Falls in older adults

{{multiple|

{{missing information|prognosis/consequences, see e.g. [https://www.cdc.gov/falls/facts.html CDC fact sheet] & {{doi| 10.1007/s11556-013-0134-8}}|date=December 2022}}

}}

{{Infobox medical condition (new)

| name = Falls in older adults

| synonyms =

| image = Walker. frame.jpg

| alt =

| caption = Front-wheeled walker

| pronounce =

| field = Emergency medicine, gerontology

| symptoms =

| complications =

| onset =

| duration =

| types =

| causes =

| risks =

| diagnosis =

| differential =

| prevention =

| treatment =

| medication =

| prognosis =

| frequency =

| deaths =

}}

{{multiple image

| align = right

| direction = vertical

| header = Accidental deaths in the United States

| total_width = 300

| image1 = Accidental deaths 2020.webp

| caption1 = {{center|2020}}

| image2 = Accidental deaths 2004 in the United States.webp

| caption2 = {{center|2004}}

| footer =

}}

Falls in older adults are a significant cause of morbidity and mortality and are a major class of preventable injuries. Falling is one of the most common accidents that cause a loss of function, independence, and quality of life for older adults, and is usually precipitated by multiple risk factors.Eibling, D. (2018). Balance disorders in older adults.Clinics in GeriatricMedicine,4(2), 175–181. doi:10.1016/j.cger.2018.01.002Bao X., Qiu Q.-X., Shao Y.-J., Quiben M., Liu H. Effect of Sitting Ba-Duan-Jin Exercises on Balance and Quality of Life among Older Adults: A Preliminary Study. Rehabil. Nurs.. 2020;45(5):271-278. doi:10.1097/rnj.0000000000000219 The cause of falling in old age is often multifactorial, and a multidisciplinary approach may be needed both to prevent and to treat any injuries sustained. The definition of a "fall" tends to vary depending on who is reporting the fall and to whom. It is generally accepted that falling includes dropping from a high position to a low one, often quickly. But a fall does not necessarily mean falling to the ground: the individual could fall back into a chair or bed, and they may be assisted by another person to help slow down the fall and perhaps avoid injury. The severity of injury is generally related to the height of the fall and the individual's health: for example whether there is osteoporosis. The type of surface onto which the person falls is also important: harder surfaces can cause more severe injury. Sometimes falls can be prevented by ensuring that interior surfaces are dry and free of clutter, carpets are tacked down, paths are well lit, hearing and vision are optimized, dizziness is minimized, alcohol intake is moderated and shoes have low heels or rubber soles.{{Cite journal|last1=Chang|first1=Huan J.|date=2010-01-20|title=Falls and older adults|journal=JAMA|volume=303|issue=3|page=288|doi=10.1001/jama.303.3.288|pmid=20085959|issn=0098-7484|doi-access=free}} External surfaces are harder to control, but ideally to reduce falls, it can be helpful to walk on surfaces that are not wet or icy, are well lit, are flat; and to have hands and arms free to help regain balance or protect from a fall.

A review of clinical trial evidence by the European Food Safety Authority led to a recommendation that people over the age of 60 years should supplement their diet with vitamin D to reduce the risk of falling and bone fractures.{{Cite journal |title=Scientific Opinion on the substantiation of a health claim related to vitamin D and risk of falling pursuant to Article 14 of Regulation (EC) No 1924/2006 |journal=EFSA Journal |date=2011 |volume=9 |issue=9 |article-number=2382 |doi=10.2903/j.efsa.2011.2382|doi-access=free}} Falls are an important aspect of geriatric medicine. In 2018, the United States Preventive Service Task Force actually recommended against vitamin D supplementation to help prevent falls, citing lack of association or conflicting results between the supplement and reduced falls in older adults.[https://www.uspreventiveservicestaskforce.org/uspstf/document/evidence-summary/falls-prevention-in-older-adults-interventions-2018#bootstrap-panel--7] Rather, older adults should be screened for osteoporosis; and if diagnosed the need to slow or stop bone loss is paramount. This can be accomplished through proper nutrition, lifestyle changes, exercises, fall prevention strategies and some medications.
[https://www.niams.nih.gov/health-topics/osteoporosis/diagnosis-treatment-and-steps-to-take]

