Falls in older adults

Falls in older adults are a significant cause of morbidity and mortality and are an important class of preventable injuries. The cause of falling in old age is often multifactorial, and may require a multidisciplinary approach both to treat any injuries sustained and to prevent future falls. Falls include dropping from a standing position, or from exposed positions such as those on ladders or stepladders. The severity of injury is generally related to the height of the fall. The state of the ground surface onto which the victim falls is also important, harder surfaces causing more severe injury. Falls can be prevented by ensuring that carpets are tacked down, that objects like electric cords are not in one's path, that hearing and vision are optimized, dizziness is minimized, alcohol intake is moderated and that shoes have low heels or rubber soles. Falls in older adults are a significant cause of morbidity and mortality and are an important class of preventable injuries. The cause of falling in old age is often multifactorial, and may require a multidisciplinary approach both to treat any injuries sustained and to prevent future falls. Falls include dropping from a standing position, or from exposed positions such as those on ladders or stepladders. The severity of injury is generally related to the height of the fall. The state of the ground surface onto which the victim falls is also important, harder surfaces causing more severe injury. Falls can be prevented by ensuring that carpets are tacked down, that objects like electric cords are not in one's path, that hearing and vision are optimized, dizziness is minimized, alcohol intake is moderated and that shoes have low heels or rubber soles. A review of clinical trial evidence by the European Food Safety Authority led to a recommendation that people over age 60 years should supplement the diet with vitamin D to reduce the risk of falling and bone fractures. Falls are an important aspect of geriatric medicine. Other definitions are more inclusive and do not exclude 'major intrinsic events' as a fall. Falls are of concern within medical treatment facilities. Fall prevention is usually a priority in healthcare settings. A 2006 review of literature identified the need for standardization of falls taxonomy due to the variation within research. The Prevention of Falls Network Europe (ProFane) taxonomy for the definition and reporting of falls aimed at mitigating this problem. ProFane recommended that a fall be defined as 'an unexpected event in which the participants come to rest on the ground, floor, or lower level.' The ProFane taxonomy is currently used as a framework to appraise falls-related research studies in Cochrane Systematic Reviews. Falls are often caused by a number of factors. The faller may live with many risk factors for falling and only have problems when another factor appears. As such, management is often tailored to treating the factor that caused the fall, rather than all of the risk factors a patient has for falling.Risk factors may be grouped into intrinsic factors, such as existence of a specific ailment or disease. External or extrinsic factors includes the environment and the way in which it may encourage or deter accidental falls. Such factors as lighting and illumination, personal aid equipment and floor traction are all important in fall prevention. When assessing a person who has fallen, it is important to try to get an eyewitness account of the incident. As the faller may have had some loss of consciousness, they may not give an accurate description of the fall. However, in practice, these eyewitness accounts are often unavailable. It is also important to remember than 30% of cognitively intact older people are unable to remember a documented fall three months later.Important points of inquiry: Fall prevention is accomplished first with a detailed assessment of the risk for falls. A large body of evidence shows that an efforts that include exercise decrease the risk of falls.