Falls in Older Adults

A fall is an event, not a diagnosis. In an older adult, it usually reflects the interaction of a chronic vulnerability—such as sarcopenia, lower-extremity weakness, impaired gait, sensory loss, cognitive disease, painful feet, or incontinence—with an acute trigger such as a new medication, delirium, dehydration, orthostatic hypotension, arrhythmia, or an environmental hazard. The same patient may therefore need both a medication change and balance training; finding one contributor does not exclude another. The immediate clinical questions are distinct: Was the patient injured? Was there transient loss of consciousness? What made the fall possible today? What can reduce the next fall? This sequence prevents a common error: labeling an unexplained or syncopal fall as mechanical and sending the patient back to an unsafe baseline. More than one in four US adults age 65 and older reports a fall each year, making recurrent-fall prevention a core primary-care and geriatric task. [9]