Definition

Other definitions are more inclusive and do not exclude "major intrinsic events" as a fall.{{cite web|url=https://www.ncbi.nlm.nih.gov/books/NBK2653/ |title=Fall and Injury Prevention – Patient Safety and Quality – NCBI Bookshelf |year=2008 |publisher=Ncbi.nlm.nih.gov |pmid=21328754 |access-date=2015-12-15|last1=Hughes |first1=R. G. |last2=Currie |first2=L. }} Falls are of concern within medical treatment facilities. Fall prevention is usually a priority in healthcare settings.{{Cite book|title=Mayo Clinic internal medicine board review.|date=2013|publisher=Oxford University Press |editor=Ficalora, Robert D. |editor2=Paul S. Mueller |editor3=Thomas J. Beckman |display-editors=etal |isbn=978-0-19-994894-9 |edition=10th |location=Oxford |page=762 |oclc=822991632}}

A 2006 review of literature identified the need for standardization of falls taxonomy due to the variation within research.{{Cite journal|vauthors=Hauer K, Lamb SE, Jorstad EC, Todd C, Becker C |year=2006|title=Systematic review of definitions and methods of measuring falls in randomised controlled fall prevention trials|journal=Age and Ageing|volume=35|issue=1|pages=5–10|doi=10.1093/ageing/afi218|pmid=16364930|doi-access=free}} The Prevention of Falls Network Europe (ProFane) taxonomy for the definition and reporting of falls aimed at mitigating this problem.{{Cite journal |vauthors=Lamb SE, Jørstad-Stein EC, Hauer K, Becker C |year=2005|title=Development of a Common Outcome Data Set for Fall Injury Prevention Trials: The Prevention of Falls Network Europe Consensus|journal=Journal of the American Geriatrics Society|volume=53|issue=9|pages=1618–1622|doi=10.1111/j.1532-5415.2005.53455.x|pmid=16137297|s2cid=19526374}} ProFane recommended that a fall be defined as "an unexpected event in which the participants come to rest on the ground, floor, or lower level." The ProFane taxonomy is currently used as a framework to appraise falls-related research studies in Cochrane Systematic Reviews.{{Cite journal|vauthors=Gillespie LD, Robertson MC, Gillespie WJ, Sherrington C, Gates S, Clemson LM, Lamb SE |year=2012|title=Interventions for preventing falls in older people living in the community|journal=Cochrane Database of Systematic Reviews |volume=2021|doi=10.1002/14651858.CD007146.pub3|pmid=22972103|pages=CD007146|issue=9|pmc=8095069}}{{Cite journal|vauthors=Hopewell S, Adedire O, Copsey BJ, Sherrington C, Clemson LM, Close JC, Lamb SE |year=2016|title=Multifactorial and multiple component interventions for preventing falls in older people living in the community (Protocol)|journal=Cochrane Database of Systematic Reviews |doi=10.1002/14651858.CD012221}}{{Cite journal |vauthors=Sherrington C, Tiedemann A, Fairhall NJ, Hopewell S, Michaleff ZA, Howard K, Clemson L, Lamb SE|title=Exercise for preventing falls in older people living in the community (Protocol)|journal=Cochrane Database of Systematic Reviews |doi=10.1002/14651858.CD012424|year=2016|s2cid=78199547}}

Signs and symptoms

Trauma
Soft tissue injuries. Bilateral orbital haematomas (two black eyes) suggests that the faller was probably not conscious as they fell, as they did not manage to protect their face as they hit the ground.
Fractures and dislocations. 5% of fallers end up having a fracture as a result of their fall, and 1% fracture their neck of femur{{Citation needed|date=May 2008}}.
Disuse atrophy and muscle wasting from reduced physical activity during recovery periods
Due to bed rest
Pneumonia
Pressure sores
Dehydration
Hypothermia
A fear of fallingDepartment of Health, National service framework for older people; Standard 6 – Falls, Crown Copyright, 24 May 2001, [http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4003066] accessed:19/5/2008

