Older adults ages ≥65 years are more likely to fall than younger adults (OR 2.84 [1.77-4.53]). Falls are often multifactorial in origin. Identifying the circumstances surrounding, and the symptoms associated with, a 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. Falls are the second leading cause of unintentional injury deaths worldwide. Each year an estimated 684,000 individuals die from falls, of which over 80% are in low- and middle-income countries.
In the US, falls are the leading cause of death due to unintentional injury in people aged ≥65. 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. Almost all age and demographic categories experienced an increase, but the greatest increase was noted in individuals ages 85 and older. The death rate from falls was also higher in this age group.
- Transient ischemic attack
- Joint buckling/instability/mechanical gait disorders
- Medication effects or polypharmacy
- Environmental or home hazards
- Visual impairment
- Peripheral sensory neuropathy
- Vestibular dysfunction
- Gait disorders
- Subdural hematoma
- Orthostatic hypotension
- Substance misuse
- Carotid sinus sensitivity
- Postprandial hypotension
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