Falls are a major public health problem, occurring in more than 27% of adults 65 years and older and costing the U.S. health care system tens of billions of dollars each year. The most common risk factors are prior falls, balance disorders, fear of falling, and dementia. Regular physical activity reduces fall risk. Identifying injuries is the first step in evaluating older adults who have fallen. The patient's history may be inaccurate if they have cognitive impairment, and the physical examination can result in false-negative findings. If injury status cannot be determined and suspicion for injury remains high, clinicians can consider whole-body computed tomography (i.e., pan-scan) to evaluate the head, cervical spine, chest, abdomen, and pelvis. After addressing injuries, the next steps are to identify the cause of the fall and implement measures to reduce future fall risk. The Centers for Disease Control and Prevention has developed an easy-to-use tool to screen for and reduce fall risk, known as STEADI (Stopping Elderly Accidents, Deaths, and Injuries). An affirmative answer to any of the three STEADI screening questions indicates further evaluation with a timed up and go test, 30-second chair stand test, and four-stage balance test. If results of these tests are abnormal, multicomponent interventions are indicated to reduce future fall risk. These components include evaluating environmental and home safety factors and optimizing care of chronic medical conditions, such as diabetes mellitus, hypertension, osteoporosis, pain, urinary urgency and incontinence, and depression. Polypharmacy and drugs that increase risk of falls should be avoided, when possible. Optimization of vision and hearing correction, podiatry care, and appropriate use of ambulation devices are also important.
The World Health Organization defines falls as incidents in which a person unintentionally comes to rest on the ground or a lower level.1 They are common, occurring in more than 27% of adults 65 years and older, with 10% of those who fall reporting an injury.2 These can include head injuries, hip fracture, and other fractures such as those in the spine, pelvis, upper and lower extremities, and ribs. One-year mortality associated with hip fractures may be as high as 20% to 30%.3 Ground-level falls are the most common cause of traumatic intracranial bleeding globally, and the risk of intracranial bleeding is even higher for older adults who fall while taking combined antiplatelet therapy.4,5
WHAT'S NEW ON THIS TOPIC
| A 2023 systematic review and meta-analysis involving 70,868 community-dwelling adults found that the most common factors associated with falls in older adults are a history of falls, balance disorders, fear of falling, and dementia. |
| Although guidelines from the Centers for Disease Control and Prevention recommend treating vitamin D deficiency, one nationwide study involving more than 25,000 individuals without vitamin D deficiency found that supplementation does not decrease the risk of falls. |
| In a systematic review, multifaceted podiatric interventions (e.g., routine podiatry evaluations, provision of specialized footwear, instruction for home-based exercises, patient education) combined with multidisciplinary interventions were shown to more effectively reduce fall rates compared with a single-component intervention, such as the use of insoles. |
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