Evaluation of falls in the elderly

Older adults ages ≥65 years are more likely to fall than younger adults.[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 [2]Talbot LA, Musiol RJ, Witham EK, et al. Falls in young, middle-aged and older community dwelling adults: perceived cause, environmental factors and injury. BMC Public Health. 2005 Aug 18;5:86. https://bmcpublichealth.biomedcentral.com/articles/10.1186/1471-2458-5-86 http://www.ncbi.nlm.nih.gov/pubmed/16109159?tool=bestpractice.com ​​ Falls are often multifactorial in origin.[3]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 a fall, and the symptoms associated with the fall, helps to determine the underlying cause, which in turn emphasizes 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.[4]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.[5]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.[5]World Health Organization. Falls. Fact sheets. Apr 2021 [internet publication]. https://www.who.int/news-room/fact-sheets/detail/falls

In the US, unintentional falls are the most common cause of injury, and death from injury, in people ages ≥65.[6]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 Sep 1;72(35):938-43. https://www.cdc.gov/mmwr/volumes/72/wr/mm7235a1.htm http://www.ncbi.nlm.nih.gov/pubmed/37651272?tool=bestpractice.com ​​[7]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 ​​​ Nearly one in four older adults reported falling in 2020.[6]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 Sep 1;72(35):938-43. https://www.cdc.gov/mmwr/volumes/72/wr/mm7235a1.htm http://www.ncbi.nlm.nih.gov/pubmed/37651272?tool=bestpractice.com

Data collected from 2007 to 2016 demonstrate that deaths from falls among people ages ≥65 years have been increasing by approximately 3% per year.[8]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 in deaths from falls, but the greatest increase was noted in individuals ages 85 and older.[8]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

In England, during the period 2023/2024, there were 1984 per 100,000 accident and emergency hospital admissions related to falls in patients ages ≥65 years, with 4969 per 100,000 in patients ages ≥80 years.[9]Office for Health Improvement & Disparities. Public health profiles (England). [internet publication]. https://fingertips.phe.org.uk/search/falls#page/1/gid/1/ati/15/iid/22401/age/27/sex/4/cat/-1/ctp/-1/yrr/1/cid/4/tbm/1 ​​ Of these hospital admissions, 76,755 (955 per 100,000) occurred in people ages 65-79 years and 142,400 (4969 per 100,000) in people ages 80 plus years.

Fractures are common following a fall. In the UK, hip fracture is associated with increased 1-year mortality of 18% to 33%.[10]Office for Health Improvement and Disparities. 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