Causes

Falls are often caused by a number of factors such as intrinsic vs extrinsic or modifiable vs non-modifiable. The older adult who may fall could have risk factors for falling and only have problems when another factor appears. As such, management is often tailored to treating the factor that caused the fall, rather than all of the risk factors a patient has for falling. Risk factors may be grouped into intrinsic factors, such as existence of a specific ailment or disease. External or extrinsic factors include the environment and the way in which it may encourage or deter accidental falls. Such factors as lighting and illumination, personal aid equipment and floor traction are all important in fall prevention.

Modifiable risk factors can include items such as gait, strength, and balance deficits, medication used, home hazards, orthostatic hypotension, vision and hearing problems, foot issues or inappropriate footwear and the presence of comorbidities. This is the basis the US Center for Disease Control (CDC) STEADI (STEADI-Stopping Elderly Accidents, Deaths and Injuries) fall prevention initiative. [https://www.cdc.gov/steadi/hcp/clinical-resources/index.html] Evidence supports the need for early identification or screening for fall risk, assessment of fall risk factors for the appropriate referral to evidence-based interventions that are patient-specific [https://www.cdc.gov/steadi/media/pdfs/STEADI-Algorithm-508.pdf]

=Intrinsic factors=

Balance and gait
Organ and physiologic changes occur with age, such as muscle strength, the nervous system (which impacts balance, gait, vision and hearing) [https://www.sciencedirect.com/science/article/abs/pii]
As a result of stroke disease, Parkinsonism, arthritic changes, neuropathy, neuromuscular disease or vestibular disease.
Visual motor reaction time problems
An extended reaction time will delay responses and compensations to standing or walking imbalances, thus increasing the likelihood of falls.
Medications
Polypharmacy is common in older people
Sedatives significantly increase the risk of falling
Cardiovascular medications can contribute towards falls
There is a list of high-risk medication related to falls in older adults that is derived from the Beer's list; general categories include antihypertensives, antihistamines, benzodiazepines, sedatives, antihyperglycemics and anticonvulsants [https://www.cdc.gov/steadi/media/pdfs/STEADI-FactSheet-MedsLinkedtoFalls-508.pdf]
Visual impairment
Visual impairments, glaucoma, macular degeneration and retinopathy increase the risk of falling and of hip fractures.
Bifocals and trifocals can increase the risk of falling as the lower portion of corrective lenses are optimized for distances approximately {{cvt|18|in|cm}}, thus precluding clear vision of one's feet/floor, approximately {{cvt|4.5-5.5|ft}} below one's eyes.
Cognitive problems
Dementia increases the likelihood of falls
Cardiovascular causes
Orthostatic hypotension
Postprandial hypotension
Carotid sinus syndrome
Neurocardiogenic syncope– the commonest cause of syncope in A&E patients
Cardiac arrhythmias
Structural heart disease, such as valvular heart disease

=Extrinsic factors=

File:Tokyu 5050 series EMU 001.JPGs with triangular handles in a modern Japanese commuter train]]

File:Passenger compartment Class 440.jpg catering for mainly seated passengers]]

Image:BMF Geländer.jpg

Poor lighting due to low luminance of existing lights or lamps, so preventing hazard identification and avoidance. Eyesight deteriorates with age, and extra lighting will be needed where seniors move frequently. The luminance provided by the bulbs used should be higher than normally accepted.
Stairs with inadequate handrails, or too steep, encouraging trips and falls. The steps should be spaced widely with low risers, and surfaces should be slip-resistant. Softer surfaces can help limit impact injuries by cushioning loads.
Doorways with adequate headroom so that the user's head does not hit the lintel. Doorways of low headroom (less than about {{cvt|6|ft}}) are common in old houses and cottages for example.
Rugs/floor surfaces with low friction, causing poor traction and individual instability. All surfaces should have a high friction coefficient with shoe soles and limited clutter.
Clothing/footwear poorly fitted, shoes of low friction against floor. Rubber soles with ribs normally have a high friction coefficient, so are preferred for most purposes. Clothing should fit the user well, without trailing parts (hems falling below the heel and loose shoelaces) which could snag with obstacles.
Lack of equipment/aids such as walking sticks or walking frames, such as Zimmer frames so as to improve user stability. Grab bars and hanging straps should be supplied plentifully, especially in critical areas where users may be vulnerable.

