appropriate. Older adults on anticoagulants should be educated about immediate first aid actions after falls to minimize bleeding risk, including applying pressure to wounds and seeking prompt medical attention even for seemingly minor injuries.
Osteoporosis treatments (eg, calcium, vitamin D, bisphosphonates, and related medications) improve bone density and can reduce fracture risk after falls. Routine bone density monitoring can help track treatment effectiveness and guide medication adjustments to optimize fracture resistance.Osteoporosis treatments (eg, calcium, vitamin D, bisphosphonates, and related medications) improve bone density and can reduce fracture risk after falls. Routine bone density monitoring can help track treatment effectiveness and guide medication adjustments to optimize fracture resistance.
If any other specific disorder is identified as a risk factor, targeted interventions are required. For example, medications and physical therapy may reduce risk for older adults with Parkinson disease. Pain management, physical therapy, and sometimes joint replacement surgery may reduce risk for older adults with arthritis. A change to appropriate lenses (single lenses rather than bifocals or trifocals) or surgery, particularly for removal of cataracts, may help older adults with visual impairment. Similarly, as a high proportion of falls occur when older adults are going to the bathroom, assessing ways to mitigate frequency, urgency, and incontinence are also important.
Environmental and situational management
Correcting environmental hazards in the home may reduce the risk of falls (see table Home Assessment Checklist). Environmental hazards that commonly increase fall risk, (eg, throw rugs, inadequate lighting, lack of grab bars and handrails, unstable furniture, clutter), should be mitigated or eliminated (6). Restraints may lead to more falls and other complications, and should generally not be used.
Older adults should also be advised on how to reduce risk due to situational factors. For example, footwear should have flat heels, some ankle support, and firm, nonskid midsoles. Many older adults with chronic limited mobility (eg, caused by severe arthritis or paresis) benefit from combined medical, rehabilitative, and environmental strategies. Wheelchair adaptations (eg, removable foot plates to reduce tripping during transfers, antitip bars to prevent backward tipping), removable belts, and wedge seating may prevent falls in older adults with poor sitting balance or severe weakness when they are sitting or transferring.
Impact-absorbing flooring such as firm rubber can dissipate force while maintaining walking stability, although excessively soft surfaces may create instability. Furniture with rounded edges and padded corners and strategic placement can break potential falls, provide handholds during balance loss events, and reduce impact injuries. Low-height beds and secured floor mats can reduce injury severity, particularly in institutional settings and for older adults with nighttime fall history. These modifications should be incorporated into comprehensive home safety assessments, with special attention to high-risk areas like bathrooms and stairways.
Older adults should also be taught what to do if they fall and cannot get up when they are alone. Useful techniques include turning from the supine position to the prone position, getting on all fours, crawling to a strong support surface, and pulling up. The following can decrease time on the floor after a fall:
Having frequent contact with family members or friends
A phone that can be reached from the floor
A remote alarm
A wearable alert device
Motion detectors (that monitor for inactivity or unsafe movement transitions)
Voice-activated smart speakers and AI (artificial intelligence) camera systems may be used to monitor seniors and alert caregivers about potential falls.
Combining human contact, wearable devices, and in-home monitoring can optimize the likelihood of a timely response to a fall.
Prevention references
1. US Preventive Services Task Force, Nicholson WK, Silverstein M, et al. Interventions to Prevent Falls in Community-Dwelling Older Adults: US Preventive Services Task Force Recommendation Statement. JAMA. 2024;332(1):51-57. doi:10.1001/jama.2024.8481
2. Kumar S, Cruz F, Yates Z, et al. Falls among older adults: An exploration of trends, clinical outcomes, predisposing risk factors, and intervention strategies. Am J Surg. 2025;245:11club85. doi:10.1016/j.amjsurg.2025.116385
3. Guirguis-Blake JM, Michael YL, Perdue LA, et al. Interventions to Prevent Falls in Older Adults: Updated Evidence Report and Systematic Review for the US Preventive Services Task Force. JAMA. 2018;319(16):1705-1716. doi:10.1001/jama.2017.21962
4. Allen NE, Sherrington C, Paul SS. Balance and falls in Parkinson's disease: A meta-analysis of the effect of exercise and motor training. Mov Disord. 2011;26 (9),1605–1615. doi.org/10.1002/mds.23790
5. Sherrington C, Fairhall N, Wallbank G, et al. Exercise for preventing falls in older people living in the community: an abridged Cochrane systematic review. Br J Sports Med. 2020;54 (15):885–891. doi: 10.1136/bjsports-2019-101512.
