Assessment of falls in the elderly

Older adults aged ≥65 years are more likely to fall than younger adults (OR 2.84 [1.77-4.53]).[1]Just KS, Dormann H, Schurig M, et al. The phenotype of adverse drug effects: do emergency visits due to adverse drug reactions look different in older people? Results from the ADRED study. Br J Clin Pharmacol. 2020 Nov;86(11):2144-54. https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.14304 http://www.ncbi.nlm.nih.gov/pubmed/32250457?tool=bestpractice.com Falls are often multifactorial in origin.[2]Deandrea S. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010 Sep;21(5):658-68. http://www.ncbi.nlm.nih.gov/pubmed/20585256?tool=bestpractice.com 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 topic primarily focuses on evaluation of falls in community-dwelling older adults.

Globally, mortality rates due to falls increased between 1990 and 2019.[3]GBD 2019 Ageing Collaborators. Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study. BMJ. 2022 Mar 10;376:e068208. https://www.doi.org/10.1136/bmj-2021-068208 http://www.ncbi.nlm.nih.gov/pubmed/35273014?tool=bestpractice.com Falls are the second leading cause of unintentional injury deaths worldwide.[4]World Health Organization. Falls. Fact sheets. Apr 2021 [internet publication]. https://www.who.int/news-room/fact-sheets/detail/falls Each year an estimated 684,000 individuals die from falls, of which over 80% are in low- and middle-income countries.[4]World Health Organization. Falls. Fact sheets. Apr 2021 [internet publication]. https://www.who.int/news-room/fact-sheets/detail/falls  

In England from 2020 to 2021, there were more than 2023 per 100,000 accident and emergency hospital admissions related to falls in patients aged ≥65 years, with 5174 per 100,000 in patients aged ≥80 years.[5]Office for Health Improvement & Disparities. Public health profiles (Counties and UAs from April 2021) [internet publication]. https://fingertips.phe.org.uk/search/falls#page/0/gid/1/pat/6/ati/402/are/E06000015/iid/92732/age/28/sex/4/cat/-1/ctp/-1/yrr/5/cid/4/tbm/1/page-options/ovw-do-0 Hip fracture has been associated with an increased 1-year mortality of between 18% and 33%, and affects daily living activities such as shopping and walking.[6]Public Health England. Guidance - falls: applying All Our Health. Feb 2022 [internet publication]. https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health

In the US, falls are the most common cause of trauma injury and the leading cause of death due to unintentional injury in people aged ≥65.[7]Burns E, Kakara R. Deaths from falls among persons aged ≥65 years - United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):509-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944976 http://www.ncbi.nlm.nih.gov/pubmed/29746456?tool=bestpractice.com [8]American College of Surgeons. Best practices guidelines​: geriatric trauma management. Nov 2023 [internet publication]. https://www.facs.org/quality-programs/trauma/quality/best-practices-guidelines ​ One in four older adults report falling at least once yearly, leading to approximately 3 million emergency department visits. Data collected from 2007 to 2016 demonstrate that this rate has been increasing by approximately 3% per year.[7]Burns E, Kakara R. Deaths from falls among persons aged ≥65 years - United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):509-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944976 http://www.ncbi.nlm.nih.gov/pubmed/29746456?tool=bestpractice.com Almost all age and demographic categories experienced an increase, but the greatest increase was noted in individuals aged 85 and older. The death rate from falls was also higher in this age group.[7]Burns E, Kakara R. Deaths from falls among persons aged ≥65 years - United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):509-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944976 http://www.ncbi.nlm.nih.gov/pubmed/29746456?tool=bestpractice.com