Diagnosis

When assessing a person who has fallen, an eyewitness account of the incident is helpful. However the person who fell may have been temporarily unconscious, and may not be able to give an accurate description of the fall. In practice, these eyewitness accounts are often unavailable.

;Important points of inquiry

Visual motor reaction time
Frequency of falls
Effectiveness of "parachute" corrective response of moving hand and arm to "break" the fall
Eyewitness account
Associated features
Risk factors for falling
Legal and illegal drug interactions
Sedative and alcohol consumption
Assessment of proper, safe use of cane or walker assistive devices

Prevention

The relationship between the person at risk of falling and their environment is important for determining the risk falls and taking measures to prevent falls. An assessment with an occupational therapist may be helpful to determine an appropriate rehabilitation plan to prevent falls by taking into consideration both the person and their living environment.{{Cite web|url=https://www.cdc.gov/steadi/pdf/STEADI-Algorithm-a.pdf|title=Resource: Algorithm for Fall Risk Screening, Assessment, and Intervention|date=2017|publisher=Centers for Disease Control and Prevention|archive-url=https://web.archive.org/web/20171231212220/https://www.cdc.gov/steadi/pdf/STEADI-Algorithm-a.pdf|archive-date=2017-12-31|access-date=31 December 2017}} A large body of evidence shows that efforts to include exercise decrease the risk of falls,{{cite journal|last1=Tricco|first1=AC|last2=Thomas|first2=SM|last3=Veroniki|first3=AA|last4=Hamid|first4=JS|last5=Cogo|first5=E|last6=Strifler|first6=L|last7=Khan|first7=PA|last8=Robson|first8=R|last9=Sibley|first9=KM|last10=MacDonald|first10=H|last11=Riva|first11=JJ|last12=Thavorn|first12=K|last13=Wilson|first13=C|last14=Holroyd-Leduc|first14=J|last15=Kerr|first15=GD|last16=Feldman|first16=F|last17=Majumdar|first17=SR|last18=Jaglal|first18=SB|last19=Hui|first19=W|last20=Straus|first20=SE|title=Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis.|journal=JAMA|date=7 November 2017|volume=318|issue=17|pages=1687–1699|doi=10.1001/jama.2017.15006|pmid=29114830|pmc=5818787}}{{cite journal|last1=Grossman|first1=David C.|last2=Curry|first2=Susan J.|last3=Owens|first3=Douglas K.|last4=Barry|first4=Michael J.|last5=Caughey|first5=Aaron B.|last6=Davidson|first6=Karina W.|last7=Doubeni|first7=Chyke A.|last8=Epling|first8=John W.|last9=Kemper|first9=Alex R.|last10=Krist|first10=Alex H.|last11=Kubik|first11=Martha|last12=Landefeld|first12=Seth|last13=Mangione|first13=Carol M.|last14=Pignone|first14=Michael|last15=Silverstein|first15=Michael|last16=Simon|first16=Melissa A.|last17=Tseng|first17=Chien-Wen|title=Interventions to Prevent Falls in Community-Dwelling Older Adults|journal=JAMA|date=24 April 2018|volume=319|issue=16|pages=1696–1704|doi=10.1001/jama.2018.3097|pmid=29710141|doi-access=free}} and yet the fear of falling can lead to a decrease in participation in physical exercise.{{Cite journal|last1=E|first1=Jian-Yu|last2=Li|first2=Tianjing|last3=McInally|first3=Lianne|last4=Thomson|first4=Katie|last5=Shahani|first5=Uma|last6=Gray|first6=Lyle|last7=Howe|first7=Tracey E.|last8=Skelton|first8=Dawn A.|date=2020-09-03|title=Environmental and behavioural interventions for reducing physical activity limitation and preventing falls in older people with visual impairment|journal=The Cochrane Database of Systematic Reviews|volume=2020|issue=9 |pages=CD009233|doi=10.1002/14651858.CD009233.pub3|issn=1469-493X|pmid=32885841|pmc=8095028}}

