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Reviewed by the Faculty of Harvard Medical School

Frequently Asked Questions (FAQs) About Falls

Falls and their resulting injuries are a serious public health issue among older adults. Falls are associated with a considerable number of deaths, a considerable number of complications, reduced functioning and premature nursing-home admission.

Both the incidence of falls and the severity of fall-related complications rise steadily after age 60. In the United States, one in three people aged 65 years and older falls each year. After age 75, the rates are even higher.

A key concern for older people is not simply the high incidence of falls but their high susceptibility to injury. Of those who fall, 20% to 30% suffer moderate to severe injuries that reduce mobility and independence and increase the risk of premature death. Approximately 5% of older people who fall must be hospitalized.

In addition to physical injury, falls can also have psychological and social consequences. It has been well described that people who fall lose their self-confidence. This leads to further reduction in their mobility, their level of activity and, eventually, their ability to socialize.

As the number of older adults in the population grows, the number of falls will increase, and the burden on financial resources will grow. At present, it is estimated that falls cost more than $20 billion per year in the U.S. Other consequences include pain, disability, lawsuits, deterioration in general well-being and effects on other family members.

Here are some of the most frequently asked questions — and their answers — about falls among the elderly:

Why do older people fall more frequently than younger people?

Factors that contribute to falls in older people include:

Age-related changes. Aging is associated with several important changes that predispose an older person to falls. For example, age-related changes in blood-pressure regulation may cause an older person's blood pressure to drop when he or she stands. This may cause the person to pass out (a condition called syncope).

Disease-related factors. Older people are also more likely to fall because they often have several co-existing diseases. Studies have shown that falls in older people more likely result from a combination of multiple disorders than from a single disease. For example, a person with low blood pressure that causes dizziness on standing, cataracts that cause poor vision, and arthritis that causes unstable knee joints is more likely to fall than someone with only one of these conditions.

Polypharmacy (the use of multiple medications). Medications are a significant contributing factor to falls in older adults. This is because older adults are more likely to be taking multiple medications for longer periods, which increases the risk of side effects and medication interactions. The medication-related mechanisms that may lead to falls include:

  • Lowering of blood pressure
  • Dizziness
  • Disorientation
  • Sedation
  • Lack of sleep (insomnia)
  • Loss of coordination
  • Loss of safety awareness

Specifically, there appears to be an increased risk of falls among patients taking four or more medications. Medications that have been shown to increase the risk of falls include sleeping pills, blood pressure medication, diuretics (water tablets) and antidepressants.

Environmental factors. Older people are less able than younger people to compensate for common environmental hazards such as loose rugs and poorly fitting shoes. Such hazards can lead to accidental falls, which account for 50% of all falls among the elderly.

What are the risk factors for falls?

Most falls in older adults are the result of a combination of several factors rather than a single event. The proportion of older adults who fall increases with the number of risk factors present. The risk factors for falls are best described as internal or external.

Internal Risk Factors

  • Sensory impairment such as poor eyesight, hearing loss and balance disturbance
  • Diseases of the brain such as stroke, Parkinson's disease and head injury
  • Cognitive impairment such as dementia
  • Depression
  • Cardiovascular, respiratory and metabolic diseases
  • Lower-limb weakness and poor grip strength
  • Bone diseases such as osteoporosis
  • Joint problems such as rheumatoid arthritis and osteoarthritis
  • Foot disorders such as bunions, calluses and deformities

External Risk Factors

  • Medications
  • Hazards inside the home
    • Stairs — Coming down is more hazardous than climbing up.
    • Loose objects such as furniture, cords and rugs
    • Poor lighting, particularly areas with dark/light variability
    • Poorly fitting shoes
    • Surfaces with glare or optical patterns
    • Lack of bathroom safety equipment
  • Hazards outside the home
    • Roads made slippery from ice, water or fallen leaves
    • Uneven pavement

What is syncope?

Syncope (pronounced SINK-o-pee) is the medical term for fainting. It is a sudden, brief loss of consciousness caused by inadequate blood supply to the brain. It is usually preceded by lightheadedness. The individual recovers spontaneously (that is, the individual does not need to be resuscitated).

Similar to a fall, syncope is a symptom, not a disease. It is a common problem with a lot of causes. These include:

  • Cardiac diseases such as a heart attack
  • Low blood pressure, which can occur when getting up from a seated or lying position, from fluid loss (for example, vomiting and diarrhea), from infection and as a drug complication
  • Abnormal blood composition such as low levels of blood sugar or blood oxygen
  • Brain diseases such as seizures and strokes

Syncope can cause falls, fractures, brain hemorrhage and loss of independent function.

