Evaluation of patient falls
Falls are a leading cause of injury and functional decline in older adults, reflecting an intersection of intrinsic risk factors (gait/balance impairment, cognitive impairment, polypharmacy) and extrinsic hazards. Evaluation combines a fall-focused history, orthostatic vital signs, targeted exam, and gait/balance testing (Timed Up and Go); management is multifactorial, centered on exercise, medication review, and home-hazard modification.
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What this article covers
- Overview
Definition: a fall is an unintentional event resulting in a person coming to rest on the ground or a lower level, distinct from (though overlapping with) syncope.
- Epidemiology
Incidence: 30% to 40% of community-dwelling adults 65 years and older fall each year; roughly 1 in 2 adults older than 80 years falls annually.
- Risk factors
Previous falls: a history of a prior fall is one of the strongest predictors of a future fall.
- Pathophysiology
Baroreflex decline with aging: older adults have a reduced ability to raise heart rate in response to a positional change, blunting compensation for a drop in blood pressure on standing.
- Clinical features
Circumstances of the fall are diagnostic: establish where and how the fall occurred, whether it was witnessed, and whether it was clearly mechanical (tripping over an identifiable obstacle) versus unexplained.
- Differential diagnosis
Syncope (cardiac or reflex): true loss of consciousness with rapid spontaneous recovery, often preceded by palpitations or diaphoresis, requires cardiac (arrhythmia, structural heart disease) or…
- Diagnosis
Fall risk is established first through annual screening: the American Geriatrics Society/British Geriatrics Society (AGS/BGS) guideline recommends screening all persons 65 years or older annually…
- Management
First step: address any acute or reversible cause identified on evaluation.
- Complications
Fracture: hip, wrist, and vertebral fractures are the most common serious injuries and carry substantial morbidity and mortality, particularly hip fracture in frail older adults.
- Prognosis
Recurrence is common: a prior fall substantially increases risk for future falls, making fall history one of the most important prognostic markers.
- Prevention
Annual screening: screen all adults 65 years and older annually per AGS/BGS guidance; escalate to full assessment for 2 or more falls in the past year, a fall-related injury, or an unsteady gait.
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