Possible interventions to prevent falls include:

= Environmental adaptations =

Improvements to the person's environment such as their home or workplace may help to reduce the risk of falling.{{Cite journal |last=Clemson |first=Lindy |last2=Stark |first2=Susan |last3=Pighills |first3=Alison C |last4=Fairhall |first4=Nicola J |last5=Lamb |first5=Sarah E |last6=Ali |first6=Jinnat |last7=Sherrington |first7=Catherine |date=2023-03-10 |editor-last=Cochrane Bone, Joint and Muscle Trauma Group |title=Environmental interventions for preventing falls in older people living in the community |url=http://doi.wiley.com/10.1002/14651858.CD013258.pub2 |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=3 |doi=10.1002/14651858.CD013258.pub2 |pmc=9998238 |pmid=36893804}}

A review of the current living conditions
Adding safety devices, such as grab handles, high friction floors, as well as low power lighting at night to the person's home or work environment
Identify and remove potential hazards
Vision improvement

= Behavioral interventions =

Regular exercise: lower limb strengthening exercise to increase muscle strength.{{Cite journal|last1=Ishigaki|first1=Erika Y.|last2=Ramos|first2=Lidiane G.|last3=Carvalho|first3=Elisa S.|last4=Lunardi|first4=Adriana C.|date=2016-11-08|title=Effectiveness of muscle strengthening and description of protocols for preventing falls in the elderly: a systematic review|journal=Brazilian Journal of Physical Therapy|volume=18|issue=2|pages=111–118|doi=10.1590/S1413-35552012005000148|issn=1809-9246|pmc=4183251|pmid=24760166}} Other forms of exercise, such as those involving gait, balance, co-ordination and functional tasks, may also help improve balance in older adults.{{Cite journal|pmid=22071817|year=2011|last1=Howe|first1=T. E.|title=Exercise for improving balance in older people|journal=The Cochrane Database of Systematic Reviews|issue=11|pages=CD004963|last2=Rochester|first2=L|last3=Neil|first3=F|last4=Skelton|first4=D. A.|last5=Ballinger|first5=C|doi=10.1002/14651858.CD004963.pub3|url=https://www.researchgate.net/publication/5901465|pmc=11493176}}
A 2014 review concluded that exercise interventions may reduce fear of falling (FOF) in community-dwelling older adults immediately after the intervention, without evidence of long-term effects.{{Cite journal|vauthors=Kendrick D, Kumar A, Carpenter H, Zijlstra G, Skelton DA, Cook JR, Stevens Z, Belcher CM, Haworth D, Gawler SJ, Gage H, Masud T, Bowling A, Pearl M, Morris RW, Iliffe S, Delbaere K|year=2014|title=Exercise for reducing fear of falling in older people living in the community|journal=Cochrane Database of Systematic Reviews|volume=Art. No.: CD009848|issue=11|pages=CD009848|doi=10.1002/14651858.CD009848.pub2|pmid=25432016|pmc=7388865|url=http://eprints.nottingham.ac.uk/47632/1/Kendrick%20Coch%20Data%20Syst%20Rev%202014.pdf|access-date=2018-11-10|archive-date=2018-07-20|archive-url=https://web.archive.org/web/20180720012901/http://eprints.nottingham.ac.uk/47632/1/Kendrick%20Coch%20Data%20Syst%20Rev%202014.pdf}}
Monitoring of medications and ongoing medical problems. For example, people with polymyalgia rheumatica often take long-term steroids, leading to osteoporosis. Research in the UK has also suggested that these people would benefit from a falls assessment when first diagnosed, and regular treatment reviews.{{Cite journal |date=2022-06-21 |title=Polymyalgia rheumatica: treatment reviews are needed |url=https://evidence.nihr.ac.uk/alert/polymyalgia-rheumatica-treatment-reviews-and-falls-assessment/ |access-date=2022-08-05 |website=NIHR Evidence |doi=10.3310/nihrevidence_51304 |s2cid=251774691 |language=en-GB}}{{Cite journal |vauthors=Sokhal BS, Hider SL, Paskins Z, Mallen CD, Muller S |date=2021 |title=Fragility fractures and prescriptions of medications for osteoporosis in patients with polymyalgia rheumatica: results from the PMR Cohort Study |journal=Rheumatology Advances in Practice |volume=5 |issue=3 |pages=rkab094 |article-number=rkab094 |doi=10.1093/rap/rkab094 |doi-access=free |pmc=8712242 |pmid=34988356}}
Improvements to footwear and use of orthotic devices if required.{{Cite journal|last1=Tricco|first1=Andrea C.|last2=Thomas|first2=Sonia M.|last3=Veroniki|first3=Areti Angeliki|last4=Hamid|first4=Jemila S.|last5=Cogo|first5=Elise|last6=Strifler|first6=Lisa|last7=Khan|first7=Paul A.|last8=Robson|first8=Reid|last9=Sibley|first9=Kathryn M.|last10=MacDonald|first10=Heather|last11=Riva|first11=John J.|date=2017-11-07|title=Comparisons of Interventions for Preventing Falls in Older Adults|journal=JAMA|volume=318|issue=17|pages=1687–1699|doi=10.1001/jama.2017.15006|issn=0098-7484|pmc=5818787|pmid=29114830}}
Supplementation with vitamin D is not recommended in those without vitamin D deficiency for fall prevention in older adults.

