What is a fall?

A fall is defined as an accidental event which results in a person coming to rest on the floor or other lower level with or without loss of consciousness.  The risk of falling increases as people age and most falls in the elderly do not cause serious injury but the fear of falling again increased the risk of recurrent falls. The leading cause of injury in adults aged 65 years or older is related to falls and can result in increased morbidity, the decline in functional independence, and quality of life.


According to the Centers for Disease Control and Prevention (CDC), 3 million older people are treated for fall-related injuries in the emergency department yearly. Hip fracture and traumatic brain injury from fall result in prolong hospital stays and cost approximately $50 billion in 2015. 

What are the causes of Falls?

Falls are a multifactorial phenomenon and there are usually several factors contributing to a fall which can be intrinsic or extrinsic. Some of the risk factors include: 

  • Previous falls
  • Age older than 85 years
  • Balance impairment, 
  • Weakened muscle strength
  • Visual impairment
  • Medications/ polypharmacy
  • Environmental Hazard
  • Acute illness
  • Female sex

What are the screening and assessment for Fall risk?

A targeted history and physical examination are crucial in identifying patients at risk of falling. There are various screening tools adopted to predict the risk of falls, but the history of falls has been the best predictor of the patient’s fall risk. Screening is very important to identify people that at greatest risk of fall so that a comprehensive fall assessment can be performed. Patients who report a single fall can be a screen with Get-Up-and-Go Test and Performance Oriented Mobility Assessment (POMA) to evaluate balance and gait abnormalities. Get-Up-and-Go Test is performed by observing the patient rising from an armchair, walking a fixed distance across the room, turning around, walking back to the chair, and sitting back down. Steps to administer POMA tools can be found here

How to treat Falls?

Implementation of multiple interventions is required to reduce a patient’s fall risk, and each is targeted to an individual’s patient needs. Medical intervention should focus on both intrinsic and extrinsic modifiable factors such as medication reduction, physical therapy, and home safety modifications which have all been effective in fall prevention.

Vitamin D supplementation is often given to long term care residents with increased risk of fall but the USPSTF recommends against vitamin D supplementation for fall prevention in community-dwelling adults aged 65 years or older.

How to prevent Falls?

  • An important risk factor for falls is visual impairment and should be corrected if possible, to avoid preventable falls.
  • A thorough medication review should be done with a goal to reduce the dose and number of medications such as psychoactive and antipsychotic drugs. 
  • Physical therapy and exercise are recommended to improve balance, gait, and mobility. It should be a targeted therapy tailored to individual deficits and be provided by a trained professional. A video of exercises that focus on balance and strength training can be found here.

Home safety is of crucial importance in preventing falls and should include checking the home environment to remove obvious fall hazards, removal of clutter to minimize tripping hazards, ensure adequate lighting, and installation of safety measures such as raised toilet seat and shower bars. More tips for making a home safe and accessible for older adults can be found here

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