6. Gill T, Williams CS, Robison JT, Tinetti ME. Gill T, Williams CS, Robison JT, Tinetti ME: A population-based study of environmental hazards in the homes of older persons. Am J Public Health. 1999;89 (4), 553–556, 1999. doi.org/10.2105/ajph.89.4.553
Prognosis
In adults ≥ 65 years of age, falls are the leading cause of injury-related death (1). Falling, particularly falling repeatedly, increases risk of injury, hospitalization, and death in older adults who are frail and have preexisting disease comorbidities (eg, osteoporosis) and deficits in activities of daily living (eg, incontinence). Longer-term complications can include decreased physical function, fear of falling, and institutionalization.
Nearly all patients with hip fractures resulting from falls are hospitalized; most estimates cite > 95% of hip fractures result from falls (2). Women tend to fall more often than men (3), and approximately 75% of all hip fractures occur in women (2).
Approximately half of older adults who fall cannot get up without assistance (4). Remaining on the floor for> 2 hours after a fall increases the risk of dehydration, pressure injuries, rhabdomyolysis, hypothermia, and pneumonia.
Function and quality of life may deteriorate drastically after a fall; up to 60% of older adults do not recover their previous level of mobility (5). After falling, older adults may fear falling again, so mobility is sometimes reduced because confidence is lost. Some people may even avoid certain activities (eg, shopping, cleaning, socializing) because of this fear. Decreased activity can increase joint stiffness and weakness, further reducing mobility, as well as increasing psychological comorbidity (eg, depression).
Prognosis references
1. Colón-Emeric CS, McDermott CL, Lee DS, et al. Risk Assessment and Prevention of Falls in Older Community-Dwelling Adults: A Review. JAMA. 2024;331(16):1397-1406. doi:10.1001/jama.2024.1416
2. Stevens JA, Olson S. Reducing falls and resulting hip fractures among older women. MMWR Recomm Rep. 2000;49(RR-2):3-12.
3. Kakara R, Bergen G, Burns E, et al. Nonfatal and Fatal Falls Among Adults Aged ≥65 Years - United States, 2020-2021. MMWR Morb Mortal Wkly Rep. 2023;72(35):938-943. Published 2023 Sep 1. doi:10.15585/mmwr.mm7235a1
4. Gurley RJ, Lum N, Sande M, et al. Persons found in their homes helpless or dead. N Engl J Med. 1996;334(26):1710-1716. doi:10.1056/NEJM199606273342606
5. Haslam-Larmer L, Donnelly C, Auais M, et al. Early mobility after fragility hip fracture: a mixed methods embedded case study. BMC Geriatr. 2021;21(1):181. Published 2021 Mar 15. doi:10.1186/s12877-021-02083-3
Key Points
Each year in the United States, approximately 14 million adults age ≥ 65 report a fall.
A significant number of falls result in an injury, with approximately 37% of adults who fall report an injury that required medical treatment.
Causes are multifactorial and include age-related functional declines (eg, reduced vision, slowed reaction time, muscle weakness), chronic illnesses that impair balance and mobility (eg, Parkinson disease, arthritis, dementia), adverse effects of medications, and environmental hazards.
Use validated tools such as the Get-Up-and-Go Test to determine the need for fuller assessment of predisposing intrinsic, extrinsic, and situational factors.
To the extent possible, optimize treatment of comorbidities and contributing conditions, modify or eliminate causative medications, correct environmental hazards, utilize exercise and protective aids to mitigate fall related injuries.
Emphasize the need to eliminate environmental hazards that commonly increase fall risk (eg, throw rugs, inadequate lighting, lack of grab bars and handrails, unstable furniture, clutter).
Use multifactorial interventions for older adults who have fallen more than once or have abnormalities in initial gait or impaired balance; interventions include referral for physical therapy and exercise programs, which are most effective when tailored and continued for ≥ 4 months.
High-risk disorders such as Parkinson disease often require targeted treatment (eg, physical therapy, assistive devices) to reduce fall risk.
Teach older adults techniques to get up after a fall, especially when they are alone, and the importance of having a phone or emergency alert device accessible from the floor.
More Information
The following English-language resources may be useful. Please note that The Manual is not responsible for the content of these resources.
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