= Psychological interventions =

Cognitive behavioral therapy (CBT) has been suggested as a prevention approach to improve confidence and help older people reduce the fear of falling. There is moderate evidence to suggest that this technique can be effective at reducing the fear of falling for up to and beyond 6 months.{{Cite journal |last=Lenouvel |first=Eric |last2=Ullrich |first2=Phoebe |last3=Siemens |first3=Waldemar |last4=Dallmeier |first4=Dhayana |last5=Denkinger |first5=Michael |last6=Kienle |first6=Gunver |last7=Zijlstra |first7=G A Rixt |last8=Hauer |first8=Klaus |last9=Klöppel |first9=Stefan |date=2023-11-15 |editor-last=Cochrane Bone, Joint and Muscle Trauma Group |title=Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community |url=http://doi.wiley.com/10.1002/14651858.CD014666.pub2 |journal=Cochrane Database of Systematic Reviews |language=en |volume=2023 |issue=11 |doi=10.1002/14651858.CD014666.pub2 |pmc=10646947 |pmid=37965937}} CBT appears to have a positive effect on activity avoidance and risk of depression; however, it is not clear whether CBT reduces the incidence of falls in older people.

= Interventions to minimize the consequences of falls =

Hip protectors may decrease risk of hip fractures slightly, although they may slightly increase the risk of a pelvic fracture in older adults living in nursing care facilities. Little or no effect reported on other fractures or falls.{{Cite journal|last1=Santesso|first1=Nancy|last2=Carrasco-Labra|first2=Alonso|last3=Brignardello-Petersen|first3=Romina|date=2014-03-31|title=Hip protectors for preventing hip fractures in older people|journal=The Cochrane Database of Systematic Reviews|volume=3|issue=3|pages=CD001255|doi=10.1002/14651858.CD001255.pub5|issn=1469-493X|pmid=24687239|s2cid=27652715 |pmc=10754476}}
Treatment for osteoporosis

=Hospital=

People who are hospitalized are at risk for falling. A randomized trial showed that use of a tool kit reduced falls in hospitals. Nurses complete a valid fall risk assessment scale. From that, a software package develops customized fall prevention interventions to address patients' specific determinants of fall risk. The kit also has bed posters with brief text and an accompanying icon, patient education handouts, and plans of care, all communicating patient-specific alerts to key stakeholders.{{Cite journal|title = Fall prevention in acute care hospitals: A randomized trial|journal = JAMA|date = 2010-11-03|issn = 0098-7484|pmc = 3107709|pmid = 21045097|pages = 1912–1918|volume = 304|issue = 17|doi = 10.1001/jama.2010.1567 |vauthors=Dykes PC, Carroll DL, Hurley A, Lipsitz S, Benoit A, Chang F, Meltzer S, Tsurikova R, Zuyov L, Middleton B }}

