Summary
Falls are often multifactorial in origin. [1] The presence of the following factors is associated with greater probability of future falls, [2] [3] and falls screening guidelines suggest identification of these characteristics in at-risk people can be useful in the implementation of falls prevention strategies:
-
Motor problems: gait or balance impairment; muscle weakness [2] [4] [5] [6] [7] [8]
-
Sensory impairment: peripheral neuropathy, vestibular dysfunction, vision impairment [2] [4] [9] [10] [11]
-
Cognitive or mood impairment: dementia, depression, delirium [5] [7]
-
Polypharmacy or certain medicines (particularly psychotropic medicines) [12]
-
Impairment of activities of daily living [13]
-
Environmental hazards (e.g., loose rugs, poor lighting, clutter) [2]
-
Additional factors such as age or comorbid illnesses. [2]
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. [14] The United States Preventive Services Task Force, for example, recommends exercise (e.g., group exercise, tai chi, multicomponent exercises) or physical therapy for prevention of falls in community-dwelling adults ≥65 years of age who are at increased risk of falls. [15] [16] Meta-analyses of vitamin D supplementation (alone or with calcium) has not shown benefit in terms of reduction of falls. [17]
One Cochrane systematic review found that multiple component interventions (that offer the same component interventions to all people without taking into account any assessment of risk of falls; most of which include exercise) may reduce the number of falls and the risk of falling compared with usual care or attention control in older people living in the community. It also found that multifactorial interventions (component interventions that differ between people depending on their assessment of risk of falls) may reduce falls in older people in the community compared with usual care or attention control.
[18]
[ 
]
[ ]
One network meta-analysis found the following interventions were more effective than usual care at preventing falls that result in injuries: [19]
-
Exercise
-
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 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. [20] One in four older adults report falling at least once yearly, leading to approximately 3 million accident and emergency department visits. Data collected from 2007 to 2016 demonstrate that this rate has been increasing by approximately 3% per year. [20] 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. [20]
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.
Differentials
Common
- Stroke
- Transient ischaemic attack
- Joint buckling/instability/mechanical gait disorders
- Deconditioning
- Medicine effects or polypharmacy
- Environmental or home hazards
- Visual impairment
- Peripheral sensory neuropathy
Uncommon
- Vestibular dysfunction
- Gait disorders
- Dementia
- Delirium
- Depression
- Seizure
- Subdural haematoma
- Syncope
- Orthostatic hypotension
- Substance abuse
- Carotid sinus sensitivity
- Post-prandial hypotension
Contributors
Authors VIEW ALL
Assistant Professor
Cleveland Clinic Lerner College of Medicine of Case Western Reserve University
Geriatric Medicine Fellowship Program Director
Center for Geriatric Medicine, Medicine Institute
Cleveland Clinic
Cleveland
OH
Disclosures
RF is a Pfizer stockholder.
Peer reviewers VIEW ALL
Professor of Medicine
Division of Geriatric Medicine
Saint Louis University
Saint Louis
MO
Disclosures
DT declares that he has no competing interests.
Consultant Physician
Nuffield Department of Medicine
John Radcliffe Hospital
Oxford
UK
Disclosures
AD declares that he has no competing interests.
Use of this content is subject to our disclaimer