Falls in older adults !

A fall is an unplanned drop to the ground. In older adults falls are common, usually have several causes and can end in fractures and loss of independence.

Updated 2026-11-01

Structures involved

Tap one to see what it is and open it in 3D.

In the clinical exam

Why it happens

What it is

An event in which a person unintentionally comes to rest on the ground or a lower level. In older adults it is treated as a geriatric syndrome: falls rarely have a single cause and are a marker of frailty, hidden illness or medication harm.

Who gets it

Falls are the second leading cause of unintentional injury death worldwide, and most fall deaths occur in people aged 60 and over. Roughly one in four older adults falls each year, and a first fall doubles the chance of another. As Colombia and Latin America age quickly, fall-related hip fractures and head injuries are a growing burden on emergency and orthopaedic services.

Causes

Intrinsic factors: weakness of the hip and leg muscles, impaired balance and gait, poor vision, foot problems and cognitive impairment
Acute illness presenting as a fall (infection, delirium, dehydration, arrhythmia, stroke)
Medications, especially sedatives, psychotropics, antihypertensives and drugs causing orthostatic hypotension or hypoglycaemia
Extrinsic factors: poor lighting, loose rugs, stairs without rails, slippery bathrooms and unsafe footwear

Risk factors

Previous fall, especially in the last year
Age over 80, frailty and sarcopenia
Gait or balance disorder, Parkinson disease, stroke or peripheral neuropathy
Dementia, delirium and depression
Polypharmacy and psychoactive drugs (benzodiazepines, hypnotics, antidepressants, antipsychotics)
Orthostatic hypotension, urinary urgency or incontinence and night-time toileting
Visual impairment, vitamin D deficiency and fear of falling

Pathophysiology

Staying upright depends on vision, the vestibular system, proprioception, muscle strength, reaction time and attention. Ageing and disease erode several of these reserves at once, so a small challenge (a step, a dizzy spell, a new sedative) is enough to cause a fall. Osteoporosis and slower protective reflexes turn the impact into fractures, especially of the hip, wrist and spine.

Classification

Accidental (mainly environmental) versus non-accidental (from an intrinsic cause)
Single fall versus recurrent falls (two or more in a year)
Fall with injury, fall with a long lie on the floor, or fall without injury

Symptoms and signs

Report of a fall or a near fall, often not volunteered by the patient
Unsteady or slow gait, shuffling, or use of furniture to steady oneself
Dizziness on standing, palpitations or brief loss of consciousness before the fall
Bruises, skin tears, pain in the hip, wrist or back after the event
Fear of falling with restriction of activity

Diagnosis

Clinical: Ask every older adult about falls. After a fall: circumstances, prodrome, injuries, medication review, orthostatic blood pressure, vision, feet, cognition and a neurological and cardiovascular examination. Gait and balance tests such as the Timed Up and Go (12 seconds or more suggests increased risk), the 30-second chair stand and the 4-stage balance test; a home safety assessment.
Tests: Guided by the history: blood count, electrolytes, glucose, kidney function, vitamin D and B12, and an ECG; Holter monitoring when an arrhythmia is suspected.
Imaging: X-ray of a painful hip, wrist or spine; CT or MRI when a hip fracture is suspected and the X-ray is normal; head CT after a head injury in someone on anticoagulants or with neurological change; bone densitometry to assess osteoporosis.

Differential diagnosis

Syncope (cardiac, reflex or orthostatic)
Seizure
Stroke or transient ischaemic attack
Hypoglycaemia
Delirium from an acute illness

Goal of treatment

Treat injuries, find and correct the causes of the fall, and lower the risk of the next one with a multifactorial plan that keeps the person active and independent.

Treatment

Acute: Treat injuries first: analgesia, fracture management, head imaging when indicated, and look for rhabdomyolysis and pressure injury after a long lie.
Rehabilitation: Progressive strength, gait and balance exercise (including tai chi) supervised by physiotherapy is the most effective single intervention; walking aids fitted correctly.
Medical: Medication review to stop or reduce sedatives and other fall-risk drugs; treatment of orthostatic hypotension, arrhythmias, vitamin D deficiency and osteoporosis (bisphosphonates and other anti-osteoporotic classes).
Lifestyle: Home modification (lighting, grab bars, removing rugs), safe footwear, cataract surgery or updated glasses when vision limits safety.
Follow-up: Nursing priorities in hospital: fall-risk score on admission, bed in low position, call bell within reach, scheduled toileting, non-slip footwear, and avoidance of physical restraints, which increase injury.

Complications

Hip, wrist, humerus and vertebral fractures
Traumatic brain injury and subdural haematoma
Long lie: rhabdomyolysis, hypothermia, pressure injury and dehydration
Fear of falling, loss of confidence and reduced activity
Loss of independence and admission to long-term care

Prognosis

A fall is a warning sign: those who fall are likely to fall again, and a hip fracture after a fall carries high one-year mortality and frequent loss of independence. Multifactorial assessment with exercise and medication review clearly reduces new falls.

Prevention

Ask about falls at least once a year and screen gait and balance
Regular balance and strength exercise
Periodic medication review
Home safety and vision checks

Test yourself

Think of the answer, then tap the question to see it.

Which simple bedside test is widely used to screen gait and balance for fall risk?

The Timed Up and Go test: standing from a chair, walking 3 metres, turning and sitting down; 12 seconds or more suggests increased fall risk.

What is the strongest single predictor of a future fall?

A previous fall, especially in the last year.

Which drug classes most often contribute to falls in older adults?

Psychoactive drugs (benzodiazepines, hypnotics, antidepressants, antipsychotics) and drugs that lower blood pressure or glucose.

Which intervention most consistently reduces falls in community-dwelling older adults?

Exercise programmes focused on balance and strength, within a multifactorial plan.

Why are physical restraints avoided in hospitalised older adults at risk of falling?

They do not prevent falls, increase injury and agitation, and worsen deconditioning and delirium.

Add to my cards (5)

Educational information, not medical advice. For any symptom, see a health professional.

Sources: Falls (World Health Organization, 2025); Facts About Older Adult Falls (Centers for Disease Control and Prevention (CDC), 2024).

← All conditions

Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake

Representative model, for educational purposes only.

Femur highlighted on the Durgical 3D model