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  • Updated 06.06.2023
  • Released 06.06.2023
  • Expires For CME 06.06.2026

Falls and fall-related injuries

Introduction

Overview

Falls are the leading cause of both nonfatal injuries and unintentional injury deaths among older people. Moreover, falls are the leading cause of traumatic brain injuries in older adults, and traumatic brain injuries are responsible for approximately half of all fall-related deaths among older adults. Many older people who fall develop a fear of falling, even if uninjured, which causes them to limit their activities; this results in reduced mobility and physical fitness and an increased risk of further falls. Older adults who fall are 4 or 5 times more likely to be admitted to a long-term care facility for at least a year. A history of falling in the past year strongly predicts the likelihood of future falls. A useful scheme for classifying falls utilizes a 4-part categorization: extrinsic, intrinsic, non-bipedal, and unclassifiable. A very useful algorithm for falls risk assessment and intervention has been developed by the Centers for Disease Control and Prevention/STEADI (Stopping Elderly Accidents, Deaths, and Injuries) Program. A tiered management approach can significantly decrease the risk of future falls and prevent many fall-related injuries.

Key points

• A history of falling in the past year strongly predicts the likelihood of future falls.

• A useful scheme for classifying falls is the St. Louis Oasis Study Fall Classification, which utilizes a 4-part categorization: extrinsic, intrinsic, non-bipedal, and unclassifiable.

• More than one third of older adults fall each year, and, by some estimates, at least 10% of these falls result in serious injury.

• The risk of fatal falls increases with age.

• Nonfatal falls with injury as well as nonfatal falls with injury requiring hospitalization are significantly more frequent in women than in men, whereas fatal falls are more common among older men than older women after adjusting for age differences.

• Falls are the leading cause of traumatic brain injuries in older adults, and traumatic brain injuries are responsible for approximately half of all fall-related deaths among older adults.

• Most fractures among older adults are caused by falls. A quarter of older adults who lived independently before fracturing a hip spend at least a year in a nursing home, and more than 20% of older adults who fracture a hip die within a year of their injury.

• Many older people who fall develop a fear of falling, even if uninjured, which causes them to limit their activities; this results in reduced mobility and physical fitness and an increased risk of further falls.

• Older adults who fall are 4 or 5 times more likely to be admitted to a long-term care facility for at least a year.

• Falls are the leading cause of injury-related deaths and account for approximately 14,000 deaths among older adults in the United States each year.

• Recommendations for community-dwelling older adults to decrease the risk of falls and fall-related injuries include regular exercise (particularly directed at improving strength and balance), getting up slowly after sitting or lying down, sitting at the side of the bed for at least 30 to 60 seconds before attempting to stand, wearing appropriate footwear, using ice grippers on canes in the winter, having a vision checkup by an eye doctor at least yearly, reviewing all medicines with a doctor or pharmacist for potential contributions to the risk of falling, and reducing or eliminating home hazards that can lead to falls.

• Strategies utilizing multifactorial assessment and intervention can significantly reduce the rate of falling and the risk of fall-associated injury, including hip fractures, especially in those who are dizzy/vertiginous, elderly, frail, or infirm.

• The U.S. Centers for Medicare & Medicaid Services (CMS) defines physical restraints as "any manual method or physical or mechanical device, material, or equipment attached to or adjacent to the resident's body that the individual cannot remove easily which restricts freedom of movement or normal access to [one's] body." CMS defines chemical restraints as "any drug used for discipline or convenience and not required to treat medical symptoms."

• Despite the lack of clear benefits to restraints, the many negative potential effects of restraints, and the alternatives available, physical restraints were, and still are, commonly used in hospitals and nursing homes.

• Consider tests of bone mineral density (particularly of the hips and spine), especially in postmenopausal women or those at increased risk of osteoporosis or osteomalacia for other reasons (eg, vitamin D deficiency, anticonvulsant use, steroids, cigarette smoking, etc.).

• The aim of treatment of postmenopausal osteoporosis is to reduce the frequency of vertebral and nonvertebral fractures (especially at the hip), which are responsible for morbidity associated with the disease.

• It is cost-effective to treat patients with a fragility fracture and those with osteoporosis by WHO criteria, as well as older individuals at average risk and osteopenic patients with additional risk factors.

• Several pharmacologic agents, including the bisphosphonates (eg, alendronate, risedronate, and ibandronate) and the selective estrogen receptor modulator, raloxifene, increase bone mass, reduce fracture risk, and have acceptable side effect profiles.

• Exercise programs can decrease falls and falls with injury among most fall-prone elderly individuals, with a noted exception being those with significant cognitive impairment.

• The effectiveness of anatomically designed external hip protectors in preventing hip fractures has been demonstrated in several biomechanical and clinical studies. However, previous clinical studies of efficacy were often conflicting, in part because adherence was often low. Hip protectors with a more patient-friendly design are now available (including a “fly” for male patients) and may be better tolerated and, thus, prove to be of greater utility in preventing hip fractures.

Historical note and terminology

So-called "newborn falls" due to dropping a newborn are outside of the scope of this article, as are other falls that occur when older individuals are being carried or supported.

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