You should always call your doctor if you have had an episode of syncope. Your health care professional will need to determine:

  • If there was an obvious precipitant such as emotional stress, coughing, neck turning or bowel motion
  • If there were any associated symptoms such as palpitations, chest pain, sweating or difficulty breathing
  • If medications are responsible
  • How long the symptoms lasted

The treatment of syncope will be directed at the cause.

Should a single fall be of concern?

A fall is a symptom, not a diagnosis. Although falls are more common in older people, they should not be accepted as a normal part of aging. There is no acceptable number of falls. A single fall can cause serious injuries. It is therefore important that you consult a health care professional if you have had even a single fall.

It is also important that you continue to see your doctor for regular follow-up. This will allow early identification and management of any new risk factors for falls that may develop. It is also necessary to keep track of any deterioration in your health that may require changes to your environment.

Is there a way to prevent falls?

Many times, falls can be prevented by relatively simple interventions, such as adjusting the dose of your medication or getting new eyeglasses. Your doctor can determine your risk of falls and help you avoid falls in the future.

Your doctor may do one or more of the following:

  • Modify or adjust the dose of your medications
  • Recommend an exercise program with balance training
  • Recommend gait training (that is, proper walking technique) and training in the proper use of walking aids, such as canes
  • Correct any hazards in your home that could contribute to a fall, such as loose carpets or poor lighting
  • Treat any cardiovascular disorders, such as heart-rhythm abnormalities and low blood pressure

How can health care professionals help people at risk of falls?

Certain older people require a fall evaluation:
  • Those who need medical attention after a fall
  • Those who have fallen more than once in the past year
  • Those with gait (walking) and/or balance problems

It's important that the health care professional has the appropriate skills and experience in managing falls. This may require a referral to a geriatrician, a doctor who specializes in the care of older adults.

During the evaluation the health care professional will:

  • Review your history of falls
  • Review all of the medications you take
  • Evaluate your gait (that is, the way you walk) and balance
  • Test your vision
  • Determine the status of your cardiovascular health, including your heart rate, heart rhythm and blood pressure
  • Review your use of walking aids, such as canes and walkers

It may also be necessary to have someone look at you in your home to identify your needs more accurately.

What medical tests are used to evaluate falls?

The information obtained from your medical history and physical examination will guide which diagnostic tests you may need. Medical tests are needed only if your history and physical examination do not reveal the cause of your fall or if they point to a particular abnormality that requires more-detailed evaluation.

These tests may include:

  • Blood tests to rule out anemia, infection and metabolic problems such as diabetes and thyroid disease
  • An electrocardiogram (EKG) to rule out heart disease
  • A 24-hour EKG to rule out an irregular heartbeat
  • A heart scan (echocardiogram) if you have a heart murmur
  • Measurement of your medication levels to check if you are being undertreated or overtreated (Both undertreatment and overtreatment of certain conditions can cause falls.)
  • A brain scan to rule out a stroke or tumor
  • An X-ray of your neck to exclude arthritis of the spine, which may result in narrowing of the spinal canal

Your doctor may refer you to a specialist such as a bone doctor if you have joint problems or an ear specialist for specific balance problems.

Are falls more common among people living in nursing homes?

It is a common misconception that people in nursing homes have fewer falls. In fact, the opposite is true. Falls occur more often among people in nursing homes than among those in the community, and the injuries sustained are far greater. This may be because nursing-home residents tend to be frailer than older adults living in the community are. They also tend to be older and have more memory trouble, and they have greater limitations in their activities of daily living (such as eating, bathing and going to the bathroom). These are some of the key factors associated with falls.

The high rate of falls among nursing-home residents may also reflect better reporting of falls because of closer observation.

What is the role of exercise and balance training?

Older people who have recurrent falls should participate in regular exercise and balance training. Your health care professional can help you develop a program or provide you with information on where you can find one. The optimal type, duration and intensity of exercise are unclear. However, the following facts have been proven:
  • Balance training has the best benefit.
  • Successful programs have consistently been longer than 10 weeks.
  • Exercise needs to be sustained for sustained benefit.
  • Tai chi (short for tai chi chuan), a promising type of balance exercise, reduces the frequency of falls.

Last updated December 3, 2009




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