= Screening =

The American Geriatrics Society and the British Geriatrics Society recommend that all older adults should be screened for "falls in the past year". Fall history is the strongest risk factor associated with subsequent falls.{{cite journal|last1=DK|first1=Kiely|title=Identifying nursing home residents at risk of falling|journal=Journal of the American Geriatrics Society|volume=46|issue=5|pages=551–555|date=1998|pmid=9588366|doi=10.1111/j.1532-5415.1998.tb01069.x|s2cid=13118673}} Older people who have experienced at least one fall in the last 6 months, or who believe that they may fall in the coming months, should be evaluated with the aim of reducing their risk of recurrent falls.{{cite journal|last1=Rodríguez-Molinero|first1=Alejandro|title=A two-question tool to assess the risk of repeated falls in the elderly|journal=PLOS ONE|date=2017|volume=10|issue=12(5)|pages=e0176703|doi=10.1371/journal.pone.0176703|pmid=28489888|pmc=5425174|bibcode=2017PLoSO..1276703R|doi-access=free}}

Many health institutions in the USA have developed screening questionnaires. Enquiry includes difficulty with walking and balance, medication use to help with sleep/mood, loss of sensation in feet, vision problems, fear of falling, and use of assistive devices for walking.

Older adults who report falls should be asked about their circumstances and frequency to assess risks from gait and balance which may be compromised. A clinician performs a fall risk assessment, to include history, physical exam, functional capability, and environment.{{cite web|title=Clinical Practice Guideline: Prevention of Falls in Older Persons|publisher=The American Geriatrics Society |url=http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/prevention_of_falls_summary_of_recommendations|date=2016}}

= Population-based interventions =

Prevention approaches that target the whole population of older people in a particular area are defined as population-based interventions. These include policies put in place by governments for vitamin supplementation, maintenance programs to reduce risks in public spaces and homes, public health programs offering exercise classes and sharing resources widely (not just to people identified as being high risk), improving access to gyms (for example allowing seniors to access a gym for free if over a certain age).{{Cite journal |last=Lewis |first=Sharon R |last2=McGarrigle |first2=Lisa |last3=Pritchard |first3=Michael W |last4=Bosco |first4=Alessandro |last5=Yang |first5=Yang |last6=Gluchowski |first6=Ashley |last7=Sremanakova |first7=Jana |last8=Boulton |first8=Elisabeth R |last9=Gittins |first9=Matthew |last10=Spinks |first10=Anneliese |last11=Rapp |first11=Kilian |last12=MacIntyre |first12=Daniel E |last13=McClure |first13=Roderick J |last14=Todd |first14=Chris |date=2024-01-05 |editor-last=Cochrane Bone, Joint and Muscle Trauma Group |editor2-last=Cochrane Public Health Group |title=Population-based interventions for preventing falls and fall-related injuries in older people |url=http://doi.wiley.com/10.1002/14651858.CD013789.pub2 |journal=Cochrane Database of Systematic Reviews |language=en |volume=2024 |issue=1 |doi=10.1002/14651858.CD013789.pub2 |pmc=10767771 |pmid=38180112}} The evidence supporting population-based interventions is weak. It is not clear if population-based interventions that improve access to medications or nutritional program are effective.

