Falls are often multifactorial in origin.  The presence of the following factors is associated with greater probability of future falls,   and falls screening guidelines suggest identification of these characteristics in at-risk people can be useful in the implementation of falls prevention strategies:
Polypharmacy or certain medicines (particularly psychotropic medicines) 
Impairment of activities of daily living 
Environmental hazards (e.g., loose rugs, poor lighting, clutter) 
Additional factors such as age or comorbid illnesses. 
Key components of many fall-prevention programmes include addressing the risk factors, advocating exercise (including strength and balance training), review of medicines taken, vision assessment, and a home safety assessment, with modifications as deemed necessary.  The United States Preventive Services Task Force, for example, recommends exercise (e.g., tai chi or yoga) or physical therapy, plus vitamin D supplementation, for prevention of falls in community-dwelling adults ≥65 years of age who are at increased risk of falls.   Meta-analyses of vitamin D supplementation has not shown benefit in terms of reduction of falls.  A network meta-analysis found the following interventions were more effective than usual care at preventing falls that result in injuries: 
Combined exercise, vision assessment and treatment
Combined exercise, vision assessment and treatment, environmental assessment and modification
Combined clinic-level quality-improvement strategies (e.g., case management), multifactorial assessment and treatment, calcium supplementation, and vitamin D supplementation.
Several guidelines have examined the implementation of such interventions to prevent falls:
Falls are the leading cause of death due to unintentional injury in people aged 65 and older in the US, constituting 55% of all cases.  Data collected between 2000-2013 demonstrate that this rate has been increasing. In 2012-2013, the rate of death due to falls among people aged 85 and over was 4 times higher than among people aged 75-84, and 16 times higher than among people aged 65-74.
In the US, 1 in 5 falls in older individuals results in serious injury.  Annually, 2.5 million older people are treated in the emergency department because of falls, with 700,000 subsequently admitted to hospital, 250,000 of whom are admitted for hip fracture. 
Identifying the circumstances surrounding, and the symptoms associated with, a fall helps to determine the underlying cause, which in turn emphasises the importance of obtaining a detailed history of the fall. Identifying the cause will determine whether a more urgent medical evaluation is necessary to address life-threatening causes of falls and their consequences. This investigation will also help to identify the risk factor(s) most likely to be contributing to falls and allow the implementation of appropriate interventions to reduce the risk of future falls.
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Geriatric Medicine Fellowship Program Director
Center for Geriatric Medicine, Medicine Institute
RF is a Pfizer stockholder.
Professor of Medicine
Division of Geriatric Medicine
Saint Louis University
DT declares that he has no competing interests.
Nuffield Department of Medicine
John Radcliffe Hospital
AD declares that he has no competing interests.
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