Epidemiology

The incidence of falls increases progressively with age. According to the existing scientific literature, around one-third of the elderly population experience one or more falls each year, while 10% experience multiple falls annually. For people over 80, the annual incidence of falls can reach 50%.{{cite journal|last1=Tinetti|title=Risk Factors for Falls among Elderly Persons Living in the Community|journal=N Engl J Med|volume=319|date=1988|issue=26|pages=1701–7|pmid=3205267|doi=10.1056/NEJM198812293192604}}{{cite journal|last1=Nevitt|title=Risk factors for recurrent nonsyncopal falls. A prospective study|journal=JAMA|date=1989|volume=261|issue=18|pages=2663–68|pmid=2709546|doi=10.1001/jama.1989.03420180087036}}{{cite journal|last1=Rodríguez-Molinero|title=Falls in the Spanish elderly population: Incidence, consequences and risk factors|journal=Rev Esp Geriatr Gerontol|date=2015|volume=50|issue=6|pages=274–80|pmid=26168776|doi=10.1016/j.regg.2015.05.005}}{{cite journal|last1=Rapp|title=Fall incidence in Germany: results of two population-based studies, and comparison of retrospective and prospective falls data collection methods|journal=BMC Geriatr|date=2014|volume=14|page=105|doi=10.1186/1471-2318-14-105|pmid=25241278|pmc=4179843 |doi-access=free }}{{cite journal|last1=Shumway-Cook|title=Falls in the Medicare population: incidence, associated factors, and impact on health care|journal=Phys Ther|date=2009|volume=89|issue=4|pages=324–32|doi=10.2522/ptj.20070107|pmid=19228831|pmc=2664994}}

History

Researchers have tried to create a consensual definition of a fall since the 1980s. Tinneti et al. defined a fall as "an event which results in a person coming to rest unintentionally on the ground or other lower level, not as a result of a major intrinsic event (such as a stroke) or overwhelming hazard."{{cite journal |vauthors=Tinetti ME, Speechley M, Ginter SF | date = Dec 1988 | title = Risk factors for falls among elderly persons living in the community | journal = N Engl J Med | volume = 319 | issue = 26| pages = 1701–7 | pmid = 3205267 | doi=10.1056/NEJM198812293192604}}

Economics

The health care impact and costs of falls in older adults are significantly rising all over the world. The cost of falls is categorized into two aspects: direct cost and indirect cost.

Direct costs are what patients and insurance companies pay for treating fall-related injuries. This includes fees for the hospital and nursing home, doctors and other professional services, rehabilitation, community-based services, use of medical equipment, prescription drugs, changes made to home and insurance processing.

Indirect costs include the loss of productivity of family caregivers and long-term effects of fall-related injuries such as disability, dependence on others and reduced quality of life.

In the United States alone, the total cost of falling injuries for people 65 and older was $31 billion in 2015.{{needs update|date=April 2025}} The costs covered millions of hospital emergency room visits for non-fatal injuries and more than 800,000 hospitalizations. By 2030, the annual number of falling injuries is expected to be 74 million older adults.{{cite web|title=Costs of Falls Among Older Adults|url=https://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html|publisher=Centers for Disease Control and Prevention, Home and Recreational Safety, U.S. Department of Health & Human Services, Bethesda, MD|date=2016|access-date=2 December 2016}}{{needs update|date=April 2025}}

Research

Furthermore, a 2012 systematic review has demonstrated that performing dual-task tests (for example, combining a walking task with a counting task) may help in predicting which people are at an increased risk of a fall.{{cite journal | author = Sarofim M | year = 2012 | title = Predicting falls in the elderly: do dual-task tests offer any added value? A systematic review | journal = Australian Medical Student Journal | volume = 3 | issue = 2| pages = 13–19 }}

References

External links

{{Medical resources

| DiseasesDB =

| ICD10 = {{ICD10|R29.6}}

| ICD9 =

| ICDO =

| OMIM =

| MedlinePlus =

| MeSH =

| GeneReviewsNBK =

| GeneReviewsName =

}}

[http://www.networkofcare.org/library/Morse%20Fall%20Scale.pdf Morse Fall Assessment] An assessment tool to determine and quantify persons as low, mid, and high risk for falls.
[https://www.cdc.gov/HomeandRecreationalSafety/Falls/index.html Older Adult Falls] – Centers for Disease Control and Prevention

Category:Geriatrics

Older adults

Category:Causes of death

Category:Injuries